Top

BMC Oral Health

Published in:

Open Access 01-12-2023 | Pseudomonas Aeruginosa | Research

Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis

Authors: Mojtaba Bayani, Kiyavash Raisolvaezin, Amir Almasi-Hashiani, Seyed Hamed Mirhoseini

Published in: BMC Oral Health | Issue 1/2023

Abstract

Backgrounds

Numerous studies have shown that dental unit water lines (DUWLs) are often contaminated by a wide range of micro-organisms (bacteria, fungi, protozoa) and various prevalence have been reported for it in previous studies. Therefore, this review study aims to describe the prevalence of bacterial biofilm contamination of DUWLs.

Methods

This is a systematic review and meta-analysis in which the related keywords in different international databases, including Medline (via PubMed) and Scopus were searched. The retrieved studies were screened and the required data were extracted from the included studies. Three standard methods including American Dental Association (ADA), The Center for Disease Control and Prevention (CDC) and contaminated > 100 CFU/ml(C-100) standards were used to assess the bacterial biofilm contamination of DUWLs. All studies that calculated the prevalence of bacterial biofilm contamination of DUWLs, and English full-text studies were included in the meta-analysis. Studies that did not have relevant data or used unusual laboratory methods were excluded. Methodological risk of bias was assessed by a related checklist and finally, the data were pooled by fixed or random-effect models.

Results

Seven hundred and thirty-six studies were identified and screened and 26 related studies were included in the meta-analysis. The oldest included study was published in 1976 and the most recent study was published in 2020. According to the ADA, CDC and C-100 standards, the prevalence of bacterial contamination was estimated to be 85.0% (95% confidence interval (CI): 66.0–94.0%), 77.0% (95%CI: 66.0–85.0%) and 69.0% (95%CI: 67.0–71.0%), respectively. The prevalence of Legionella Pneumophila and Pseudomonas Aeruginosa in DUWLs was estimated to be 12.0% (95%CI: 10.0–14.0%) and 8.0% (95%CI: 2.0–24.0%), respectively.

Conclusion

The results of this review study suggested a high prevalence of bacterial biofilm in DUWLs; therefore, the use of appropriate disinfecting protocol is recommended to reduce the prevalence of contamination and reduce the probable cross-infection.

Available only for authorised users

O’Donnell MJ, Tuttlebee CM, Falkiner FR, Coleman DC. Bacterial contamination of dental chair units in a modern dental hospital caused by leakage from suction system hoses containing extensive biofilm. J Hosp Infect. 2005;59(4):348–60. https://doi.org/10.1016/j.jhin.2004.10.001. Epub 2005/03/08 PubMed PMID: 15749324.CrossRefPubMed

Ireland R. Clinical textbook of dental hygiene and therapy. 2013.

Siegel SC, von Fraunhofer JA. The effect of handpiece spray patterns on cutting efficiency. J Am Dental Assoc. 2002;133(2):184–8. https://doi.org/10.14219/jada.archive.2002.0142. Epub 2002/03/02 PubMed PMID: 11871401.CrossRef

Barbeau J, Buhler T. Biofilms augment the number of free-living amoebae in dental unit waterlines. Res Microbiol. 2001;152(8):753–60. https://doi.org/10.1016/s0923-2508(01)01256-6. Epub 2001/11/01 PubMed PMID: 11686389.CrossRefPubMed

Hughes G, North J, Walker J, Sharp R. Biofilms, bacteriophage interactions and bacteriophage therapy. Bioline 2001:325–32.

Walker JT, Marsh PD. Microbial biofilm formation in DUWS and their control using disinfectants. J Dent. 2007;35(9):721–30. https://doi.org/10.1016/j.jdent.2007.07.005.CrossRefPubMed

Zhang K, Li X, Yu C, Wang Y. Promising Therapeutic Strategies Against Microbial Biofilm Challenges. Front Cellul Infect Microbiol. 2020;10:359. https://doi.org/10.3389/fcimb.2020.00359.CrossRef

Blake G. The Incidence and Control of Bacterial Infection in Dental Spray Reservoirs. Brit Dent J. 1963;115(10):413–6.

