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DOI: 10.1055/s-0039-1698858
Effects of Hydrogen Peroxide on Dental Unit Biofilms and Treatment Water Contamination
Publication History
Publication Date:
30 September 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042133/201101/lookinside/thumbnails/10-1055-s-0039-1698858_00047-1.jpg)
ABSTRACT
Objectives: To study effects of various concentrations of hydrogen peroxide on mature waterline biofilms and in controlling planktonic (free-floating) organisms in simulated dental treatment water systems; and to study in vitro the effects of 2%, 3%, and 7% hydrogen peroxide on the removal of mature biofilms and inorganic compounds in dental waterlines. Methods: Four units of an automated dental unit water system simulation device was used for 12 weeks. All units were initially cleaned to control biofilms and inorganic deposits. H2O2 at concentrations of 1%, 2%, 3% was used weekly for periodic cleaning in three treatment group units (units 1, 2 & 3), with 0.05%, 0.15% and 0.25% H2O2 in municipal water used as irrigant respectively. The control unit (unit 4) did not have weekly cleanings and used municipal water as irrigant. Laser Scanning Confocal Microscopy and Scanning Electron Microscopy were used to study deposits on lines, and weekly heterotrophic plate counts done to study effluent water contamination. A 24 hour in vitro challenge test with 7%, 3% and 2% H2O2 on mature biofilms was conducted using harvested waterlines to study biofilm and inorganic deposit removal. Results: Heterotrophic plate counts of effluent water showed that the control unit reached contamination levels in excess of 400,000 CFU/mL while all treatment units showed contamination levels <500 CFU/mL through most of the 12 weeks. All treatment units showed varying levels of biofilm and inorganic deposit control in this short 12 week study. The in vitro challenge test showed although there was biofilm control, there was no eradication even when 7% H2O2 was used for 24 hours. Conclusions: 2% H2O2 used as a periodic cleaner, and diluted to 0.05% in municipal water for irrigation was beneficial in controlling biofilm and planktonic contamination in dental unit water systems. However, to remove well established biofilms, it may take more than 2 months when initial and multiple periodic cleanings are performed using H2O2. (Eur J Dent 2011;5:47-59)
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REFERENCES
- 1 Peters E, McGaw W. Dental unit water contamination. J Can Dent Assoc 1996;62:492-495.
- 2 Barbeau J. Multiparametric analysis of waterline contamination in dental units. J Can Dent Assoc 2000;66:539-541.
- 3 Williams HN, Kelly J, Folineo D. Assessing microbial contamination in clean water dental units and compliance with disinfection protocol. J Am Dent Assoc 1994;125:1205-1211.
- 4 Putnins EE, Di Giovanni D, Bhullar AS. Dental unit waterline contamination and its possible implications during periodontal surgery. J Periodontol 2001;72:393-400.
- 5 Fayle SA, Pollard MA: Decontamination of dental unit water system: a review of current recommendations. Br Dent J 1999;181:369-372.
- 6 Williams JF, Johnston AM, Johnson B, Huntington MK, Mackenzie CD. Microbial contamination of dental unit water- lines: prevalence, intensity and microbiological characteristics. J Am Dent Assoc 1993;124:59-65.
- 7 Puttaiah R, Mills SE. Longitudinal pilot study of the efficacy of different treatments on dental unit water systems. 1995 Conference on Pharmaceutical Science and Technology, in Conjunction with the 26 Annual Meeting of the Fine Particle Society. 08/26/1995, Chicago, IL.
- 8 Puttaiah R, Mills SE, Plamondon TJ, Thrash WJ, Cottone JA. A multi-group longitudinal study of dental unit waterline contamination. J Dent Res 1996:75: 414.
- 9 Scarbeck K. Dental unit waterlines - curbing infectious midstream. AGD Impact 1993:21:6-12.
- 10 Lizotte JR, Peters E, Whitehouse R. Influence of biofilms on microbial contamination in dental unit water. J Dent 1991;19:290-295.
- 11 Kim PJ, Cederberg RA, Puttaiah R. A pilot study of 2 methods for control of dental unit biofilms. Quintessence Int 2000;31:41-48.
- 12 Puttaiah R, Lin S, Giletto A, Svoboda KKH. Efficacy of H202 in controlling dental unit water system contamination. Abstract # 0639, AADR 2006 Annual Scientific Session, Orlando, Florida, USA. (http://iadr.confex.com/iadr/2006Orld/ techprogram/abstract_76738.htm) 13. Sawyer DR, Page DG, Sweeney W, Dalton HP. Bacterial contamination and disinfection of the dental handpiece and the water it delivers. Virginia Dent J 1976;53:14-23.
