Contamination Of Dental Unit Waterlines Research Articles

Effectiveness and safety of low-concentrated ozonized water for the reduction of contamination in dental unit water lines

Contamination of dental unit waterlines (DUWL) with heterotrophic bacteria can cause problems in immune compromised patients (aged, tumor and organ transplantation-patients). We focused on the use of low-concentrated ozonized water (OZW) as the biofilm formation restraint system for DUWL. Here, we examined the effects of low-concentrated OZW on the growth of bacteria and related biofilm formation and harmfulness to dental unit components (DUCs) in vitro. ObjectivesTo evaluate the bactericidal effects of OZW on biofilms in DUWL and DUC in vitro. MethodsLow-concentrated OZW (0.4 mg/L) was generated using an OZS-PTDX generator. Heterotrophic bacterial biofilms in old DUWL tubes and Candia albicans solution (control microbe) were treated with OZW for 1 h with gentle agitation before static culturing for 96 h in Reasoner's 2A liquid media. The control solutions were 0.1% cetylpyridinium chloride (CPC), chlorinated tap water (TW), and phosphate-buffered saline (PBS). Adenosine triphosphate (ATP) amounts of the microbes were measured and the biofilms of these microbes were observed using scanning electron microscopy (SEM). Moreover, surfaces of DUC soaked in OZW and TW were observed by SEM. ResultsThe OZW reduced ATP levels in microbes to 50% compared to TW and PBS treatment, although CPC reduced it below detection limits. SEM observation revealed deformation of microbes cultured with OZW, whereas no changes were seen on DUC surfaces. ConclusionsLow-concentrated OZW is bactericidal against heterotrophic bacteria biofilms and it is not harmful to DUC, suggesting that it might be useful in preventing DUWL contamination.

Plasma Sterilization Effectively Reduces Bacterial Contamination in Dental Unit Waterlines.

Objective To investigate the effectiveness of plasma sterilization in reducing bacterial contamination and controlling biofilms in dental unit waterlines. Materials and Methods Ten identical dental chair units (DCUs) were used. Five DCUs were installed with an automated plasma sterilization system (PSS) and the other five were kept as nontreated controls (CTL). Water flushed from the airotor line served as the output water of the dental unit waterlines (DUWLs). Water samples were collected at the beginning and on a weekly basis for 4 months. Water was analyzed for bacterial contamination (CFU/mL). Scanning electron microscopy (SEM) was used to investigate the amount of biofilm in the waterlines. Biofilm viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. All statistical analyses were performed using the Mann–Whitney U test. A value of p < 0.05 was considered significant. Results The DCU output water was found to be heavily contaminated with bacteria. Plasma sterilization effectively reduced bacterial contamination from an average of 212 CFU/mL to 8 CFU/mL. During the entire period of 4 months, the level remained below 500 CFU/mL, the standard level recommended by the Centers for Disease Control and Prevention (CDC) of the USA. The reduction in the bacterial count was significant compared with the CTL group (p < 0.05). Plasma sterilization could not eradicate the existing biofilms in the waterlines, and it did reduce biofilm mass and viability. Moreover, treatment with plasma sterilization did not induce a change in the composition of microorganisms, as analyzed by Gram staining. Conclusion Plasma sterilization, which is part of electrochemically activated water, effectively reduces bacterial contamination and reduces biofilms in dental unit waterlines.

Evaluation of Microbiological and Free-Living Protozoa Contamination in Dental Unit Waterlines.

Studies conducted over the last 40 years have demonstrated that the water output from dental unit waterlines (DUWLs) is often contaminated with high densities of microorganisms. It has been monitored the microbiological quality of the water in 30 public dental facilities in northern Italy in order to assess the health risk for patients and dental staff. In each facility, samples of water both from taps and from DUWLs were analyzed in order to evaluate heterotrophic plate counts (HPCs) at 22 °C and 36 °C, and to detect coliform bacteria, Pseudomonas aeruginosa, Legionella pneumophila and amoebae. In 100% of the samples taken from the DUWLs, the concentration of HPCs was above the threshold as determined by the Ministère de la Santé et des Solidarités (2007). The concentration of P. aeruginosa was greater than the indicated threshold in 16.67% of the hand-pieces analyzed. A total of 78.33% of samples were contaminated by L. pneumophila, while in the samples taken from the DUWLs alone, this percentage rose to 86.67%. Amoebae were detected in 60% of the samples taken from hand-pieces; all belonging to the species V. vermiformis. This study documented the presence of various microorganisms, including Legionella spp., at considerably higher concentrations in water samples from DUWLs than in samples of tap water in the same facilities, confirming the role of the internal DUWLs in increasing microbial contamination, especially in the absence of proper management of waterborne health risks.

