The Application of Silver to Decontaminate Dental Unit Waterlines-a Systematic Review

Periodic detection and disinfection maintenance of dental unit waterlines in dental simulation head model laboratories

Dental simulation head model laboratories are crucial for clinical simulation training for stomatological students, yet the maintenance of their dental unit waterlines (DUWLs) has been overlooked. This study investigated water contamination in DUWLs within these laboratories and proposed solutions. Water samples were collected from 12 dental chairs in three laboratories at three time points: the beginning, middle, and end of the semester. At the start of the semester, severe contamination was observed, with colony counts of 11,586[Formula: see text]1715 CFU/ml for high-speed handpieces and 5375[Formula: see text]874 CFU/ml for three ways syringes. As the semester progressed, colony counts gradually decreased but remained above clinical thresholds. Both 20 mg/L organochlorine disinfectant and 20 mg/L chlorine dioxide were effective in reducing bacterial contamination below standard ranges three days post-disinfection. Microbial diversity analysis revealed Proteobacteria and Bacteroidota as the dominant bacterial phyla, with Ascomycota as the dominant fungal phylum. Potentially pathogenic bacteria such as Pseudomonas, Burkholderia-Caballeronia-Paraburkholderia, Ralstonia, Mycobacterium, Legionella, Paenibacillus, Streptomyces, Acinetobacter, and Prevotella, as well as fungi like Fusarium and Penicillium, were detected. Therefore, urgent attention is needed to address DUWL contamination in dental laboratories, and it is recommended to disinfect DUWLs using either 20 mg/L organochlorine disinfectant or 20 mg/L chlorine dioxide every three days.

Antimicrobial and Oxidative Activities of Different Levels of Silver-Exchanged Zeolites X and ZSM-5 and Their Ecotoxicity

OBJECTIVES

The antimicrobial, oxidative activities, and ecotoxicity of synthesized silver-loaded zeolites (X and ZSM-5(MFI), Si-to-Al ratios 12 and 25) were studied, linking antimicrobial properties to material structure and released active silver species.

METHODS

The materials were characterized by SEM, EDX, TEM, and XRPD. All materials, with a silver content of 1-3%wt for the Ss and about 35%wt for the X-zeolites, were tested against Escherichia coli and Staphylococcus aureus. Redox activity was studied in physiological (pH 7.4/37 °C) and optimal (pH 8.5/37 °C) conditions in chemiluminescent model systems. In the ecotoxicity tests, we used Daphnia magna. Results: A proportional correlation was observed between the bactericidal effect of and the silver content in the zeolites. AgX with a Si/Al ratio of ~1.23 and 35% silver showed a higher antimicrobial efficiency, particularly against Gram-negative E. coli versus Gram-positive S. aureus. The concentration thresholds were as follows: AgXas had a bactericidal effect at 0.003 g/L-1, with an MIC at 0.0015 m/L-1 for E. coli; SA25-Ag, AgXcl, AgXrc had a bactericidal effect at 2.5 g/L-1. The bacteria were more resilient than Daphnia magna, which showed a 90-100% lethality at Ag-zeolite concentrations of 0.00625 to 0.0125 g/L-1. AgXas and AgXrc demonstrated strong reactive oxygen species generation at both the physiological and optimal pH, explaining their bactericidal effects. In general, the tested materials showed an inhibition of the generated reactive oxygen species depending on the model system and conditions.

CONCLUSIONS

The silver species leached from the new materials explain their higher oxidation and bactericidal activity. While suitable for stringently controlled biological applications, their release into the environment, in concentrations higher than 0.01g/L-1, should be avoided.

Study on the disinfection effect of chlorine dioxide disinfectant (ClO2) on dental unit waterlines and its in vitro safety evaluation

BACKGROUND

Ensuring the safety of dental unit waterlines (DUWLs) has become a pivotal issue in dental care practices, focusing on the health implications for both patients and healthcare providers. The inherent structure and usage conditions of DUWLs contribute to the risk of biofilm formation and bacterial growth, highlighting the need for effective disinfection solutions.The quest for a disinfection method that is both safe for clinical use and effective against pathogens such as Staphylococcus aureus and Escherichia coli in DUWLs underscores the urgency of this research.

MATERIALS

Chlorine dioxide disinfectants at concentrations of 5, 20, and 80 mg/L were used to treat biofilms of S. aureus and E. coli cultured in DUWLs. The disinfection effectiveness was assessed through bacterial counts and culturing. Simultaneously, human skin fibroblast cells were treated with the disinfectant to observe changes in cell morphology and cytotoxicity. Additionally, the study included corrosion tests on various metals (carbon steel, brass, stainless steel, aluminum, etc.).

