Analysis of causes and solutions for vacuum suction weakness of dental units / 中国医学装备

An efficient vacuum suction system is a necessary prerequisite for the smooth operation of the oral diagnosis and treatment.During the use of the dental units,there is often a situation of vacuum suction weakness,resulting in the inability to discharge the mixture of blood,saliva,dental tissue and other mixtures in time,which affects the doctor's treatment field and increases the risk of aspiration pneumonia and cross-infection in patients.The working principle,pipeline system,filters and other aspects of the vacuum suction system that may affect the suction efficiency was analyzed.The causes and solutions of vacuum suction weakness were discussed,and operation suggestions were proposed to ensure the safe and effective use of equipment and ensure the safety of diagnosis and treatment.

Comparison of two types of disinfectants on the disinfection of the fixed end of the table suction pipe in the oral comprehensive treatment table / 口腔疾病防治

Objective@#To compare the disinfection effects of 500 mg/L chlorine-containing disinfectant and 3% hydrogen peroxide disinfectant applied to the threaded plastic hose at the fixed end of the saliva suction pipe of the oral comprehensive treatment table after diagnosis and treatment of patients in stomatology to provide a basis for clinical cleaning and disinfection.@* Methods @#The fixed ends of saliva suction pipes of 12 comprehensive treatment tables in the dental pulp department and maxillofacial surgery were selected as the research objects. The absorption was randomly divided into two groups and a control group: experimental group 1 with 500 mg/L chlorine disinfectants and experiment 2 group with 3% hydrogen peroxide disinfectant rinse disinfection and the control group with 0.9% sterile saline flushing pipe once a week for four weeks. Before and after washing and disinfection, samples from the inner wall of the threaded plastic hose interface were collected for bacterial culture and colony count, and colony counts within and between groups were compared before and after disinfection. Statistical analysis was conducted using SPSS 24.0 software.@*Results@#The baseline number of bacterial colonies in the first three groups was balanced, with no statistically significant difference (χ2 = 0.538, P = 0.764). The number of bacterial colonies after washing and disinfection was lower than that before washing and disinfection. The difference between 500 mg/L chlorine-containing disinfectant and 3% hydrogen peroxide disinfectant before and after disinfection was highly significant (Z = -4.801, P<0.001; Z = -4.429, P<0.001). There was no significant difference between the disinfection effect of 500 mg/L chlorine-containing disinfectant and 3% hydrogen peroxide disinfectant, but they were both better than the control group (χ2 = 18.070, P<0.001).@*Conclusion@#Disinfecting the saliva suction pipe with disinfectant between diagnosis and treatment can effectively reduce the bacterial contamination at the fixed end threaded plastic hose interface of the saliva suction pipe. The disinfection method is simple and convenient, and it is worth applying in the oral clinic.

The Optimum Duration of Flushing Dental Unit Waterlines for Microbial Removal

ABSTRACT@#This study aims to evaluate the optimum duration of flushing dental unit waterlines (DUWLs) in Universiti Sains Islam Malaysia (USIM) dental polyclinics for removal of heterotrophic bacteria. Water samples were obtained from triple air syringes at each dental chair from oral surgery clinic, outpatient clinic and polyclinic 17 at Faculty of Dentistry, USIM after 16 and 64 hours of not operating the dental units as baseline samples. This is followed by sampling after continuous flushing at 30 seconds, 1 minute, 2 minutes and 3 minutes of flushing duration. The levels of heterotrophic plate count (HPC) for each flushing duration were determined by quantification of colony forming units (CFUs) after cultivation of samples on plate count agar (PCA), R2A agar and 5% sheep blood agar (SBA). Statistically, there was no significant reduction in CFUs of HPC for all flushing duration compared to baseline (P > 0.05) with the most notable HPC reducing level after 1 minute and 3 minutes of flushing DUWLs. However, HPC level at USIM dental clinics is still exceeding the recommendation by Centers for Disease Control and Prevention (CDC) which should be less than 500 CFU/mL. The existing method of controlling DUWLs contamination in USIM dental clinics is only by flushing DUWLs 1 minute every morning prior to dental treatment as recommended by Malaysian Dental Council (MDC) without the use of chemical germicides. Thus, the flushing method alone is not reliable to reduce the number of microorganisms in the DUWLs.

Protocolo com produtos químicos para o enfrentamento do biofilme em linhas d'água de equipos odontológicos: perspectiva física, química, mecânica e biológica / Protocol with chemical products to combat biofilm on dental unit waterlines: physical, chemical, mechanical, and microbiological perspective