Assessment of nosocomial bacterial contamination in dental unit waterlines: Impact of flushing

PurposeThis study evaluated the extent of bacterial contamination in water from dental unit waterlines (DUWLs). MethodologyWater samples were collected (before flushing, 1 min post-flushing, and 3 min post-flushing) from 24 clinics (Group A: no disinfection, Group B: citric acid disinfectant) of a Government Dental College. Bacterial counts, identification, antibiotic sensitivity tests, determination of endotoxin levels, and scanning electron microscopy (to confirm the presence of biofilm) were performed. ResultsThe most common opportunistic bacteria were P. aeruginosa (95%), S. aureus (58%), S. auricularis (49%), P. fluorescens (44%), and A. baumannii (20%). Approximately 50% of the bacterial isolates were resistant to two or more antibiotics. Flushing for 3 min did not reduce the contamination of water from Group A clinics which exceeded the recommendation of ≤500 CFU/ml. No bacterial growth was seen in Group B samples. Endotoxin levels were >5.00 endotoxin units (EU)/ml in Group A and ranged from 1.33 to 5.00 EU/ml in Group B clinics. Scanning electron microscopy images showed bacterial biofilms on the surfaces of the tubes. ConclusionsDUWL contamination is a serious issue in dentistry, and the microbiological quality of the water must be monitored regularly. Further studies on endotoxin exposure and prevention are therefore necessary.

Effect of Inhibition of Bacterial Proliferation by Neutral Electrolytic Water inDental Unit Waterlines

Background: Microbial contamination in dental unit waterlines (DUWLs) has recently become an important issue in the field of dental infection control. Using neutral electrolytic water as a new disinfecting method has attracted considerable attention. However, long term data about the effect of using neutral electrolytic water in clinical settings are scarce. This is the first study to evaluate the long term effectiveness of inhibition of bacterial proliferation using the purification system to supply neutral electrolytic water to refine the waterworks in DUWLs. Methods: Before the study, we investigated the actual levels of bacterial contamination in DUWLs. Then we did thorough cleaning of DUWLs and water samples were collected 6 dental units. Three dental units assigned as Group A had purification systems that used neutral electrolytic water, and the other 3 units were the Control group. Water samples were collected from the gargle water, high-speed handpieces and the three-way syringe. We utilized the equipment in Group A, and both groups were maintained for daily clinic work for 14 months. We counted the bacterial colony forming units (cfu) for each sample and identified the pathogenic bacterial species. Results: 3 and 14 months later, no microbes were detected during the study period in Group A whereas numbers of cfu which grew from the Control group increased and glucose non-fermenting gram-negative rod of possible pathogenic organisms to human were identified in the control groups. Conclusions: The water purification system using neutral electrolytic water was effective to control the proliferation of bacteria and could maintain a hygienic environment in DUWLs.

Optimization of Ozonation Process for Disinfection of Dental Unit Waterlines Using Response Surface Methodology

ABSTRACTThe reduction of microbial contamination in dental unit waterlines (DUWLs) appears to be necessary because of a potential risk of infections in immunocompromised patients and medical staff, which are regularly exposed to water and aerosols generated from DUWLs. In the present study, the qualitative and quantitative microbial contamination of water in DUWLs were determined and the conventional biomedical diagnostic tests were applied to identify microorganisms. A 3-level, 2-factor central composite design was utilized to investigate the effects of chief operating parameters and optimize ozone disinfection conditions. Also, the activity of three disinfectant (ozone, NaOCl, and peracetic acid) in microbial decontamination of DUWLs were compared. The results indicated that Microbacterium laevaniformans were the most prevalent genera (21%) among both Gram-negative and positive species in all samples. Regression analysis illustrated the good fit of the experimental data to the predicted model with R2 and R2adj correlation coefficients of 0.988 and 0.980, respectively. Moreover, under the optimal circumstances (Ozone concentration = 1.2 ppm and reaction time = 13.5 min) the disinfection efficiency was 97.52%. The results also revealed that ozone was effective disinfectant to reduce prevalent genera (with the removal of 93.75%, 92.57% and 96.15% of Pseudomonas aeruginosa, Microbacterium ‎laevaniformans, and Alcaligenes faecalis, respectively) and already formed biofilms under optimum conditions. Based on achieved results, ozone was highly effective on microbial decontamination compared to peracetic acid and NaOCl disinfectant and can be used for disinfection of DUWLs.