- 14 Fitzgibbon EJ, Bartzokas CA, Martin MV, Gibson MF, Graham R. The source, frequency and extent of bacterial contamination of dental unit water systems. Brit Dent J 1984;157:98-101.
- 15 Neff JH, Rosenthal SL. A possible means of inadvertent transmission of infection to dental patients. J Dent Res 1957;36:932-934.
- 16 Blake GC. The incidence and control of bacterial infection in dental spray reservoirs. Brit Dent J 1963;115:413-416.
- 17 Moriarty JD, Crawford JJ. Evaluation of an independent sterile water reservoir system for highspeed instrumentation. J Dent Res 1976;55: B275.
- 18 Oppenheim BA, Sefton AM, Gill ON, et al. Widespread Legionella pneumophila contamination of dental stations in a dental school without apparent human infection. Epidemiol Infect 1987;99:159-166.
- 19 Pankhurst CL, Philpott-Howard JN, Hewitt JH, Casewell MW. The efficacy of chlorination and filtration in control and eradication of Legionella from dental chair water systems. J Hosp Infect 1990;16:9-18.
- 20 Mills SE, Lauderdale PW, Mayhew RB. Reduction of microbial contamination in dental units with povidone-iodine 10%. J Am Dent Assoc 1986;113:280-284.
- 21 Barbeau J, Buhler T. Biofilms augment the number of free-living amoebae in dental unit waterlines. Res Microbiol 2001;152:753-760.
- 22 Speller DCE, Stephens ME, Viant AC. Hospital infection by Pseudomonas cepacia. Letters to the editor. Lancet 1971;17:798.
- 23 Sorrell WB, White LV. Acute bacterial endocarditis caused by a variant of the genus. Herrella Amer J Clin Path 1953;23:134.
- 24 Basset DCJ, Stokes KJ, Thomas WRC. Wound infection with Pseudomonas multivaorans a water-borne contamination of disinfectant solutions, Letters to the editor. Lancet 1970;6:1188.
- 25 Speller DCE. Colonization of dental units by water bacteria. Brit Dent J 1973;135:189-190.
- 26 Schiff J, Suter LS, Gourley RD. Flavobacterium as a cause of bacterial endocarditis. Ann of Intern Med 1961;55:499- 506.
- 27 Lowry PW, Beck-Sague CM, Bland LA, et al. Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. J Infect Dis 1990;161:85-90.
- 28 Weinberger M, Berg SL, Feuerstein IM, Pizzo PA, Witebsky FG. Disseminated infection with Mycobacterium gordonae: report of a case and critical review of the literature. Clin Infect Dis 1992;14:1229-1239.
- 29 Costrini AM, Mahler DA, Gross WM, et al. Clinical roentgenographic features of nosocomial pulmonary disease due to Mycobacterium xenopi. Am Rev Resp Dis 1981;123:104-109.
- 30 Lowry PW, Jarvis WR, Oberle AD, et al: Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice. N Engl J Med 1988;319:978-982.
- 31 Miller RL, Micik RE, Abel C, Ryge G. Studies on dental aerobiology: II. Microbial splatter discharged from the oral cavity of dental patients. J Dent Res 1971;50:621-625.
- 32 Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc 1994;125:579-584.
- 33 Atlas RM, Williams JF, Huntington MK. Legionella contamination of dental-unit waters. Appl and Environ Microbiol 1995;61:1208-1213.
- 34 Fotos PG, Westfall HN, Snyder IS, Miller RW, Mutchler BM. Prevalence of Legionella-specific IgG and IgM antibody in a dental clinic population. J Dent Res 1985;64:1382-1385.
- 35 Reinthaler FF, Mascher F, Stunzner D. Serological examination for antibodies against Legionella species in dental personnel. J Dent Res 1988;67:942-943.
- 36 Puttaiah R, Cederberg RA. Assessment of endotoxins in dental unit treatment water. J Dent Res 1998;77:263.
- 37 Puttaiah R, Mills SE. Research model addressing policy issues for the dental unit water system. 1995 Conference on Pharmaceutical Science and Technology, in Conjunction with the 26 Annual Meeting of the Fine Particle Society. 08/26/1995, Chicago, IL.
- 38 Fayle SA, Pollard MA. Decontamination of dental unit water systems: A review of current recommendations. Brit Dent J 1996;181:369-72.