A biossegurança na odontologia visa o enfrentamento da contaminação cruzada e o biofilme em linhas d'água de equipos odontológicos. O objetivo deste estudo foi investigar, na perspectiva física, química, mecânica e biológica, um protocolo de uso de produtos químicos com possível aplicabilidade nas linhas d'água de equipos odontológicos para melhoria e manutenção da qualidade da água. O protocolo com produtos químicos (Produto A - ácido cítrico + cloreto de sódio; Produto B - bicarbonato de sódio + cloreto de sódio; Produto AB - ácido cítrico + bicarbonato de sódio + cloreto de sódio) foi empregado em corpos de prova de aço inoxidável que, posteriormente, foram submetidos aos ensaios de microdureza e corrosão. Ainda, ensaios de cor, microdureza, rugosidade e de atividade antibiofilme [biomassa total (cristal violeta), atividade metabólica (XTT), viabilidade por meio de corante fluorescente e microscopia confocal de varredura à laser, bem como morfologia estrutural do biofilme por microscopia eletrônica de varredura (MEV)] foram realizados em corpos de prova de poliuretana. As cepas padrão empregadas para avaliar a atividade antibiofilme monoespécie foram Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 29923) e Escherichia coli (ATCC 25922). Com relação à alteração da microdureza no aço inoxidável, após a imersão simulada por 1 e 2 anos nos Produtos (A+B+AB), não houve diferença dos resultados com o grupo controle (água). Decorrida a exposição aos produtos e grupo controle, a maioria das amostras de aço inoxidável apresentou tendência à corrosão. Ainda, houve alterações de cor, microdureza e rugosidade nas superfícies de poliuretana após a imersão simulada por 1 e 2 anos dos produtos e do grupo controle. A avaliação da biomassa dos biofilmes indicou que o Produto A (p=0,003) e o Produto AB (p=0,019) reduziram significativamente o biofilme de P. aeruginosa em comparação com o controle. Por outro lado, a avaliação da biomassa do biofilme formado por S. aureus sugeriu que o Produto B (p=0,018) promoveu maior ação antibiofilme. Em relação aos biofilmes formados por E. coli, o Produto A (p=0,001) e o uso sequencial dos Produtos A+B+AB (p=0,021) mostraram os melhores resultados. Para o XTT em comparação com o controle, os tratamentos com o Produto A (p=0,001), o Produto AB (p<0,001) e o uso sequencial dos Produtos A+B+AB (p=0,002) reduziram significativamente a atividade metabólica do biofilme de P. aeruginosa. No biofilme formado por S. aureus, contrariando os resultados observados na avaliação da biomassa, o Produto B não promoveu alterações significantes na atividade metabólica (Produto A: p<0,001; Produto AB: p=0,007; uso sequencial dos Produtos A+B+AB: p<0,001). Considerando o biofilme formado por E. coli, observou-se que o Produto B (p=0,046), o Produto AB (p<0,001) e o uso sequencial dos Produtos A+B+AB (p<0,001) promoveram redução da atividade metabólica. Observou-se redução significativa do biofilme total após o emprego dos produtos (p<0,001), em relação ao controle. Apesar da redução significativa, ainda se observou agregados de biofilme residual, cobrindo extensa porção das superfícies, mesmo após o uso dos produtos. Considerando a quantidade de células vivas de P. aeruginosa e E. coli, o Produto A e o Produto B, isolados ou em conjunto demostraram resultados semelhantes. Além disso, o Produto AB e o uso sequencial dos Produtos A+B+AB não promoveu diferença na quantidade de células vivas de S. aureus, em comparação ao controle, indicando que a combinação dos produtos não potencializou a atividade antibiofilme. Em conclusão, os produtos analisados nesta pesquisa mostraram potencial inovador para o enfrentamento do biofilme linha d'água dos equipos odontológicos, preservando as propriedades físicas, químicas e mecânicas dos materiais.

Biosafety in dentistry aims to combat cross-contamination and biofilm on dental unit waterlines. The aim of this study was to investigate, from a physical, chemical, mechanical, and biological perspective, a protocol for the use of chemical products with possible applicability in dental unit waterlines to improve and maintain water quality. The protocol with chemicals (Product A - citric acid + sodium chloride; Product B - sodium bicarbonate + sodium chloride; Product AB - citric acid + sodium bicarbonate + sodium chloride) was used in stainless steel specimens which, later, were subjected to microhardness and corrosion tests. Moreover, color, microhardness, roughness and antibiofilm activity tests [total biomass (crystal violet), metabolic activity (XTT), viability by means of fluorescent dye and confocal laser scanning microscopy, as well as structural morphology of biofilm by scanning electron microscopy (SEM)] were performed on polyurethane specimens. The standard strains used to assess monospecies antibiofilm activity were Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 29923) and Escherichia coli (ATCC 25922). Regarding the microhardness change in stainless-steel, after simulated immersion for 1 and 2 years in Products (A+B+AB), there was no difference in the results with the control group (water). After exposure to the products and control group, most stainless-steel samples showed a tendency to corrosion. Furthermore, there were changes in color, microhardness, and roughness on the polyurethane surfaces after simulated immersion for 1 and 2 years of the products and the control group. Biofilm biomass evaluation indicated that Product A (p=0.003) and Product AB (p=0.019) significantly reduced P. aeruginosa biofilm compared to the control. On the other hand, the evaluation of the biomass of the biofilm formed by S. aureus suggested that Product B (p=0.018) promoted greater antibiofilm action. Regarding biofilms formed by E. coli, Product A (p=0.001) and the sequential use of Products A+B+AB (p=0.021) showed the best results. For XTT compared to the control, treatments with Product A (p=0.001), Product AB (p<0.001) and sequential use of Products A+B+AB (p=0.002) significantly reduced metabolic activity from the biofilm of P. aeruginosa. In the biofilm formed by S. aureus, contrary to the results observed in the biomass assessment, Product B did not promote significant changes in metabolic activity (Product A: p<0.001; Product AB: p=0.007; sequential use of Products A+B+ AB: p<0.001). Considering the biofilm formed by E. coli, it was observed that Product B (p=0.046), Product AB (p<0.001) and the sequential use of Products A+B+AB (p<0.001) promoted a metabolic activity reduction. There was a significant reduction in the total biofilm after using the products (p<0.001), compared to the control. Despite the significant reduction, residual biofilm aggregates were still observed, covering a large portion of the surfaces, even after using the products. Considering the amount of living cells of P. aeruginosa and E. coli, Product A and Product B, alone or together, showed similar results. In addition, Product AB and the sequential use of Products A+B+AB did not promote difference in the amount of living S. aureus cells, compared to the control, indicating that the combination of products did not enhance the antibiofilm activity. In conclusion, the products analyzed in this research showed innovative potential for facing the biofilm on dental unit waterline, preserving the physical, chemical, and mechanical properties of the materials.