Three key factors influencing the bacterial contamination of dental unit waterlines: a 6-year survey from 2012 to 2017

The contaminated output water from dental unit waterlines (DUWLs) is a potential risk to both patients and dental personnel who are frequently exposed to this water or aerosols. The purpose was to evaluate the contamination level and prevalence of bacteria in the output water of DUWLs, and to identify key factors to provide technical support for formulating relevant policies. We developed a special sampling connector designed for collecting dental handpiece output water and a measurement device to assess retraction of a dental chair unit (DCU). Output water from dental handpieces and air/water syringes were collected as representative of DUWLs. Water samples were tested with reference to China's national standard. From 2012 to 2017, 318 DCUs were randomly selected from 64 hospitals in Tianjin, China. Of these DCUs, 78.93% had no disinfection to prevent DUWL contamination. Three-hundred and forty-three (56.14%) samples complied with the guidelines on DUWL output water. The highest concentration of bacteria was 1.8×106 colony-forming units (CFUs)/mL. The three key factors of influence were as follows: daily or weekly disinfection of DUWLs; water supply source being hospital self-made purified water or purchased purified bottled water; and DCU with a valid anti-retraction valve. Potential infectious agents, including Bacillus cereus, Burkholderia cepacia and Pseudomonas aeruginosa, were isolated. There was a high rate of contamination in DUWLs. This highlights the need to develop national standards. There is a need to disinfect the DUWLs periodically and use a cleaner source of water; more attention should be paid to the efficacy of DCU anti-retraction valves.

Efficacy of acoustic waves in preventing Streptococcus mutans adhesion on dental unit water line.

The quality and health safety of water used for refrigeration and flushing of the handpieces, water-syringes and other components of dental units is of considerable importance. Water crosses these devices by a system of intersected small plastic tubes (about 2 mm of diameter), named dental unit water lines (DUWLs). DUWLs may be heavily colonized by many bacterial species in a planktonic phase, adherent or in biofilm lifestyle, resulting in a potential risk of infection, not only for all professionals who routinely use these devices, but also for occasional-patients, especially immunocompromised patients. Contamination of DUWLs can be prevented or reduced with the use of disinfectants, but the eradication of microorganisms, especially which those are adherent or living in biofilm lifestyle on the inner surfaces of DUWLs is challenging and often, the normal methods of water disinfection are not effective. Moreover, disinfectants routinely used to disinfect DUWLs may alter the bond strength of the dentine bonding agent used for restorative practice in dentistry. To identify an innovative and alternative strategy, able to prevent bacterial adhesion to DUWL surfaces through a physical approach, which is more effective in overcoming the problem of DUWL contamination and the risk of infection compared to the standard methods already in use. In this pilot study we tested a member of the oral streptococci family, that is not a component of the biofilm detected on the walls of DUWL, but is frequently detected in water samples from DUWL, due to human fluid retraction during dental therapy. Namely, the pathogenic bacterial species Streptococcus mutans. We employ elastic acoustic waves at high-energy in preventing S. mutans adhesion to the inner walls of an experimental water circuit reproducing a DUWLs. To stress the capability of acoustic waves to interfere with bacterial adhesion also in extreme conditions, a high S. mutans contamination load was adopted. We observe a significant decrease of adherent bacteria exposed to acoustic waves treatment respect to control. This study demonstrates the effectiveness of acoustic waves in counteracting the adhesion of S. mutans to the inner walls of an experimental water circuit reproducing a DUWL, opening up new prospects for future practical applications. The interesting results, so far obtained, require an in-depth analysis of the methods regarding both the various bacterial species involved and the infective charges to be used.

Planktonic free-living amoebae susceptibility to dental unit waterlines disinfectants.

