title: Microbial biofilm formation in DUWS and their control using disinfectants.
abstract: OBJECTIVE
  Due to the presence of extended narrow bore tubing and long periods of stagnation, dental unit water systems (DUWs) can be prone to relatively high levels of microbial contamination, including the formation of biofilm and the presence of opportunistic pathogens, irrespective of the source and quality of the inflowing water. Whilst the European Union (EU) has yet to set a definitive microbiological guideline, the American Dental Association (ADA) has set a maximum of <200 colony forming units (cfu)/ml for DUWs water in the USA. The objective of this review is to discuss why microbial contamination and biofilms are so prevalent in DUWs, as well as the role of disinfectants and their potential for achieving microbial water quality levels recommended by the ADA.
  
  
  METHODS
  The review outlines the principal factors responsible for biofilm formation in DUWs and a number of mechanisms used for microbial control.
  
  
  METHODS
  The source material contained in this review is taken from the peer-reviewed literature.
  
  
  METHODS
  A variety of disinfectants are available for use, but controlled laboratory and clinical studies have shown that they can vary markedly in their efficacy and suitability for use. Some products have been shown to successfully remove biofilm and consistently reduce the microbial load of out-flowing water to <200 cfu/ml.
  
  
  CONCLUSIONS
  The effective delivery of approved disinfectants can control the level of microorganisms in DUWs at acceptable levels.
authors: Centre for Emergency Preparedness and Response, HPA Porton Down, Salisbury, United Kingdom.
authors: J T
authors: JT
authors: Walker
authors: P D
authors: PD
authors: Marsh
mesh_terms: D018441:Biofilms / Q000145:classification / Q000187:drug effects*; D015169:Colony Count, Microbial; D003748:Dental Equipment / Q000382:microbiology*; D004202:Disinfectants / Q000145:classification / Q000627:therapeutic use*; D004203:Disinfection / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D019552:Infection Control, Dental / Q000379:methods; D014871:Water Microbiology; D018508:Water Purification / Q000379:methods
chemical_list: D004202:Disinfectants