Prevalência de infecções bucais em ambiente hospitalar / Prevalence of oral infections in a hospital environment

Objetivo: Verificar a prevalência de infecções bucais em ambiente hospitalar no período de 13 meses. Materiais e métodos: Estudo transversal, realizado no Centro de Terapia Intensiva (CTI) e na Clínica Neurológica da Santa Casa de Caridade de Diamantina, Minas Gerais, Brasil. Foram analisados todos os dados referentes às infecções bucais e hospitalares, ocorridas no período de março de 2017 a março de 2018, obtidos pela Comissão de Controle de Infecção Hospitalar da instituição. A população estudada compreendeu todos os pacientes desses setores, com idade acima de 16 anos, de ambos os sexos e que tiveram infecção bucal após 48 horas de internação. Resultados: Dentro do total de 2.703 pacientes a prevalência de infecção bucal foi de 1,15% (n=31) dentro do período de 13 meses, sendo a candidíase de maior ocorrência. A prevalência de infecção hospitalar foi de 2,85%. Conclusão: A prevalência das infecções bucais foi maior no CTI, em comparação à Clínica Neurológica, sendo a infecção mais prevalente a candidíase oral. Sugere-se maior atenção à saúde bucal dos pacientes hospitalizados, diante da maior vulnerabilidade dosmesmos às infecções bucais

Aim: To verify the oral infections prevalence in a hospital environment within a period of 13 months. Materials and methods: A cross-sectional study was carried out at the Intensive Care Center and Neurological Clinic of Santa Casa de Caridade, in Diamantina,Minas Gerais, Brasil. All data referring to oral and hospital infections occurred in the period from March 2017 to March 2018 were obtained. The research source was the Hospital Infection Control Committee of the institution. The sample comprised all the patients of these sectors, aged over 16 years, of both genders and who had oral infection after 48 hours of hospitalization. Results: Within 2703 patients, the oral infection prevalence was 1.15% (n=31) within 13 months, being candidiasis the most frequent. The prevalence of nosocomial infection was 2.85%. Conclusion:The prevalence of oral infections was higher in the Intensive Care Center compared to Neurological Clinic, being candidiasis the most common oral infection. More attention should be given tothe hospitalized patients's oral health, considering their greater vulnerability to oral infections

Água em elevada temperatura: é viável a sua aplicabilidade no controle do biofilme de equipo odontológico? / Water at high temperature: is its applicability for biofilm control of dental unit viable?

Na Odontologia, as linhas d'água de equipos odontológicos são substratos para a formação de biofilme e, consequentemente, dispersão dessa contaminação microbiana para água destinada ao tratamento odontológico. O objetivo desta pesquisa foi investigar a atividade antibiofilme da água em elevada temperatura contra Pseudomonas aeruginosa, visando à sua aplicabilidade em linhas d'água de equipos odontológicos para o controle dessa problemática. Trata-se de um estudo do tipo experimental/laboratorial in vitro. Alíquotas de 2mL de Tryptic Soy Broth com 1% do inóculo bacteriano padronizado (106UFC/mL) de P. aeruginosa (ATCC 27853) foram inoculadas em cada um dos poços de placas de poliestireno de 24 poços. Em seguida, fragmentos de linha d'água (FL) de 1cm (n=48) foram transferidos para os poços das placas. A incubação foi efetuada em estufa de agitação a 37°C por 24h em 80rpm. Decorrido o período de incubação, os FL foram enxaguados com 5mL de solução salina a 0,85% por três vezes para retirada das células planctônicas. Posteriormente, as amostras foram transferidas para duas placas de 24 poços contendo 2mL de água purificada do tipo II (osmose reversa) esterilizada em cada poço. Grupos experimentais com temperaturas e tempos de exposição diferentes foram avaliados: temperatura ambiente (controle) - (n=24) e a 60°C (n=24), e 30s (n=12) e 60s (n=12). As amostras dos FL foram transferidas para microtubos contendo 1mL de Tryptic Soy Broth e pérolas de vidro. Os tubos foram homogeneizados em agitador de tubos por 2min e, em seguida, alíquotas de 50µL in natura e diluídas (diluição decimal seriada até 10-5) foram semeadas em placas de Petri (60x15mm) com Cetrimide Agar. Após o período de incubação em estufa a 37°C por 24h, os números de unidades formadoras de colônia expressas por FL (UFC/FL) foram determinados. Além disso, as amostras dos FL foram fixadas, desidratadas, metalizadas e submetidas à análise por meio de microscopia eletrônica de varredura (MEV). Os dados coletados foram submetidos à análise estatística empregando-se os testes de Shapiro-Wilk e U de Mann-Whitney por meio do software BioEstat® (versão 5.3) e nível de significância a=5%. Houve diferença entre a comparação das medianas das cargas bacterianas expostas à água à temperatura ambiente (335.000UFC/FL) e a 60°C (2.030UFC/FL) por 30s (p=0,0005), com redução de 3logUFC/FL. Ainda, a comparação entre as medianas das cargas bacterianas expostas à água à temperatura ambiente (173.000UFC/FL) e a 60°C (1.780UFC/FL) por 60s mostrou diferença (p=0,0047), com redução de 2logUFC/FL. A MEV demonstrou a presença de biofilme em todas as amostras analisadas, entretanto nos FL expostos à água a 60°C, os bastonetes (P. aeruginosa) foram evidenciados em menor quantidade e com características morfológicas atípicas. Em conclusão, a exposição do biofilme de P. aeruginosa formado nos FL de equipo odontológico à água em elevada temperatura reduziu a carga e alterou a morfologia bacteriana, demonstrando possível aplicabilidade na biossegurança: controle de contaminação/infecção na Odontologia