A high diversity of microorganisms is encountered inside dental unit waterlines (DUWL). Among those the presence of free-living amoebae (FLA) appears currently underestimated, although human infections may occur due to contact with FLA-contaminated water during dental cares. In order to limit microbial DUWL contamination, disinfectants are provided by dental unit manufacturer, however, with limited documentation on their activities against FLA. The aim of this study was to evaluate the efficiency of three commercial DUWL disinfectants: the Calbenium© (Airel, Champigny-sur-Marne, France), the Oxygenal 6© (Kavo, Biberach, Germany) and the Sterispray© (Gammasonic, Billom, France), against two FLA species, i.e. Acanthamoeba castellanii and Vermamoeba vermiformis alone or co-cultured with Pseudomonas aeruginosa and Candida albicans at concentrations ranging from 0% to 5% (v/v). Results showed varied efficacies of disinfectants: the Oxygenal 6© did not exhibit FLA killing activity, while the Sterispray© and the Calbenium© displayed concentration- and species-dependent activities with a maximum eradication rates of 100% and 86%, and 79% and 97% for A. castellani and V. vermiformis, respectively. None of the disinfectants were able to totally eradicate FLA at concentrations recommended by manufacturers. Present results highlight unsatisfactory anti-FLA activities of 3 DUWL disinfectant preparations advocating deeper investigation of antimicrobial spectra of commercial disinfectants in use for DUWL maintenance.

Contamination of dental unit waterlines: assessment of three continuous water disinfection systems.

Objectives:To assess the efficacy of three continuous water disinfection systems for dental units under real conditions of dental care.Design and settings:A prospective study carried out from 45 days to 20 months on the water microbial quality of the dental units is benefited from three different systems: two chemical treatment systems (IGN EVO/Calbenium/IGN Cartridge and Sterispray) and one physical treatment system (BacTerminator). Studied items were six dental units of the Dental Medicine and Oral Surgery Center within the University Hospital of Strasbourg (HUS), France.Results and disucussion:The IGN EVO/Calbenium/IGN Cartridge and Sterispray systems showed an immediate and long-term efficacy on contaminated dental unit waterlines. However, the first system offers ergonomic advantages (automatic system, action on the water from the water supply network). The BacTerminator system took longer to be effective and was less effective than the other two.

Occurrence and diversity of both bacterial and fungal communities in dental unit waterlines subjected to disinfectants.

Chemical disinfectants are widely advocated to reduce the microbial contamination in dental unit waterlines (DUWL). However, until now their efficacy has been poorly examined after long-term application. In this study, through quantitative PCR and high-throughput sequencing, both bacterial and fungal communities were profiled from 8- to 12-year-old DUWL treated with disinfectants commonly used by European dentists. Water was collected from the tap water supplying units to the output exposure point of the turbine handpiece following a stagnation period and dental care activity. Results showed that (i) the unit itself is the principal source of microbial contamination and (ii) water stagnation, DU maintenance practices and quality of water supplying DU appeared as parameters driving the water quality. Despite disinfecting treatment combined to flushing process, the microbial contamination remained relevant in the studied output water, in association with a high bacterial and fungal diversity. The occurrence of potentially pathogenic microorganisms in these treated DUWL demonstrated a potential infectious risk for both patients and dental staff. A disinfectant shock before a prolonged stagnation period could limit the microbial proliferation inside DUWL. Necessity to proceed to regular water quality control of DUWL was highlighted.

Disinfection effect of slightly acidic electrolyzed water on Dental unit water lines

Objective To explore the disinfection effect of slightly acidic electrolyzed water on dental unit water lines (DUWLs). Methods First, a total of 5 dental chair units (DCUs) with self-contained water supply were selected and were placed with freshly slightly acidic electrolyzed water (SAEW) every night. And then, we collected water samples from dental handpieces and water outlet of the gun for three purposes at 8 am and 12 am of the next day to count bacterial colony. This research included four stages involving that the content of effective chlorine of SAEW was about 40 mg/L with 20 days for continuous disinfection, the content of effective chlorine was about 20 mg/L with 10 days for continuous disinfection and 7 days for stopped disinfection, the content of effective chlorine was about 10 mg/L with 15 days for continuous disinfection. Results The average pass rates of water samples were 99.25%, 98.00%, 98.33% with SAEW of three different concentrations for the disinfection of DUWLs. The pass rate of water quality was changed from initial 100% to 0 without disinfection for water lines for 7 days. Conclusions There is microbial contamination in DUWLs. The disinfection effect is remarkable with SAEW for DUWLs, and there is no significant difference among DUWLs of different concentrations. Therefore, SAEW with low concentration of effective chlorine can be applied in clinic for continuous disinfection of DUWLs with self-contained water supply by taking all factors (disinfection effect, safety of dental treatment instruments, degree of comfort of patients and so on) into account. Key words: Disinfection; Slightly acidic electrolyzed water; Dental chair unit; Dental water lines

