title: Reducing bacterial counts in dental unit waterlines: distilled water vs. antimicrobial agents.
abstract: BACKGROUND
  This study evaluated five chemical disinfectants to compare their abilities to improve dental unit waterline quality and assess their effects, if any, on the biofilm layer.
  
  
  METHODS
  Sixty new dental units, with a closed-circuit water system, were used to compare microbial levels in DUWLs treated with five antimicrobials: Listerine, Bio 2000, Rembrandt, Dentosept, and sodium fluoride to a control group of sterile distilled water alone over a six-week period. For all units, the waterlines were filled with solution, left overnight, and then flushed for 30 seconds with sterile distilled water the following morning prior to patient treatment. Waterlines were examined for biofilm buildup using scanning electron microscopy and colony-forming-unit counts.
  
  
  RESULTS
  The sodium fluoride and the four chemical antimicrobials reduced the microbial count to 200 cfu/ml or less. Only samples taken from dental units receiving the control treatment (distilled water with no added antimicrobial) failed to meet ADA's stated goal. Examination of the SEMs revealed an apparent decrease in the biofilm mass but not elimination, despite repeated treatment with the four antimicrobial materials.
  
  
  CONCLUSIONS
  Even in a closed-circuit water system, distilled water alone cannot reduce microbial contamination of dental treatment water from dental unit waterlines to the 200 cfu/ml ADA stated goal. However, water treated with Listerine mouthrinse, Rembrandt mouthrinse, Bio 2000, 0.5 percent sodium fluoride and Dentosept, did meet the microbial reduction goal. The biofilm apparently was reduced in volume, but not entirely eliminated.
  
  
  CONCLUSIONS
  The ADA goal of a maximum of 200 cfu/ml was achieved using any of five chemical antimicrobials and distilled water in a closed-water system. Despite the successful reduction in microbial contamination of the dental treatment water, the biofilm was not completely eliminated. Biofilm elimination and prevention would be needed through some other means.
authors.affiliation: School of Medicine at Loma Linda University, CA 92350, USA. jkettering@som.llu.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Kettering
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Muñoz-Viveros
authors.forename: Joni A
authors.initials: JA
authors.lastname: Stephens
authors.forename: W Patrick
authors.initials: WP
authors.lastname: Naylor
authors.forename: Wu
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000704:Analysis of Variance; D001419:Bacteria / Q000254:growth & development*; D018441:Biofilms; D015169:Colony Count, Microbial; D019551:Dental Disinfectants; D003748:Dental Equipment / Q000382:microbiology*; D004338:Drug Combinations; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D006861:Hydrogen Peroxide; D016555:Matched-Pair Analysis; D008855:Microscopy, Electron, Scanning; D009067:Mouthwashes / Q000627:therapeutic use; D012459:Salicylates; D012969:Sodium Fluoride; D013223:Statistics as Topic; D013729:Terpenes; D014867:Water; D014871:Water Microbiology
chemical_list: D019551:Dental Disinfectants; D004338:Drug Combinations; D009067:Mouthwashes; C098977:Rembrandt Mouthwash; D012459:Salicylates; D013729:Terpenes; D014867:Water; C057473:Listerine; D012969:Sodium Fluoride; D006861:Hydrogen Peroxide