In dentistry, dental unit waterlines were substrates for biofilm formation and, consequently, dispersion of this microbial contamination for distilled water to dental treatment. The objective of this study was to investigate water antibiofilm activity at high temperature against Pseudomonas aeruginosa, aiming at its applicability in dental unit waterlines for controlling this problem. It is an in vitro experimental/laboratory study. 2mL aliquots of Tryptic Soy Broth with 1% of standardized bacterial inoculum (106CFU/mL) of P. aeruginosa (ATCC 27853) were inoculated on each one of 24-well polystyrene plates. Next, fragments of waterline (FW) of 1cm (n=48) were transferred for plates wells. The incubation was carried out in an incubator shaker at 37°C for 24h at 80rpm. After the incubation period elapsed, the FW were flushed with 5mL of saline solution at 0.85% by three times for removing planktonic cells. Subsequently, the samples were transferred to two 24-well plates containing 2mL of type II purified water (reverse osmosis) sterilized in each well. Experimental groups with different temperatures and exposition times were evaluated: room temperature (control) - (n=24) and at 60°C (n=24), and 30s (n=12) and 60s (n=12). The FW samples were transferred to microtubes containing 1mL of Tryptic Soy Broth and glass beads. The tubes were homogenized in an orbital shaker for 2min and, following this, diluted in natura 50µL aliquots (serial decimal dilution up to 10-5) were seeded in Petri plates (60x15mm) with Cetrimide Agar. After the incubation period in chamber at 37°C for 24h, the numbers of colony-forming units expressed per FW (CFU/FW) were determined. Furthermore, the FW samples were fixed, dehydrated, metalized and submitted to analysis through scanning electron microscopy (SEM). The data collected were submitted to statistical analysis using Shapiro-Wilk and Mann-Whitney U tests through BioEstat® (version 5.3) software and a=5% significance level. There was a difference between the comparison of medians of bacterial loads exposed to water at room temperature (335,000CFU/FW) and at 60°C (2,030CFU/FW) for 30s (p=0.0005), with reduction of 3logCFU/FW. Moreover, the comparison between the medians of bacterial loads exposed to water at room temperature (173,000CFU/FW) and at 60°C (1,780CFU/FW) for 60s showed difference (p=0.0047), with a reduction of 2logCFU/FW. The SEM demonstrated biofilm presence on all analyzed samples, but on FW exposed to water at 60°C, the rods (P. aeruginosa) were evidenced in less quantity and with atypical morphological characteristics. In conclusion, the exposition of P. aeruginosa biofilm formed in dental unit FW to water at high temperature reduced the load and changed the bacterial morphology, demonstrating a possible applicability in biosafety: contamination/infection control in dentistry

Calidad del agua de una clínica odontológica universitaria de Bogotá / Water quality of a university dental clinic in Bogotá

Resumen Objetivo. Determinar la calidad microbiológica del agua usada en las unidades odontológicas de una clínica universitaria en Bogotá, mediante los indicadores microbiológicos coliformes totales, Escherichia coli, Enterococcus y Pseudomonas. Métodos. Se tomaron muestras de agua de la pieza de mano y de la jeringa triple en 9 unidades odontológicas y tres muestras de los tanques de suministro de agua para un total de 21 muestras. El recuento de microorganismos se realizó mediante la técnica de filtración por membrana. Se aislaron algunos microorganismos presentes en las diferentes muestras a través del kit de pruebas rápidas BBL CRYSTAL. Resultados. El agua no cumple con la Resolución 2115 de 2007 que reglamenta las normas del agua apta para consumo humano. Se aislaron bacterias importantes como Shigella sp. (microorganismo productor de la disentería e indicador de contaminación fecal), Klebsiella y Pseudomonas. Se sugiere implementar medidas correctivas y/o preventivas para minimizar la contaminación y mejorar la calidad del agua usada en estas unidades odontológicas.