Monitoring of bacterial contamination of dental unit water lines using adenosine triphosphate bioluminescence

Bacterial contamination of dental unit waterlines (DUWLs) was evaluated using ATP bioluminescence analysis and a conventional culture method. Water samples (N=44) from DUWLs were investigated for heterotrophic bacteria by culture on R2A agar, which gave counts ranging from 1.4×103 to 2.7×105 cfu/mL. The ATP bioluminescence results for DUWL samples ranged from 6 to 1189 relative light units and could be obtained within 1min; these correlated well with the culture results (r=0.727-0.855). We conclude that the results of the ATP bioluminescence assay accurately reflect the results of conventional culture-based testing. This method is potentially useful for rapid and simple monitoring of DUWL bacterial contamination.

Evaluation of bacterial contamination of dental unit waterlines and use of a newly designed measurement device to assess retraction of a dental chair unit

Dental unit waterline (DUWL) output water is delivered through instruments of a dental chair unit (DCU) to irrigate and cool teeth. However, these waterlines can be heavily contaminated with bacteria. The purpose of the present study was to assess retraction and investigate the contamination level and prevalence of bacteria in DUWL output water. Fifty-eight DCUs were randomly selected from 30 hospitals in 10 districts of Tianjin, one of the four special municipalities of China. A unique sampling connector was used in place of the dental handpiece to collect water samples. Evaluation of retraction was accomplished using a retraction measurement device designed in accordance with the International Standard ISO 7494-2:2015(E). A total of 263 water samples were collected, and the highest concentration of bacteria [1.8 × 10(6) colony-forming units (CFU)/mL] was found in the handpiece group. Thirty (51.72%) water samples in the handpiece group and 21 (36.21%) in the air/water syringe groups were cultured, yielding colony counts of > 500 CFU/mL. Potential infectious agents, such as Bacillus cereus, Kocuria kristinae and Pseudomonas fluorescens, were isolated from the water samples. Thirty (51.72%) DCUs failed the retraction evaluation. There was a significant, positive correlation (P < 0.05) between the concentration of bacteria in the water sample and the retracted volume. It is of paramount importance to increase compliance with the standards for controlling DUWL contamination. Routine microbial monitoring and evaluation of retraction are necessary to provide high-quality water for use in dental treatment.

Monitoring the decontamination efficacy of the novel Poseidon-S disinfectant system in dental unit water lines.

Contaminated dental unit waterlines (DUWLs) are a known source of specific health care-acquired infections because of the difficulty in keeping them clean during routine dental practice. Recently, an electrolysis apparatus that uses only the chlorine normally present in municipal water, the Poseidon-S system, was developed as a novel additive-free disinfectant system to control microbial contamination in DUWLs. The microbiological quality of water samples collected from DUWLs was assessed before and after installation of the Poseidon-S system in terms of the total viable counts (TVCs) of microorganisms. The microbicidal effects of the electrolyzed water against oral organisms and its cytotoxicity against human oral-derived cell lines were also examined. Water samples from the DUWLs initially had average microbial TVCs of 103-106 colony-forming units (CFU)/mL. After installation of the Poseidon-S system, the number of microorganisms in the water samples decreased to less than 1×102CFU/mL. The electrolyzed water also exhibited remarkable microbicidal effects on the microorganisms present in the DUWLs as well as microorganisms commonly isolated from human oral cavities, but showed low cytotoxicity towards human oral-derived cells. This study demonstrated that routine use of the Poseidon-S system can effectively maintain low microbial levels in DUWLs.

Evaluation of Bacterial Contamination in Dental Unit Waterlines of Qazvin’ Dental School ,Iran

Background: Contamination of dental unit waterlines is a well-known issue in the field of dentistry. Objectives: This study was designed to evaluate contamination of dental unit waterlines by common gram positive and negative bacteria in Qazvin's dental school during the year 2012. Materials and Methods: This survey was performed on 24 dental units routinely used in the dental school of the city of Qazvin. Four samples of 100 mL were obtained in sterile bottles from each unit at different work stages as follows: the beginning of daily activity, after flushing for 30 seconds, following two minutes of flushing, and after the end of daily practice. The number of bacterial colonies was determined for each sample and the mean colony number was calculated. Results: Bacterial contamination was found in all 24 units at the beginning of daily activity with a mean colony count of 17850. The number of colonies decreased to 3250 following 30 seconds of flushing in 16 units and later to 1837 after flushing for two minutes in 13 units. In addition, the number of contaminated units at the end of daily activity was 19 with a mean colony number of 11170. Conclusions: Flushing dental unit waterlines are an effective measure in reducing the number of bacterial contaminants.