RESULTS

Experimental results showed that chlorine dioxide disinfectants at concentrations of 20 mg/L and 80 mg/L significantly reduced the bacterial count of S. aureus and E. coli, indicating effective disinfection. In terms of cytotoxicity, higher concentrations were more harmful to cellular safety, but even at 80 mg/L, the cytotoxicity of chlorine dioxide remained within controllable limits. Corrosion tests revealed that chlorine dioxide disinfectants had a certain corrosive effect on carbon steel and brass, and the degree of corrosion increased with the concentration of the disinfectant.

CONCLUSION

After thorough research, we recommend using chlorine dioxide disinfectant at a concentration of 20 mg/L for significantly reducing bacterial biofilms in dental unit waterlines (DUWLs). This concentration also ensures satisfactory cell safety and metal corrosion resistance.

The importance of biofilm contamination control for dental unit waterlines: a multicenter assessment of the microbiota diversity of biofilm in dental unit waterlines

BACKGROUND

The biofilm formation in Dental Unit Waterlines (DUWLs) could become an important cause of infection during dental care, which could put immunocompromised individuals at risk of cross-infection. The aim of this study was to characterize the microbial communities of biofilms among DUWLs using high-throughput sequencing technology.

METHODS

Twenty-nine biofilm samples were obtained from 24 dental chair units at 5 hospitals and 2 dental clinics. The genomic DNA of the samples was extracted, then 16S rDNA and ITS2 gene were amplified and sequenced. Alpha-diversity and Beta-diversity were calculated with QIIME2 and the Kruskal - Wallis H-test was adopted for statistical analysis.

RESULTS

Microbial communities with a high diversity of bacteria (377 genera) and fungi (83 genera) were detected in the biofilm samples. The dominant phylum of bacteria was Proteobacteria (93.27%) and that of fungi was Basidiomycota (68.15%). Potential human pathogens were detected including 7 genera of bacteria (Pseudomonas, Stenotrophomonas, Hafnia-Obesumbacterium, Burkholderia-Caballeronia-Paraburkholderia, Ralstonia, Enterobacter, Klebsiella) and 6 genera of fungi (Malassezia, Candida, Alternaria, Cryptococcus, Rhodotorula, Rhinocladiella).

CONCLUSIONS

This multicenter assessment revealed the infectious risk during dental care. It emphasized the importance of biofilm control due to biofilm accumulation and multiple kinds of opportunistic pathogens in DUWLs.

The Effect of Hydrogen Peroxide Colloidal-Ag Used in Dental Unit Waterline on Shear Bond Strength of Orthodontic Brackets

BACKGROUND

The quality of the water passing through the water lines is crucial to dental procedures. Studies on bracket adhesion of hydrogen peroxide colloidal-Ag, which is widely used to prevent biofilm formation, are limited in the literature.

AIM

To determine whether disinfecting the dental units' waterlines (DUW) with hydrogen peroxide colloidal-Ag has any effect on the shear bond strength (SBS) of orthodontic brackets bonded to enamel.

MATERIALS AND METHODS

Sixty premolar teeth were divided randomly into two groups. The study and control groups consists of 30 teeth that were etched for 30 seconds with 37% phosphoric acid. Study groups washed with hydrogen peroxide colloidal-Ag water and the control group washed with municipal water. Transbond XT adhesive system was used to bond stainless steel brackets on all the teeth. A 300-g force was applied using a tension gauge to ensure a uniform adhesive thickness and light cured with 6 seconds. The SBS was quantified by means of a universal testing machine. The residual adhesive on the enamel surface was evaluated after debonding using the adhesive remnant index (ARI).

RESULTS

The t-test results indicated that there were no significant differences in the SBS. The comparison of the results of ARI scores was found statistically insignificant.

CONCLUSION

It has been found that hydrogen peroxide colloidal-Ag, which is used to reduce the amount of biofilm in DUW, does not have a negative effect on the adhesion of the brackets.

Construction of ZnO/PCL Antibacterial Coating Potentially for Dental Unit Waterlines

The formation of bacterial biofilms and the contamination of treatment water within dental unit waterlines can lead to a risk of secondary bacterial infections in immunocompromised patients. Although chemical disinfectants can reduce the contamination of treatment water, they can also cause corrosion damage to dental unit waterlines. Considering the antibacterial effect of ZnO, a ZnO-containing coating was prepared on the surface of polyurethane waterlines using polycaprolactone (PCL) with a good film-forming capacity. The ZnO-containing PCL coating improved the hydrophobicity of polyurethane waterlines, thus inhibiting the adhesion of bacteria. Moreover, the continuous slow release of Zn ions endowed polyurethane waterlines with antibacterial activity, thus effectively preventing the formation of bacterial biofilms. Meanwhile, the ZnO-containing PCL coating had good biocompatibility. The present study suggests that ZnO-containing PCL coating can realize a long-term antibacterial effect on the polyurethane waterlines by itself, providing a novel strategy for the manufacture of autonomous antibacterial dental unit waterlines.