Abstract Objectives. To determine the microbiological quality of the water used in dental units of a University Clinic in Bogotá, through the microbiological indicators like total coliforms, Escherichia coli, Enterococcus and Pseudomonas. Methods. Water samples from hand piece and the triple syringe 9 dental units and three samples of tanks for water supply for a total of 21 samples were taken. The microorganism counting was performed by membrane filtration method according to the Standard Methods. Some microorganisms present in different samples were isolated through the BBL CRYSTAL rapid test kit. Results. The water does not comply with the Resolution 2115 2007, which regulates the water suitable for human consumption standards. Important bacteria such as Shigella sp. (producer of dysentery and a fecal pollution indicator organism), Klebsiella and Pseudomonas were isolated. It is suggested to implement corrective or preventive measures to minimize the pollution and improve the quality of the water used in these dental units.

Comparative evaluation of chlorhexidine and cinnamon extract used in dental unit waterlines to reduce bacterial load in aerosols during ultrasonic scaling

Dental unit waterlines (DUWL) are believed to be a source of infection. Ultrasonic instruments generate aerosols with significantly greater numbers of bacteria. Chlorhexidine (CHX) exhibits significant antiseptic effect. Recently, cinnamon (CIN) has been displayed to have antibacterial and anti-inflammatory properties in vivo. Aim: The aim of this study is to compare and evaluate the efficacy of CHX versus CIN extract in the reduction of bacterial count in dental aerosols when used as an irrigant through DUWL during ultrasonic scaling. Materials and Methods: Sixty patients with moderate-to-severe gingivitis were randomly divided into 3 groups of 20 patients each undergoing ultrasonic scaling. For experimental group I, CHX was added in dental unit reservoir before ultrasonic scaling. Similarly, in group II, CIN extract was used and group III served as control where distilled water (DW) was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. One plate from each position was incubated aerobically for 48 h and other plate anaerobically for 72 h. The total number of colony forming units (CFUs) was then calculated and statistically interpreted. Results: CHX and CIN both were equally effective (P > 0.05) in reducing the bacterial count in aerosols as compared to DW (P < 0.05) when used through DUWL. Maximum contamination was seen on the agar plate placed at the chest of the patient. Conclusion: Both CIN and CHX used as an irrigant through DUWL effectively helped in the reduction of bacterial count in dental aerosols.

Slightly acidic electrolyzed water cytotoxicity to oral keratinocyte monolayers / 口腔疾病防治

Objective @#To investigate the cytotoxicity of slightly acidic electrolyzed water (SAEW) on oral keratinocyte monolayers. @*Methods@#TR146 human keratinocyte monolayers were exposed to SAEW pretreated with bovine serum albumin（BSA）. It was divided into 4 groups, BSA 0 mg/mL (SAEW stock solutsion), BSA 0.5 mg/mL, BSA 1 mg/mL and BSA 2 mg/mL. The relative growth rate (RGR) was measured using a CCK-8 assay at 1 min, 5 min, 15 min, 30 min and 1 h, and the survival rate was measured using a Trypan Blue exclusion assay at 1 h. @*Results@#The CCK-8 assay showed significantly different OD values in the SAEW and negative control groups at different times and FAC concentrations (P<0.05). With increasing FAC concentrations and observation times, the RGR in the SAEW group decreased, and the SAEW showed moderate to severe cytotoxic effects. The OD values in the BSA (0.5~2 mg/mL)-pretreated SAEW and negative control groups were not significantly different at different times or FAC concentrations (P > 0.05); the RGRs of the BSA-pretreated SAEW group all approached 100%, and no cytotoxic effects were observed in the BSA-pretreated SAEW group. The Trypan Blue exclusion assay showed significantly different survival rates in the SAEW and negative control groups at different FAC concentrations (P < 0.05). As the FAC concentration increased, the survival rate in the SAEW group decreased, and SAEW showed moderate to severe cytotoxic effects. The survival rates in the BSA-pretreated SAEW and negative control groups were not significantly different at different FAC concentrations (P > 0.05); the survival rates in the BSA-pretreated SAEW group all approached 100%, and no cytotoxic effects were observed.@*Conclusion@#SAEW showed no adverse effects on the viability of dental oral keratinocyte monolayers in vitro in the presence of BSA at concentrations equivalent to that of protein in saliva.

Qualidade da água em clínica odontológica na perspectiva microbiológica: uma proposta de intervenção / Water quality in a dental clinic in the microbiological perspective: a proposal of intervention

