Dental Unit Water

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Dental Unit Water

• The dirtiest area in dental surgery.
• www.dentalproducts.net

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The Dirtiest Area in Dental Surgerywww.dentalpr
oducts.net

• Bacterial colonization of dental water lines
  (DUWLs) was first reported in scientific
  literature in 1963.
• Conventional DUWLs expose patients and staff to
  harmful microorganisms in the office in which you
  work.

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The Big Four agree DUWLs are a problem.

These organizations provide the primary opinions
on standards of care in Dentistry. All of
them have issued many statements regarding DUWL
contamination and infection control
recommendations.
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DUWL Contamination Dynamics
Input Water quality
Waterline Biofilm
Output Retraction and Backflow
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Water Quality
Tap water is a reliable source of
contamination. You have no way of knowing
exactly what is in it at any given
time. Distilled or sterile water is not good
enough unless the reservoir and the DUWL are
sterile.
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Retraction and Backflow

• Oral microflora have been recovered from DUWLs.
• If retraction of patient fluids is not a problem,
  then why are there anti-retraction valves built
  into the handpieces???
• How do you test a handpiece anti-retraction
  valve?
• Eddies of backflow can travel through an open
  anti-retraction valve even during positive flow!

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Waterline Biofilm

• The small diameter and long length of the DUWL
  provides a large surface area for the adherence
  of microorganisms.
• Microorganisms from water and patients combine in
  the DUWL and form a biofilm complex similar to
  dental plaque.

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Bacteria in Biofilms

• Bacteria in biofilms tend to be
• -more difficult to culture
• (for waterline testing)
• -more resistant to control strategies
  (antibiotics and biocides)
• than when grown in the laboratory.
• Their resilience has been related to physiology
  and protection by the EPS slime matrix that they
  produce.
• Source http//centerforgenomicsciences.org/resear
  ch/biofilm.html

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Changes in Biofilm Bacteria
Changes which occur in microorganisms
incorporated in biofilms

• Become Chronic in Nature
• Become Culture Negative
• Poor Response to Antibiotics
• Greater Potential for Metastasis

http//www.genomenewsnetwork.com
/articles/06_02/biofilms.shtml
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Sterilization Destroys Biofilms

• Because of the highly resistant effects of
  biofilm and its ability to leech
• endotoxins and microorganisms into dental water
  even after disinfection,
• it is critical to sterilize the entire pathway
  to eliminate the risk of contamination during
  dental procedures.

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Disinfection is not Sterilization

• Disinfection Destruction of pathogenic and other
  kinds of microorganisms by physical or chemical
  means.
• Sterilization Use of a physical or chemical
  procedure to destroy all microorganisms including
  substantial numbers of resistant bacterial
  spores.
• Disinfection does not ensure the degree of
  safety
• associated with sterilization processes.
• Disinfection is less lethal than sterilization,
  because it destroys the majority of recognized
  pathogenic microorganisms, but not necessarily
  all microbial forms (e.g., bacterial spores).
• SourceCDC Guidelines for Infection Control in
  Dental Health-Care Settings -2003

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Universal Precautions

• Since disinfection does not sterility,
• and dangerous pathogens
• have been found in DUWLs,
• the moment that biofilm contaminated
• water enters the patients mouth,
• universal precautions are compromised.

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Standard of Care

• Most state Dental Boards consider the
• 2003 CDC Guidelines for Infection Control
• in Dental Health Care Settings
• to be the standard of care
• in their communities.

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Standard of Care

• What does that mean for
• Dental Unit Water
• compliance in your office?

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CDC Guidelines for Infection Control in DUWLs

• Exposing patients or dental health care
  personnel to water of uncertain microbiological
  quality,
• despite the lack of documented adverse
• health effects,
• is inconsistent with generally accepted
  infection control principles.

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Exposing patients

• According to the CDC
• you are exposing patients if you perform
  
• any of the following procedures
• incision, excision, or reflection of tissue
• biopsy
• periodontal surgery
• apical surgery
• implant surgery
• surgical extractions of teeth requiring elevation
  of mucoperiosteal flap

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to water of uncertain microbiological quality

• According to the CDC
• Conventional dental units cannot reliably
  deliver sterile water
• because the water-bearing pathway
• cannot be reliably sterilized.

