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Microbial quality of water in dental unit reservoirs

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Microbial quality of water in a dental unit is of considerable importance since patients and dental staff are regularly exposed to water and aerosol generated by the unit. Water delivered to a dental unit by the so-called independent water system is the water coming from a reservoir which, at the same time, is an initial part of dental unit waterlines (DUWL). Thus, microbiological quality of this water is extremely important for the quality of water flowing from dental handpieces. The aim of the study was to assess microbiologically the water contained in dental unit reservoirs. Water samples were collected aseptically from the water reservoirs of 19 dental units. Results concerning microbial contamination: potable water quality indices, and detection and isolation of Legionella species bacteria, were presented. Over a half of the samples did not comply with the norms for potable water. In 63.1% of the cases, the number of colony forming units (cfu/ml) and of coliform organisms significantly exceeded acceptable values. Enterococcus was not detected in the samples of examined water. Similarly, no Legionella were found in the samples of dental unit reservoirs water. Reservoirs as water supplies and initial segment of DUWL should be subject to protocol to eliminate microbial contamination and routine monitoring to guarantee an appropriate quality of water used in dental treatment.
The investigation was carried out by evaluating the microbiological characteristics of the water before and after treatment with Er:YAG laser and turbine. The study was carried out in 2 dental surgeries. In both cases the laser and dental units were served by two independent circuits, fed by the same potable tap water. Samples were taken from the water supplying and the water leaving the turbine and laser before and after treatment on the same patient. Total heterotrophic plate count was measured at 36oC and at 22oC, and the presence of Staphylococcus species and non-fermenting Gram negative bacteria was investigated. Bacterial contamination was found within the circuit, especially in the laser device. Pseudomonas aeruginosa was detected in only 1 sample of supply water, in 11.1% and in 19.4% of the samples from the turbine and the laser respectively. No evidence of Staphylococcus aureus was found. The contamination of supply water was low, whereas that of the water leaving the handpieces of the 2 devices was high, especially in the laser. Attention should be paid to the control of the water leaving laser devices, given the increasingly wide use of such instruments in dental treatment exposed to risk of infection.
Microbiological control of water quality in dental units waterlines is extremely significant for patients and dental personnel. Based on the latest scientific literature, ways of reducing microbial contamination of dental treatment water and biofilm elimination are presented. The use of disinfectants, drying, and flushing are described. Further research to evaluate effectiveness, convenience on a day-to-day basis and economic aspects of various methods is required.
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