Na odontologia, o biofilme formado nas linhas d'água de equipos odontológicos pode disseminar a contaminação microbiana na água. O objetivo desta pesquisa foi investigar a contaminação microbiana da água de abastecimento e de equipos odontológicos antes e após a implementação de um protocolo para melhoria e manutenção da qualidade microbiológica da água de equipos odontológicos, bem como desenvolver produtos antibiofilme com possível aplicabilidade nas linhas d'água. A carga microbiana da água de 27 torneiras e equipos (reservatórios, seringas tríplice e alta rotação) de uma clínica odontológica foi avaliada por meio do sistema Petrifilm(TM) (bactérias aeróbias totais e fungos) e meios de cultura convencionais (enterobactérias e Legionella spp.) em duas etapas distintas, sendo a segunda análise realizada após a implementação de um protocolo para melhoria e manutenção da qualidade microbiológica da água dos equipos. Ainda, as atividades antibacteriana (concentração inibitória mínima - hipoclorito de sódio, ácido cítrico, bicarbonato de sódio, cloreto de sódio, dodecil sulfato de sódio, peróxido de hidrogênio, polissorbato 20 e quitosana) e antibiofilme (biomassa total e viabilidade celular) foram determinadas in vitro a partir de substâncias e produtos com possível aplicabilidade na desinfecção de linhas d'água de equipos. As amostras de água das torneiras apresentaram carga bacteriana dentro do parâmetro estabelecido pela legislação brasileira, no entanto, as seringas tríplices e os alta rotação não. A implementação do protocolo para manutenção da qualidade microbiológica da água dos equipos demonstrou uma redução nas cargas bacteriana e fúngica apenas nos alta rotação. Enterobactérias e Legionella spp. não foram isoladas das amostras de água das torneiras e dos equipos. De acordo com a concentração inibitória mínima, o ácido cítrico, bicarbonato de sódio, cloreto de sódio, hipoclorito de sódio e peróxido de hidrogênio demonstraram as melhores atividades antibacterianas. As melhores atividades antibiofilme (biomassa total) foram do peróxido de hidrogênio a 5% (E. coli e P. aeruginosa), ácido cítrico a 30% (P. aeruginosa) e bicarbonato de sódio a 30% (S. aureus). Os produtos (Wanitox A e Wanitox B) desenvolvidos apresentaram atividade antibiofilme (viabilidade celular) contra a E. coli e S. aureus. Assim, os produtos desenvolvidos nesta pesquisa apresentaram possível aplicabilidade no enfrentamento do biofilme nas linhas d'água de equipos odontológicos, que permanece como um dos grandes desafios na odontologia. Ainda, pesquisas adicionais são necessárias para o aperfeiçoamento e aplicabilidade destes produtos

In dentistry, biofilm formed on dental unit waterlines can disseminate microbial contamination in water. The objective of this research was to determine the microbial contamination of water from supplies and dental units before and after the implementation of a protocol for improvement and maintenance of microbiological water quality of water from dental units as well as to develop antibiofilm products with possible applicability in waterlines. The microbial load of water from 27 taps and dental units (reservoirs, air-water syringes and high-speed turbines) in a dental clinic was evaluated through a Petrifilm(TM) system (total aerobic bacteria and fungi) and conventional culture mediums (enterobacteria and Legionella spp.) in two distinct stages, being the second analysis performed after the implementation of a protocol for improvement and maintenance of microbiological water quality of water from dental units. Moreover, the antibacterial (minimum inhibitory concentration - sodium hypochlorite, citric acid, sodium bicarbonate, sodium chloride, sodium dodecyl sulfate, hydrogen peroxide, polysorbate 20 and chitosan) and antibiofilm (total biomass and cell viability) activities were determined in vitro from substances and products with possible applicability in disinfection of dental unit waterlines. The water samples from taps presented bacterial load within the parameter established by Brazilian legislation; however, air-water syringes and high-speed turbines did not. The protocol implementation for maintenance of microbiological water quality of water from dental units showed a decrease on bacterial and fungal loads only on high-speed turbines. Enterobacteria and Legionella spp. were not isolated from water samples from taps and dental units. According to minimum inhibitory concentration, citric acid, sodium bicarbonate, sodium chloride, sodium hypochlorite and hydrogen peroxide showed the best antibacterial activities. The best antibiofilm activities (total biomass) were from 5% hydrogen peroxide (E. coli and P. aeruginosa), 30% citric acid (P. aeruginosa) and 30% sodium bicarbonate (S. aureus). The developed products (Wanitox A and Wanitox B) showed antibiofilm activity (cell viability) against E. coli and S. aureus. Thus, the products developed in this research presented a possible applicability in confrontation with biofilm on dental unit waterlines, and this remains as a major challenge in dentistry. Besides, additional researches are necessary for enhancement and applicability of these products

Potentially pathogenic Acanthamoeba genotype T4 isolated from dental units and emergency combination showers

BACKGROUND Acanthamoeba is the genus of free-living amoebae that is most frequently isolated in nature. To date, 20 Acanthamoeba genotypes have been described. Genotype T4 is responsible for approximately 90% of encephalitis and keratitis cases. Due to the ubiquitous presence of amoebae, isolation from environmental sources is not uncommon; to determine the clinical importance of an isolation, it is necessary to have evidence of the pathogenic potential of amoebae. OBJECTIVE The aim of this study was to physiologically characterise 8 Acanthamoeba T4 isolates obtained from dental units and emergency combination showers and to determine their pathogenic potential by employing different laboratory techniques. METHODS Eight axenic cultures of Acanthamoeba genotype T4 were used in pathogenic potential assays. Osmotolerance, thermotolerance, determination and characterisation of extracellular proteases and evaluation of cytopathic effects in MDCK cells were performed. FINDINGS All of the isolates were osmotolerant, thermotolerant and had serine proteases from 44-122 kDa. Two isolates had cytopathic effects on the MDCK cell monolayer. MAIN CONCLUSION The presence of Acanthamoeba T4 with pathogenic potential in areas such as those tested in this study reaffirms the need for adequate cleaning and maintenance protocols to reduce the possibility of infection with free-living amoebae.