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despite the lack of documented adverse health
effects,

• Since dentistry is typically performed in an
• outpatient setting, patients are not usually
  monitored for post-treatment illness.
• Although this makes it difficult to establish an
  epidemiologic association between infection and
  recent exposure to dental unit water, there are
  several notable exceptions.

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despite the lack of documented adverse health
effects,

• The death of a California dentist from
  legionellosis.
• It is likely that aerosols from those dental
  units were the source of the fatal Legionella
  infection."
• Atlas RM, et al. Appl Environ Microbiol
  1995611208-13.
• Two patients with immunodeficiency infected with
  Pseudomonas aeruginosa after dental visit.
• Identical strain of microorganism identified
  in the dental unit waterline."
• Martin MW. Br Dent J 1987163152-4.
• "58 (81.2) out of 71 patients colonized with
  Pseudomonas aeruginosa identified in dental unit
  waterlines.
• The microorganism could be identified in the
  patients 7 days after dental appointment."
• Martin MW. Br Dent J 1987163152-4.

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despite the lack of documented adverse health
effects,

• "The temporal onset of asthma may be associated
  with occupational exposure to contaminated dental
  unit waterlines.
• Most of the organisms isolated from dental
  unit waterlines are Gram-negative bacteria,
  which contain cell wall endotoxin. A
  consequence of endotoxin exposure is the
  exacerbation of asthma."
• Pankhurst, et al. Prim Dent Care. 2005
  Apr12(2)53-9.
• "Dentists had the highest prevalence of L.
  pneumophila antibodies, followed by assistants
  and technicians, when compared with a control
  group of non-medical workers, indicating that
  dental personnel are at an increased risk of
  legionella infection."
• Reinthaler FF, et al. J Dent Res. 1988
  Jun67(6)942-3.

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despite the lack of documented adverse health
effects,

• OSAP Agrees
• The present lack of epidemiologic evidence of
  illness or injury among patients or dental
  healthcare workers does not provide a valid
  rationale for inaction.

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is inconsistent with generally accepted
infection control principles.

• Generally accepted infection control principles
• are based on ensuring no cross contamination
  and on not introducing new pathogens
• as a result of the dental procedure.
• Oral microflora have been recovered from DUWLs
• proving cross contamination is possible if not
  likely.

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CDC Recommendations

• 1. Use water that meets EPA standards.
• 2. Consult with manufacturer to maintain water
  quality.
• 3. Monitoring of water quality
• 4. Maintenance of the anti-retraction mechanism.
• 5. Boil water advisories.
• 6. Eliminate the risk of DHCP non-compliance with
  disinfectant and water line monitoring.

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What can you do?

• How can you incorporate the recommendations of
  the CDC into your practice?
• How can you protect your patients and staff from
  the dangerous contaminants found in DUWLs?
• How can you prevent costly malpractice litigation
  due to contamination from your practice?

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• STERILE DELIVERY
• is possible if you choose an
• unconventional
• delivery system

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AQUASEPT Sterile Delivery

• The AQUASEPT sterile delivery system can be
  retrofitted onto your
• existing unit to enable you to meet or exceed all
  of the CDC
• recommendations for water used in dental
  procedures.

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AQUASEPTCDC Recommendations

• 1. Use water that meets EPA standards.
• AQUASEPT lets you use whatever water you want
  from the sterilized bottle.
• 2. Consult with manufacturer to maintain water
  quality.
• AQUASEPT is sterile every time no consultation
  needed.
• 3. Monitoring of water quality.
• AQUASEPT allows you to choose the quality of
  water you are putting in the sterile bottle.

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AQUASEPT CDC Recommendations

• 4. Maintenance of the anti-retraction mechanism.
• AQUASEPT eliminates reliance on this since the
  entire pathway is sterilized between each
  patient.
• 5. Boil water advisories.
• AQUASEPT prevents work stoppage, accidental
  patient exposures and contamination due to boil
  water advisories.
• 6. Virtually eliminates the risk of DHCP
  non-compliance with disinfectant and water line
  monitoring.
• AQUASEPT only requires proper sterilization
  technique- no messy flushing and dangerous
  chemicals and improper flushing technique.

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AQUASEPT

• DONT put your
• patients, staff, and practice
• at risk!

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AQUASEPT

• Choose AQUASEPT and operate with the
• peace of mind
• that sterile delivery brings!

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AQUASEPT

• Sterile Delivery
• Its the right thing to do!!!