bi·o·film /ˈbīōˌfilm
What it is
"A complex structure adhering to surfaces that are regularly in contact with water, consisting of colonies of bacteria that secrete a mucilaginous protective coating in which they are encased. Biofilms, which are resistant to antibiotics and disinfectants, corrode pipes and cause diseases such as lung infections, but they can be used beneficially to treat sewage, industrial waste, and contaminated soil." (American Heritage® Dictionary of the English Language)
Why it's There
It's all about the Waterline!
It is becoming increasingly recognized that dental unit coolant systems are the source of disease-bearing microorganisms between dental patients. The waterline connected to a handpiece becomes contaminated by aerosols generated during use, which then enter the patient's mouth. These aerosols can contain pathogenic microorganisms, which spread upstream in the waterline and water reservoir. It doesn't take long for these microorganisms to multiply to dangerous levels. While anti-retraction valves built into handpieces and dental units sound effective in theory, they often fail in practice.
Who is at Risk?
Everyone.
Biofilm in dental unit waterlines can harbor hundreds of various bacterial, viral, fungal and protozoan species. Some of these can be particularly serious, including:
- Legionella
- Pseudomonas species
- Streptococcus
- Staphylococcus
- Non-tuberculosis mycobacteria
- Klebsiella pneumoniae
- Tuberculosis (TB)
Because dentistry is typically performed in an outpatient setting, patients are not monitored for post-treatment illnesses. After visiting the dentist, patients continue with their daily lives, making it difficult to establish a direct cause-and-effect relationship between dental treatment and any subsequent illness.
Despite the challenges in conducting reliable studies to establish a clear association between dental treatment water and clinical illness, case reports have linked illnesses to dental water contamination.
Current Infection Controls in Dentistry
Anti-retraction Valves
Anti-retraction valves, which are commonly found in older dental units, are designed to prevent contamination. However, their effectiveness is limited to when the unit is turned off. Due to passive retraction, contamination can still occur while water is flowing. Studies have raised concerns about the reliability of anti-retraction valves in maintaining the safety of waterlines.
Filtering
Microfilters can help reduce the number of microbes in the output water. However, bacteria from the patient's mouth can accumulate on the patient side of the filter. Additionally, viruses, being smaller than bacteria, can pass through the filter and may not be effectively removed.
Flushing
Daily flushing of waterlines does not completely eliminate microbial contamination in the dental unit water supply. While concentrations of microbes may decrease after two minutes of flushing, they quickly return to pre-flush levels within 30 minutes.
"In 1993, the CDC recommended flushing dental waterlines at the beginning of the clinic day to reduce the microbial load. However, studies have shown that this practice does not effectively address biofilm in the waterlines or reliably improve the quality of water used during dental treatment." (MMWR)
Chemical Germicides
Various chemical germicides are used to reduce Colony-Forming Units per Milliliter (CFU/mL) levels in dental unit water to meet CDC and ADA guidelines. However, these germicides may not completely remove biofilm from tubing surfaces. Additionally, the safety of these chemicals is crucial, both for the patient and the dental equipment. Some chemicals can be corrosive to dental materials and components of the water delivery system. They may also produce potentially hazardous disinfectant by-products. Furthermore, if waterlines are not properly rinsed, patients might experience an unpleasant chemical taste.
What else can I do?
AquaSept™
AquaSept™ is the only fully autoclavable sterile delivery system available, ensuring the highest level of hygiene. It integrates seamlessly with most dental units, elevating patient care to new standards. By reducing procedure time and boosting patient volume, the AquaSept™ system is an essential addition to any dental suite, optimizing efficiency and enhancing overall practice performance.
AquaSept™ in Action
The size of an AquaSept™ Mobile Cart is shown on the right. Each AquaSept™ system detaches from the cart and fits into a sterilizable cassette. Autoclave the AquaSept™ system (waterlines and bottle) after each patient. A quick disconnect allows for fast, easy breakdown and transitioning between patients.
Entirely autoclavable, AquaSept™ provides a truly sterile water pathway.
- 0 CFU/mL, every patient, every time
- No chemical shocking, no tablets, no worries