Characterization of consultations for odontogenic abscesses in a major Chilean hospital

OBJECTIVES: To characterize consultations for odontogenic abscesses at the dental and maxillofacial unit of the public emergency hospital in Santiago, Chile. METHODOLOGY: descriptive study, involving consecutive sampling of patients with diagnosis of odontogenic abscess, conducted between august and september 2016. descriptive statistics were performed to determine the frequency of diagnosis, affected tooth, sex and need for hospitalization. RESULTS: odontogenic abscesses accounted for 6.3 percent (n=414) of a total of 6,535 consultations. males represented 59 percent; 42 percent of odontogenic abscesses presented in molars and maxillary premolars. the vestibular space was the most frequently affected anatomical space (50 percent), associated in 53 percent of the cases to submucosal abscesses. ninety-eight per cent of patients were successfully treated on an outpatient basis, 2 percent required hospitalization, mainly associated to abscesses involving the deep submandibular space. CONCLUSION: odontogenic abscesses account for a low percentage of dental emergencies at the public emergency hospital in Santiago, Chile. most cases receive outpatient treatment.

Development and application of portable integral dental unit in ship / 医疗卫生装备

Objective To develop a portable integral dental unit in the ship to fulfill medical service during canvoy operation.Methods The unit developed was modified based on WD6232-E dental unit,and comprised of a chair and accessories.An earth box and a seat box were under the chair,and a base was at one side of it.The accessories included a level bar,emesis basin,cold light and etc.The digital unit was modified,which involved in a miniature digital dental X-ray machine and a micro computer.Results The dental unit developed could fulfill dental auxiliary diagnosis and treatment similar to them in garrison hospital.Conclusion The unit gains advantages in portability and easy operation and adapts itself to dental service during expedition,and thus is worthy promoting practically.

Efficacy of aseptic processing on dental unit waterlines / 中国感染控制杂志

Objective To compare the effect of different ways of water supply and whether or not drain water from waterlines for overnight on bacterial counts in dental unit waterlines(DUWLs).Methods In the first phase,6 sets of DUWLs were randomly divided into 2 groups (external storage tank water supply group and municipal water sup-ply group);in the second phase,6 sets of DUWLs were all changed to use external storage tank and randomly di-vided into 2 groups (draining water for overnight group and without draining water for overnight group),bacterial count before and within one week of disinfection between two groups at two phases were compared respectively. Results In the first phase,handpiece water of DUWLs was most seriously contaminated by bacteria,the average colony count was 4117 CFU/mL,qualified rate was 15.38%.Before disinfection,no significant difference in bacte-rial count were found among each groups (all P>0.05),bacterial count of DUWLs of all groups severely exceeded the standard(all >3000 CFU/mL).Comparison of bacterial count in DUWLs from different water supply routes after disinfection was not significantly different on day 1(P>0.05),but were significantly different at day 2-7(all P0.05),but were significantly different on day 2-7(all P100 CFU/mL.Conclusion Use of external storage tank,daily change of sterile distilled water,and daily emptying water for overnight can effectively reduce bacterial count in DUWLs.

Dental unit water lines decontamination with the aid of nanotechnology.

Aim: This article reviews the issue of dental unit waterline (DUWL) contamination which affects all the clinical and hospital settings. The contaminating microorganisms commonly isolated from these settings and the most pathogenic among them have serious consequences. Over the years several measures are inculcated for decontamination of water, their advantages and shortcomings have been addressed. Options using nanotechnology which are available in the market are described briefly. Materials and Methods: A manual and electronic search was conducted. Google and PubMed were searched for relevant material from studies up to 2013. Medical Subject Headings words looked for were “Nanotechnology,” “Water purification,” and “Biofilms.” Reviewed findings were summarized by topic, using the Preferred Reporting Items for Systematic Reviews and Meta‑analyses statement for reporting. Seventy articles were shortlisted for articles pertaining to our topic of discussion. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, data extraction, data synthesis, and drawing of conclusion. Results: Dental waterline contamination is widespread in any type of dental setting having serious implications on clinicians and patients alike, especially elderly and immune‑compromised. Hence, international bodies like center for disease and control and American Dental Association have come up with stringent measures for maintenance of water quality. A gamut of procedures has been tried to overcome this problem ranging from chlorinated products, water filters to the usage of distilled water. The use of nanoemulsions, nanofilters, nanomembranes, etc., and their applicability for routine usage is discussed. Conclusions: Biofilm formation in DUWLs is inevitable with the subsequent release of part of microbiota into the otherwise sterile dental settings. These consequences can be quite serious on clinicians and dental patients. Though conventional measures in water decontamination have been partly successful, the quest for more foolproof methods has led to the use of latest technology, i.e., nanotechnology. The most practical option has to be chosen based on the ease of their usage.