Putnins EE, Di Giovanni D, Bhullar AS. Dental unit waterline contamination and its possible implications during periodontal surgery. J Periodontol. 2001;72(3):393–400. https://doi.org/10.1902/jop.2001.72.3.393. Epub 2001/05/01 PubMed PMID: 11327068.CrossRefPubMed

10.

Meiller TF, Kelley JI, Baqui AA, DePaola LG. Disinfection of dental unit waterlines with an oral antiseptic. J Clin Dent. 2000;11(1):11–5 Epub 2001/07/20 PubMed PMID: 11460287.PubMed

11.

Spagnolo AM, Sartini M, Cristina ML. Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review. Pathogens. 2020;9(8):651. https://doi.org/10.3390/pathogens9080651. PubMed PMID.CrossRefPubMedPubMedCentral

12.

Salam N, Mulamoottil V, George B. Assessment of Microbial Contamination in Dental-Unit Water Lines: An Analytical Study. J Indian Assoc Public Health Dent. 2017;15(1):97–101. https://doi.org/10.4103/2319-5932.201925.CrossRef

13.

Wirthlin MR, Marshall GW Jr, Rowland RW. Formation and decontamination of biofilms in dental unit waterlines. J Periodontol. 2003;74(11):1595–609. https://doi.org/10.1902/jop.2003.74.11.1595. PubMed PMID: 14682656.CrossRefPubMed

14.

Lee TK, Waked EJ, Wolinsky LE, Mito RS, Danielson RE. Controlling biofilm and microbial contamination in dental unit waterlines. J Calif Dent Assoc. 2001;29(9):679–84 Epub 2001/10/24 PubMed PMID: 11668730.PubMedCrossRef

15.

Gawish S, Abbass A, Abaza A. Occurrence and biofilm forming ability of Pseudomonas aeruginosa in the water output of dental unit waterlines in a dental center in Alexandria. Egypt Germs. 2019;9(2):71.PubMedCrossRef

16.

Coleman D, O’Donnell M, Shore A, Russell R. Biofilm problems in dental unit water systems and its practical control. J Appl Microbiol. 2009;106(5):1424–37.PubMedCrossRef

17.

Veena H, Mahantesha S, Joseph PA, Patil SR, Patil SH. Dissemination of aerosol and splatter during ultrasonic scaling: a pilot study. J Infect Public Health. 2015;8(3):260–5.PubMedCrossRef

18.

Watanabe A, Tamaki N, Yokota K, Matsuyama M, Kokeguchi S. Use of ATP bioluminescence to survey the spread of aerosol and splatter during dental treatments. J Hosp Infect. 2018;99(3):303–5.PubMedCrossRef

19.

Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS ONE. 2017;12(5):e0178007.PubMedPubMedCentralCrossRef

20.

Holt SC, Ebersole JL. Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia: the ‘red complex’, a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000. 2005;38(1):72–122.PubMedCrossRef

21.

Wade WG. The oral microbiome in health and disease. Pharmacol Res. 2013;69(1):137–43.PubMedCrossRef

22.

Badri M, Olfatifar M, Abdoli A, Houshmand E, Zarabadipour M, Abadi PA, et al. Current Global Status and the Epidemiology of Entamoeba gingivalis in Humans: A Systematic Review and Meta-analysis. Acta Parasitol. 2021;66(4):1102–13. https://doi.org/10.1007/s11686-021-00423-2.CrossRefPubMed

23.

Sedghi L, DiMassa V, Harrington A, Lynch SV, Kapila YL. The oral microbiome: Role of key organisms and complex networks in oral health and disease. Periodontol 2000. 2021;87(1):107–31. https://doi.org/10.1111/prd.12393.CrossRefPubMedPubMedCentral

24.

Atarashi K, Suda W, Luo C, Kawaguchi T, Motoo I, Narushima S, et al. Ectopic colonization of oral bacteria in the intestine drives TH1 cell induction and inflammation. Science. 2017;358(6361):359–65.PubMedPubMedCentralCrossRef

25.