Monitoring Dental-Unit-Water-Line Output Water by Current In-office Test Kits

The importance of monitoring contamination levels in the output water of dental-unit-water-lines (DUWLs) is essential as they are prone to developing biofilms that may contaminate water that is used to treat patients, with opportunistic pathogens such as species of Legionella, Pseudomonas and others. Dentists and practice staff are also at risk of being infected by means of cross-infection due to aerosols generated from DUWL water. The unit of measurement for the microbial contamination of water by aerobic mesophilic heterotrophic bacteria is the colony-forming unit per millilitre (cfu/ml) of water. The UK has its own guidelines set by the Department of Health for water discharged from DUWL to be between 100 and 200 cfu/ml of water. The benchmark or accepted standard laboratory test is by microbiological culture on R2A agar plates. However, this is costly and not convenient for routine testing in dental practices. A number of commercial indicator tests are used in dental surgeries, but they were not developed for the dental market and serve only to indicate gross levels of contamination when used outside of the manufacturer's recommended incubation period. The aim of this article is to briefly review the universal problem of DUWL contamination with microbial biofilms and to update dental professionals on the availability of currently available commercial in-office monitoring systems for aerobic mesophilic heterotrophic bacteria and to discuss their limitations for testing water samples in assuring compliance with recommended guidelines.

Effect of Different Disinfection Protocols on Microbial and Biofilm Contamination of Dental Unit Waterlines in Community Dental Practices

Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.

Microbial contamination of dental unit waterlines and effect on quality of indoor air

The microbiological quality in dental unit waterlines (DUWLs) is considered to be important because patients and dental staff with suppressed immune systems are regularly exposed to water and aerosols generated from dental units (DUs). Opportunistic pathogens like Pseudomonas, Legionella, Candida, and Aspergillus can be present in DUWLs, while during consultations, bioaerosols can be dispersed in the air, thus resulting in effects on microbiological quality of indoor air. This present study represents microbiological air and water quality in dental offices (DOs) and also concerns the relationship between the quality of DO air and dental unit water. This study aimed to assess both the microbial quality of dental unit water and the indoor air in 20 DOs and to survey the effect on the quality of the indoor air with the existing microorganisms in dental unit water. Fourteen out of 20 (70 %) DUWLs were found to be contaminated with a high number of aerobic mesophilic heterotrophic bacteria. In terms of bacterial air contamination levels, in 90 % of DOs, a medium level (<500 colony-forming units (CFU)/m(3)) of contamination was determined, while in terms of microfungal air contamination, in all DOs, a low level (<100 CFU/m(3)) of contamination was determined. Potential infection or allergen agents, such as Pseudomonas, Micrococcus, Staphylococcus, Alternaria, Cladosporium, Penicillium, Aspergillus, and Paecilomyces were isolated from water and air samples. This study's determination of contamination sources and evaluation of microbial load in DOs could contribute to the development of quality control methods in the future.

Mycological contamination in dental unit waterlines in Istanbul, Turkey.

Studies on dental units (DUs) are conducted either for the prevention or the reduction of the density of bacterial contamination in dental unit waterlines (DUWLs). However, the existence of fungi in the these systems requires more attention. During dental treatment, direct contact with water contaminated with fungi such as Candida, Aspergillus, or inhalation of aerosols from high-speed drill may cause various respiratory infections, such as asthma, allergies, and wounds on mucose membranes, especially on immunocompromised patients and dentists. The aims of this study are to investigate the number and colonization of fungi in DUWLs in the city of Istanbul, Turkey. Water samples were collected from air-water syringes, high-speed drills, and inlet waters from 41 DUs. The aerobic mesophilic fungi count in high- speed drills was higher than inlet waters and air-water syringes. Non-sporulating fungi were found in 7 DUs. The isolated fungi were identified as Penicillium waksmanii, Cladosporium spp., Penicillium spp., Candida famata, Cryptococcus laurentii, Candida guilliermondii, Penicillium verrucosum, Aspergillus pseudoglaucus, Penicillium decumbens, and Acremonium sp. Some of these fungal genera are known as opportunistic pathogens that led to respiratory diseases such as allergic rhinits. This study shows the importance of regular control of mycological contamination on water at DUs.