Efficacy of dental unit disinfectants against Candida spp. and Hartmannella vermiformis.

Human oral commensal Candida yeasts, as well as environmental free-living amoebae (FLA) such as Hartmannella, are known to be direct or indirect human pathogens. These microorganisms may be isolated from dental unit waterlines (DUWL), because of contamination coming from the tap water and/or a patient's mouth. This study compared the efficacy of commonly used DUWL disinfectants (chlorine, H2 O2 , and Oxygenal 6©) against three species of Candida (C. albicans, C. glabrata, and C. parapsilosis) and one FLA species (H. vermiformis), growing either as single or as mixed biofilms in tap water. Results showed variable efficacies: H2 O2 had no significant activity, while chlorine was effective but only at the highest doses tested, probably not compatible with DUWL uses. Oxygenal 6© was the most efficacious in preventing the growth of yeasts in tap water. However, in the presence of FLA, Oxygenal 6© displayed a reduced antimicrobial activity against sessile C. albicans. In conclusion, none of the tested disinfectants could eradicate yeasts or FLA. Moreover, the antiyeast activity of Oxygenal 6© was reduced in the presence of FLA. Both sessile or planktonic and mixed or single-species conditions should be considered when evaluating the activity of disinfectants for DUWL maintenance. This study also highlighted that FLA should be included in the testing protocols.

Are dentists enough aware of infectious risk associated with dental unit waterlines ?

Environmental conditions in DU encourage biofilm development. This biofilm may represent a risk for patients and dental staff exposed to water and aerosols generated during dental cares, particularly for immunocompromised persons. A survey was conducted on the 175 dental surgeons of the department of Vienne (France) to investigate the motivations of dental practitioners to renew their DU, their awareness levels with respect to infectious risks related to water circulating within DU, and methods used for the maintenance of DU waterlines. These dentists were only partially aware of the need for maintaining DU waterlines. For this maintaining, chemical treatments and purges of pipes were carried out by 88% and 91.5% of dentists respectively ; chemical treatments were usually on a continous mode and dentists seemed to have complete confidence in their DU supplier regarding the choice and the use of chemical treatments. Flushes were performed only once per day in most cases (63%). This survey also highlighted that dentists were not enough aware of water related infectous risk, even though 68% estimated that the development of a biofilm within DU waterlines was an actual risk. Finally, very positively, dentists strongly indicated their wish to be more informed regarding all these risks. Although these results are based on a relatively small sample, corresponding to dentists of a French department, they clearly suggest that awareness of dental surgeons is still insufficient and must be performed to permit an effective prevention of infectious risk related to DU waterlines.

Update on infectious risks associated with dental unit waterlines.

Modern dental chair units consist of a network of interconnected narrow-bore plastic tubes called dental unit waterlines (DUWLs). The water delivered by these DUWLs acts as both a coolant for a range of instruments and an irrigant during dental treatments. The quality of water is of considerable importance because both patients and dental team are regularly exposed to water and aerosols generated by dental equipment. Studies have demonstrated that DUWLs provide a favourable environment for microbial proliferation and biofilm formation, and that water is consequently often contaminated with high densities of various microorganisms (bacteria, fungi, protozoa, viruses). The presence of high levels of microbial contamination may be a health problem for dentists and patients, especially those who are immunocompromised. The current status of knowledge on microbial contamination of DUWLs is presented, with an emphasis on the infectious risk associated with DUWLs and on the various approaches for disinfecting and protecting DUWLs.

Saliva promotes survival and even proliferation of Candida species in tap water.

Candida yeasts colonize the human oral cavity as commensals or opportunistic pathogens. They may be isolated from water circulating in dental unit waterlines mixed with traces of saliva mainly because of the dysfunction of antiretraction valves. This study deals with the growth ability of Candida albicans, Candida glabrata and Candida parapsilosis in tap water with saliva (0-20% v/v). Results show that C. glabrata is the most susceptible species in tap water. Furthermore, saliva promotes both survival and proliferation of the three studied Candida species in tap water.