Baker JL, Edlund A. Exploiting the oral microbiome to prevent tooth decay: has evolution already provided the best tools? Front Microbiol. 2019;9:3323.PubMedPubMedCentralCrossRef

26.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9, w64 Epub 2009/07/23. PubMed PMID: 19622511.PubMedCrossRef

27.

O’Donnell MJ, Boyle M, Swan J, Russell RJ, Coleman DC. A centralised, automated dental hospital water quality and biofilm management system using neutral Ecasol maintains dental unit waterline output at better than potable quality: a 2-year longitudinal study. J Dent. 2009;37(10):748–62. https://doi.org/10.1016/j.jdent.2009.06.001. Epub 2009/07/04 PubMed PMID: 19573971.CrossRefPubMed

28.

Spagnolo AM, Sartini M, Cristina ML. Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review. Pathogens (Basel, Switzerland). 2020;9(8):651. https://doi.org/10.3390/pathogens9080651. PubMed PMID: 32823641; PubMed Central PMCID: PMCPMC7460066.CrossRefPubMed

29.

Bain R, Cronk R, Wright J, Yang H, Slaymaker T, Bartram J. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med. 2014;11(5):e1001644. https://doi.org/10.1371/journal.pmed.1001644. Epub 2014/05/08 PubMed PMID: 24800926; PubMed Central PMCID: PMCPMC4011876 and indicators for enhanced global monitoring of drinking-water post-2015 which commissioned the systematic review to inform its deliberations. JB is a member of the expert working group and is an unpaid advisor to both WHO and UNICEF.CrossRefPubMedPubMedCentral

30.

Harbord R, Harris RJ, Sterne JA, Steichen T. METABIAS: Stata module to test for small-study effects in meta-analysis. Statistical Software Components S404901, Boston College Department of Economics, revised 07 Dec 2010. 2009.

31.

Nyaga V. METAPREG: Stata module to compute fixed and random effects meta-analysis and meta-regression of proportions. Statistical Software Components S458693, Boston College Department of Economics, revised 26 Apr 2022. 2022.

32.

Gross A, Devine MJ, Cutright DE. Microbial contamination of dental units and ultrasonic scalers. J Periodontol. 1976;47(11):670–3.PubMedCrossRef

33.

Williams JF, Johnston AM, Johnson B, Huntington MK, Mackenzie CD. Microbial contamination of dental unit waterlines: prevalence, intensity and microbiological characteristics. J Am Dent Assoc (1939). 1993;124(10):59–65.CrossRef

34.

Walker JT, Bradshaw DJ, Bennett AM, Fulford MR, Martin MV, Marsh PD. Microbial biofilm formation and contamination of dental-unit water systems in general dental practice. Appl Environ Microbiol. 2000;66(8):3363–7. https://doi.org/10.1128/aem.66.8.3363-3367.2000. Epub 2000/08/05 PubMed PMID: 10919792; PubMed Central PMCID: PMCPMC92156.CrossRefPubMedPubMedCentral

35.

Cobb CM, Martel CR, McKnight SA III, Pasley-Mowry C, Ferguson BL, Williams K. How Does Time-Dependent Dental Unit Waterline Flushing Affect Planktonic Bacteria Levels? J Dent Educ. 2002;66(4):549–55.PubMedCrossRef

36.

Souza-Gugelmin MC, Lima CD, Lima SN, Mian H, Ito IY. Microbial contamination in dental unit waterlines. Braz Dent J. 2003;14(1):55–7. https://doi.org/10.1590/S0103-64402003000100010.CrossRefPubMed

37.

Araujo R, Contreras H. Microbiological contamination of dental unit water systems in general practices from Barcelona (Spain). Water Sci Technol Water Supply. 2004;4(2):1–5. https://doi.org/10.2166/ws.2004.0020.CrossRef

38.

Walker JT, Bradshaw DJ, Finney M, Fulford MR, Frandsen E, ØStergaard E, et al. Microbiological evaluation of dental unit water systems in general dental practice in Europe. Eur J Oral Sci. 2004;112(5):412–8 Epub 2004/10/02 PubMed PMID: 15458499.PubMedCrossRef

39.

