Impact of Chlorine Dioxide on Pathogenic Waterborne Microorganisms Occurring in Dental Chair Units

Different Disinfection Strategies in Bacterial and Biofilm Contamination on Dental Unit Waterlines: A Systematic Review

OBJECTIVE

The aim of this systematic review is to explore the effectiveness of different methods of reducing contamination and biofilms in dental unit waterlines (DUWLs) and to provide reference for future standardisation of disinfection practices in dental clinic.

METHODS

This systematic review searched PubMed and Web of Science databases for DUWL disinfection studies from 2013 to 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Synthesis Without Meta-analysis, additional extracting relevant data based on predefined inclusion and exclusion criteria.

RESULTS

The study review identified 8442 articles, with 58 included after rigorous screening. Disinfection methods for DUWLs were categorised into 14 physical and 90 chemical methods. Peroxides, chloramine-based, and biguanide methods were frequently used, often in combination. The effectiveness of these methods varied; for instance, phenolic was effective, while alcohol was not, in reducing bacterial and biofilm contamination. Biguanide, when used alone or combined with chlorine-based or alcohol, showed mixed results. Chlorine-based methods, particularly when combined with quaternary ammonium salt or enzymes, were generally effective. Enzymes and iodophor also demonstrated efficacy, though with some inconsistencies. Mechanical systems, peroxides, quaternary ammonium salts, silver, and tube coatings had varying degrees of success. Other innovative methods, such as Aloe vera and slightly acidic electrolysed water, showed promise in some studies, but the effectiveness of flushing was questioned. This comprehensive analysis highlights the diversity and complexity of disinfection strategies for DUWLs.

CONCLUSION

Future studies should focus on how material composition and tubing design affect biofilm development and the effectiveness of disinfection methods to guide the design of advanced dental units.

Method to Generate Chlorine Dioxide Gas In Situ for Sterilization of Automated Incubators

Pharmaceutical preclinical tests using cell cultures are nowadays commonly automated. Incubator microbial contaminations impact such tests. Chlorine dioxide (ClO2) is widely used in aqueous solutions. However, a gaseous form, such as chlorine dioxide gas (gClO2), can effectively access unreachable spaces, such as closed cell culture incubators. Steam sterilization requires a temperature rise to at least 121 °C, thus limiting the possibility of automation elements for sensors and actuators. gClO2 sterilization is an ambient-temperature sterilization method. This article aims to demonstrate that gClO2 generated from solid powder tablets is efficient for sterilizing incubators and can be automated. We selected (i) Bacillus subtilis strain, (ii) Saccharomyces cerevisiae, and (iii) T7 phages as representatives for (i) bacteria, (ii) fungi, and (iii) viruses for each domain to evaluate the sterilization efficiency. This study demonstrated that gClO2 can be generated inside the incubator from a solid powder tablet without specific equipment and can effectively fight biological proxies in 15 min. After 30 sterilization cycles, the actuators and sensors mounted inside the incubator were still operating. Our proposed sterilization method seems to be generally applicable for automated in situ sterilization of incubators and medical robots.

Chlorine dioxide is a broad-spectrum disinfectant against Shiga toxin-producing Escherichia coli and Listeria monocytogenes in agricultural water

Agricultural water is commonly treated with chlorine-based disinfectants, which are impacted by water quality. Understanding how water quality influences disinfectants such as chlorine dioxide (ClO2) against pathogenic bacteria is important for creating efficacious sanitation regimens. In this study, the minimum inhibitory concentration (MIC) of ClO2 needed to achieve a 3-Log reduction against Shiga toxin-producing Escherichia coli (STEC) and Listeria monocytogenes was compared across agricultural water samples. Sterile ddH2O served as a control to compare with environmental samples from Salinas Valley, CA, and laboratory standards. To test different dosages and water qualities, stock ClO2 was diluted in 24-well plates with target concentrations of 10, 5, 2.5, and 1.25 mg/L. Well plates were inoculated with pathogens and treated with sanitizer for 5 min. Following treatment, surviving pathogens were enumerated using viable cell counts. The results demonstrate that groundwater samples had the highest water quality of the environmental samples and required the lowest concentration of disinfectant to achieve 3-Log reduction against both bacteria, with MIC between 1.4 and 2.0 mg/L. Open-source samples had lower water quality and required a higher concentration of ClO2 for 3-Log reduction, with MIC between 2.8 and 5.8 mg/L for both pathogens. There was no correlation between pH, turbidity, or conductivity/TDS and reduction for either STEC or L. monocytogenes, suggesting no individual water metric was driving reduction. A lower dosage was required to achieve 3-Log reduction against STEC, while L. monocytogenes required greater concentrations to achieve the same level of reduction. Overall, these results help guide growers in using ClO2 as a broad-spectrum disinfectant and demonstrate its efficacy in reaching 3-Log reduction across agricultural water samples.

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.

Effective disinfecting of negative pressure pipelines of DCUs reduces the risk of cross infection in dental care

Objectives

Microbial contamination of various accessory parts of the dental chair units (DCUs) is an essential source of cross infection, while the accessories of the crucial suction function are usually overlooked. In this study, we aim to find an effective disinfectant and a cost-effective method to remove bacterioplankton and bacterial biofilm deposited in the negative pressure suction pipelines to control cross infection during dental treatment.

Methods

Double-chain quaternary ammonium salt disinfectant (Orotol Plus®), 3% hydrogen peroxide solution plus multi-enzyme cleaning agent and chlorine disinfectant are used to clean and disinfect the negative pressure pipelines of DCUs. Microbiological examinations, air condition detection, corrosion tests and gene sequencing are performed.

Results

Little bacteria grow in the pipelines disinfected with double-chain quaternary ammonium salt disinfectants, destruction of biofilms in these pipelines appears, and multi-resistant bacteria cannot be detected. Minimal damage to metal sheets and fittings is caused by double-chain quaternary ammonium salt disinfectants.

Conclusion

Double-chain quaternary ammonium salt disinfectant has excellent bactericidal ability and anti-biofilm effect, and it is less corrosive to the fittings of the pipelines. Thus, the double-chain quaternary ammonium salt disinfectant is a potential novel disinfectant for negative pressure suction pipelines of DCUs to control cross infection during dental treatment.

Clinical significance

It is essential to add all these data to our dental practice to control cross infection with a broader landscape.