Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review

Abstract

Several studies have revealed that dental unit waterlines (DUWLs) are often contaminated by large numbers of various micro-organisms (bacteria, fungi, protozoa, viruses). Microbial contamination in DUWLs may originate from the mains water piped into the dental unit, the suck-back of patients' saliva into the line due to the lack of adequate valves, and contamination from bottled water systems. Some of the main determinants of microbial contamination in DUWLs are: a very small lumen size (0.5-2 mm) of the tubing used, high surface-to-volume ratio (6:1), low throughput and the materials of which the tubing is made, water stagnation outside of working hours. The environmental conditions present inside the conduits of the dental unit may facilitate the proliferation of micro-organisms and the consequent formation of biofilm on the interior surface of the pipes of DUWLs. During the use of handpieces, particularly high-speed rotating instruments, a spray is thrown up in the form of aerosols or spatters containing biological material (saliva, blood and dental plaque) and micro-organisms. This means that the health of both dental staff and patients could be at risk of infection. The risk of cross-infections in dental settings can be tackled by implementing combined interventions to prevent the contamination of DUWLs.

Keywords: biofilms; dental infection control; water microbiology.

Figure 1

Part of the interior of a dental unit (reproduced with permission from Marshall GW Jr [5]).

Figure 2

Biofilm formation on dental unit waterline tubing (reproduced with permission from Mills SE [41]).

Figure 3

Phases of biofilm formation on the surface of a dental unit waterline (reproduced with permission from Mills SE [41]): (A) carbonate deposits (which resemble ice floes); (B) initial attachment; (C) division of cells into microcolonies; (D) formation of biofilm.