Walker RJ, Burke FT, Miller CH, Palenik CJ. An investigation of the microbial contamination of dental unit air and water lines. Int Dent J. 2004;54(6):438–44.PubMedCrossRef

40.

Göksay D, Çotuk A, Zeybek Z. Microbial contamination of dental unit waterlines in Istanbul Turkey. Environ Monit Assess. 2008;147(1):265–9.PubMedCrossRef

41.

Dahlén G, Alenäs-Jarl E, Hjort G. Water quality in water lines of dental units in the public dental health service in Göteborg Sweden. Swed Dent J. 2009;33(4):161–72.PubMed

42.

Nikaeen M, Hatamzadeh M, Sabzevari Z, Zareh O. Microbial quality of water in dental unit waterlines. J Res Med Sci. 2009;14(5):297.PubMedPubMedCentral

43.

Türetgen I, Göksay D, Cotuk A. Comparison of the microbial load of incoming and distal outlet waters from dental unit water systems in Istanbul. Environ Monit Assess. 2009;158(1):9–14.PubMedCrossRef

44.

Pasquarella C, Veronesi L, Napoli C, Castiglia P, Liguori G, Rizzetto R, et al. Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values. Sci Total Environ. 2012;420:289–99.PubMedCrossRef

45.

Siang MM, Yunus Z, Yunus ARM, Ahmad Z, Toosa H. The microbiological quality of water from dental unit waterlines in Malaysian Armed Forces dental centres. Arch Orofac Sci. 2012;7(1):1–7.

46.

Dobaradaran S, Nabipour I, Ramavandi B, Zazouli MA, Tahmasebi R, Ghaedi H, et al. Microbial contamination of dental unit waterlines in Bushehr. Iran Fresenius Environmental Bulletin. 2014;23(4):1000–5.

47.

Güngör ND, Kadaifçiler DG, Peker OÖ. Investigation of the bacterial load and antibiotic susceptibility of dental units. Environ Monit Assess. 2014;186(3):1847–53.PubMedCrossRef

48.

Kadaifciler DG, Cotuk A. Microbial contamination of dental unit waterlines and effect on quality of indoor air. Environ Monit Assess. 2014;186(6):3431–44.PubMedCrossRef

49.

Lisboa GM, Lisboa YR, Pinheiro TM, Stegun RC, da Silva-Filho EA. Microbial diversity in dental unit waterlines. Acta Odontol Latinoam. 2014;27(3):110–4.PubMed

50.

Leoni E, Dallolio L, Stagni F, Sanna T, D’Alessandro G, Piana G. Impact of a risk management plan on Legionella contamination of dental unit water. Int J Environ Res Public Health. 2015;12(3):2344–58.PubMedPubMedCentralCrossRef

51.

Lal B, Ravindra K, Biswal M. Appraisal of microbial contamination of dental unit water systems and practices of general dental practitioners for risk reduction. Environ Sci Pollut Res. 2018;25(33):33566–72.CrossRef

52.

Zhang Y, Ping Y, Zhou R, Wang J, Zhang G. High throughput sequencing-based analysis of microbial diversity in dental unit waterlines supports the importance of providing safe water for clinical use. J Infect Public Health. 2018;11(3):357–63.PubMedCrossRef

53.

Ji X-Y, Fei C-N, Zhang Y, Liu J, Liu H, Song J. Three key factors influencing the bacterial contamination of dental unit waterlines: a 6-year survey from 2012 to 2017. Int Dent J. 2019;69(3):192–9.PubMedCrossRef

54.

Spagnolo AM, Sartini M, Di Cave D, Casini B, Tuvo B, Cristina ML. Evaluation of microbiological and free-living protozoa contamination in dental unit waterlines. Int J Environ Res Public Health. 2019;16(15):2648.PubMedPubMedCentralCrossRef

55.

Volgenant C, Persoon I. Microbial water quality management of dental unit water lines at a dental school. J Hosp Infect. 2019;103(1):e115–7.PubMedCrossRef

56.