Disinfection efficacy of different disinfectants on dental unit waterlines / 中国感染控制杂志

Objective To compare the disinfection efficacy of different disinfectants on dental unit waterlines (DUWLs). Methods 18 sets of DUWLs were randomly divided into 4 groups,and disinfected or treated with hydrogen peroxide (H2 O2 )disinfectant,sodium hypochlorite (NaClO)disinfectant,hydrogen peroxide silver ion disinfectant(Sanosil),and distilled water (DW)respectively.Water specimens from triple syringes and high-speed handpieces were taken,bacterial count before and after disinfection were compared.Results Before disinfection,no significant differences in bacterial counts were found among four groups (all P >0.05),bacterial counts of DUWLs of all groups severely exceeded the standard(all>3 000 CFU/mL).After disinfection,except DW group,bacterial counts of DUWLs of the other groups declined dramat-ically (all <100 CFU/mL),bacterial count after disinfection were all obviously lower than before disinfection (all P <0.001 ).One week after disinfection,bacterial counts among three disinfectant groups in different time periods were statisti-cally different (triple syringes:Day1—Day5,all P <0.05;high-speed handpieces:Day2,Day3 and Day5,all P <0.05). Day3 after disinfection of triple syringes by H2 O2 and NaClO,Day4 after disinfection of high-speed handpieces by H2 O2 and NaClO,and Day5 of triple syringes and high-speed handpieces by Sanosil all exceeded the standard of Center for Disease Control and Prevention of America.One week after disinfection,bacterial counts of three disinfection groups all exceeded or approximated to that before disinfection.Conclusion Three types of disinfectants can all effectively reduce bacterial load in DUWLs.Compared with other disinfectants,Sanosil has advantage of inhibiting bacterial growth after disinfection.

Retraction of dental unit waterlines in Tianjin City / 中国感染控制杂志

Objective To survey the retraction of dental unit waterlines (DUWLs)in medical institutions,and evaluate the influencing factors for retraction of DUWLs.Methods In May-November 2014,dental chair units (DCUs)in medical institutions in Tianjin City were sampled through systematic random sampling method,retrac-tion volume of DUWLs was detected by independently made detector,the relevant influencing factors were investi-gated.Results A total of 58 DCUs in 30 medical institutions in 10 districts(counties)of Tianjin were investigated, the average retraction volume of DUWLs was (103.60 ±117.85 )mm3 ,the qualified rate of retraction volume of DUWLs was 48.28 %(28/58);length of utilization of DCUs was positively correlated with DUWLs retraction (r=0.52,P 0.05 ).Conclusion The qualified rate of retraction volume of DUWLs is low,routine maintenance of DUCs needs to be intensified,especially the long-term used DUCs,contaminatin of DUWLs due to the invalidity of retraction valve should be prevented.

Bioaerosol Contamination In Dental Clinic : A Potential Health Hazard.

Dental clinics are potential hazardous areas as large amount of bio-aerosols are produced here. Bioaerosols are microorganisms or particles, gases, vapors, or fragments of biological origin (i.e., alive or released from a living organism) that are in the air. Many sources of bioaerosols exist within and outside the dental clinic. The concentration of aerosols and splatters appears to be highest during dental procedures, especially those generated by some procedures such as ultrasonic scaling, or using a high speed drill. Bioaerosols may reach up to 12-16 feet from the source during patient care and may stay suspended in the air for hours if there is inadequate ventilation of air exchanges. Therefore, several infectious diseases could be transmitted to staff and patients by airborne bacterial and other contaminants in the dental clinic. Dental staff should use personal protective measures, which reduce contact with bacterial aerosols and splatters in the dental clinic.

Contamination status of dental unit waterlines in three general hospitals / 中国感染控制杂志

Objective To realize the contamination status of dental unit waterlines (DUWL)in general hospitals, and provide scientific evidence for making preventive measures.Methods Three hospitals were selected for study, water source adopted by hospital A,B and C was running water,reservoir water,and filtered water through reverse osmosis filtration system respectively,specimens of dental handpiece spray water and flushing water of dental chair units were collected quarterly,total bacterial colony in water were detected.Results The qualified rate of source wa-ter,handpiece spray water,and flushing water in hospital A was 75.00%(3/4),0 (0/40)and 0 (0/40)respectively,col-ony count of handpiece spray water and flushing water was (1.20×103 -5.53×104 )CFU/mL(M=3.80×104 CFU/mL) and (2.11×104 -1.66×105 )CFU/mL(M=4.80×104 CFU/mL)respectively.The qualified rate of source water,hand-piece spray water,and flushing water in hospital B was 50.00%(2/4),60.00%(24/40)and 72.50%(29/40)respectively, colony count of handpiece spray water and flushing water was (0.00 -3.71 ×106 )CFU/mL(M=83.00 CFU/mL)and (0.00-2.39×106 )CFU/mL(M=72.00 CFU/mL)respectively.The qualified rate of source water,handpiece spray wa-ter,and flushing water in hospital C was 100.00%(4/4),55.00%(22/40)and 65.00%(26/40)respectively,colony count of handpiece spray water and flushing water was (0.00-6.20×103 )CFU/mL(M=96.00 CFU/mL)and(0.00-1.63×103 )CFU/mL(M=87.50 CFU/mL)respectively.Conclusion Water of DUWL in general hospitals is seriously con-taminated,disinfection and standardized management of source water and DUWL must be strengthened.

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 highspeed 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.