Castellano Realpe OJ, Gutiérrez JC, Sierra DA, Pazmino Martinez LA, Prado Palacios YY, Echeverría G, et al. Dental Unit Waterlines in Quito and Caracas contaminated with Nontuberculous Mycobacteria: A potential health risk in dental practice. Int J Environ Res Public Health. 2020;17(7):2348.PubMedPubMedCentralCrossRef

57.

Agahi RH, Hashemipour MA, Kalantari M, Ayatollah-Mosavi A, Aghassi H, Nassab AHG. Effect of 0.2% chlorhexidine on microbial and fungal contamination of dental unit waterlines. Dent Res J. 2014;11(3):351.

58.

Linger JB, Molinari JA, Forbes WC, Farthing CF, Winget WJ. Evaluation of a hydrogen peroxide disinfectant for dental unit waterlines. J Am Dent Assoc. 2001;132(9):1287–91.PubMedCrossRef

59.

Smith A, Bagg J, Hood J. Use of chlorine dioxide to disinfect dental unit waterlines. J Hosp Infect. 2001;49(4):285–8.PubMedCrossRef

60.

Wu M, Shi Z, Yu X, Xu Y, Jin X, Zhang L, et al. Disinfection methods of dental unit waterlines contamination: a systematic review. J Med Microbiol. 2022;71(6):001540.CrossRef

61.

Alkhulaifi MM, Alotaibi DH, Alajlan H, Binshoail T. Assessment of nosocomial bacterial contamination in dental unit waterlines: Impact of flushing. Saudi Dent J. 2020;32(2):68–73. https://doi.org/10.1016/j.sdentj.2019.07.003. Epub 2020/02/20 PubMed PMID: 32071534; PubMed Central PMCID: PMCPMC7016225.CrossRefPubMed

62.

Singh V, Nagaraja C, Hungund SA. A study of different modes of disinfection and their effect on bacterial load in dental unit waterlines. Eur J Gen Dent. 2013;2(03):246–51.CrossRef

63.

Uzel A, Cogulu D, Oncag O. Microbiological evaluation and antibiotic susceptibility of dental unit water systems in general dental practice. Int J Dent Hyg. 2008;6(1):43–7. https://doi.org/10.1111/j.1601-5037.2007.00269.x. Epub 2008/01/22 PubMed PMID: 18205653.CrossRefPubMed

64.

Fulford MR, Walker JT, Martin MV, Marsh PD. Total viable counts, ATP, and endotoxin levels as potential markers of microbial contamination of dental unit water systems. Br Dent J. 2004;196(3):157–9; discussion 3. https://doi.org/10.1038/sj.bdj.4810943. Epub 2004/02/14 PubMed PMID: 14963441.CrossRefPubMed

65.

Singh R, Stine OC, Smith DL, Spitznagel JK Jr, Labib ME, Williams HN. Microbial diversity of biofilms in dental unit water systems. Appl Environ Microbiol. 2003;69(6):3412–20. https://doi.org/10.1128/aem.69.6.3412-3420.2003. Epub 2003/06/06 PubMed PMID: 12788744; PubMed Central PMCID: PMCPMC161485.CrossRefPubMedPubMedCentral

Title: Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis
Authors: Mojtaba Bayani
Kiyavash Raisolvaezin
Amir Almasi-Hashiani
Seyed Hamed Mirhoseini
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Pseudomonas Aeruginosa
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-02885-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis

Abstract

Backgrounds

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Backgrounds

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

The effect of different ferrule heights and crown-to-root ratios on fracture resistance of endodontically-treated mandibular premolars restored with fiber post or cast metal post system: an in vitro study

Comparative evaluation of open tray impression technique: investigating the precision of four splinting materials in multiple implants

Diagnostic value of cervical vertebral maturation stages for midpalatal suture maturation assessment: a study in the Chinese population

The use of mouthguards and related factors among basketball players in Indonesia

The global prevalence of oral leukoplakia: a systematic review and meta-analysis from 1996 to 2022

Efficacy of curcumin gel as an adjunct to scaling and root planing on salivary procalcitonin level in the treatment of patients with chronic periodontitis: a randomized controlled clinical trial