- 39 Montebgnoli L, Dolci G. A. Effectiveness of two devices designed to prevent fluid retraction in a high-speed handpiece. J Prosthet Dent 2000;84:225-228.
- 40 Berlutti F, Testarelli L, Vaia F, De Luca M, Dolci G. Efficacy of anti-retraction devices in preventing bacterial contamination of dental unit water lines. J Dent 2003;31:105-110.
- 41 Samaranayke LP, Scheutz F, Cottone J. Infection control for the dental team. Copenhagen Munksgaard 1991:98-99.
- 42 Samaranayke LP. Handpiece and water-line decontamination and HIV transmission: A critique. Dent Update 1993;20:53-56.
- 43 US Department of Health and Human Services, Centers for Disease Control and Prevention: Recommended Infection Control Practices for Dentistry. MMWR 1993, 42:No. RR-8.
- 44 US Department of Health and Human Services, Centers for Disease Control and Prevention: Guidelines for Infection Control in Dental Health-Care Settings. MMWR 2003, 52:No. RR-17.
- 45 Karpay RI, Puttaiah R, Mills SE et al. Efficacy of flushing dental units for different time periods. J Dent Res 1997;76:434.
- 46 Kellet M, Hobrook WP. Bacterial contamination of dental handpieces. J Dent 1980;8:249-253.
- 47 Puttaiah R, Shafer T, Svoboda KKH, Spears R, Heaton M, Lin S, Thomas AC. Evaluation of hydrogen peroxide for dental unit waterline contamination control. Abstract # 1070, AADR 2003 Annual Scientific Session, San Antonio, Texas, USA.
- 48 Blake GC. The incidence and control of bacterial infection in dental spray reservoirs. Brit Dent J 1963;115:413-420.
- 49 Puttaiah E, Cederberg RA, Sargent C, Spears R, Powers D. Efficacy of a CHG irrigant in biofilm and planktonic contamination of dental unit water systems. Abstract # 665, IADR 2000 Annual Scientific Session, Washington DC. Special Issue Vol: 79, p 227.
- 50 Abel IC, Miller RL, et al. Studies on dental aerobiology: IV. Bacterial contamination of water delivered by dental units. J Dent Res 1971;50:1567-1569.
- 51 Plamondon TJ, Mills SE, Sherman LR, Nemeth J, Puttaiah R. Effect of bleach on mature biofilm in dental unit waterlines. J Dent Res 1996;75:414.
- 52 Puttaiah R, Karpay RI, Fabre C, Sherman LR, Nemeth JF, Mills SE, Plamondon TJ. Dental unit waterline treatment with sodium hypochlorite and acetic acid. Microchemical Journal 1998;59:333-340.
- 53 Puttaiah R, Siebert J, Cederberg R, Spears R. Effects of constantly present low-grade iodine on dental unit waterline biofilm and planktonic contamination. Abstract presented at the OSAP Annual Scientific Session, June, 1999, Cincinnati OH, USA.
- 54 Meiller T, Baqui A, DePaola L, Overholser CD. Disinfection of dental unit water lines using Listerine antiseptic. J Dent Res 1995;74:153.
- 55 Meiller TF, Kelley JI, Zhang M, DePaola LG. Efficacy of Adec's ICX dental unit waterline treatment solution in the prevention and treatment of microbial contamination in dental units. J Clin Dent 2004;15:17-22.
- 56 Puttaiah R, Lin S, Lumsden J. Evaluation of a silver citrate dental water decontaminating agent. March 2006, Abstract #0638, AADR, Orlando, Florida, USA. (http://iadr.confex. com/iadr/2006Orld/techprogram/abstract_76640.htm) 57. Puttaiah R, Waggoner MB, Sherman LE, Bryan WR, Kim PJ. Efficacy of citric acid in controlling biofilms in dental unit waterlines. J Dent Res 1998;77:851.
- 58 Puttaiah R, Cederberg R, Wneck R. Efficacy of chlorhexidine in controlling biofilm contamination of dental unit waterlines. J Dent Res 1998;77:262.
- 59 Brett DW. A discussion of silver as an antimicrobial agent: alleviating the confusion. Ostomy Wound Manage 2006;52:34-41.
- 60 Schaller M, Laude J, Bodewaldt H, Hamm G, Korting HC. Toxicity and antimicrobial activity of a hydrocolloid dressing containing silver particles in an ex vivo model of cutaneous infection. Kin Pharmacol Physiol 2004;17:31-36.
- 61 Lansdown AB, Williams A, Chandler S, Benfield S. Silver absorption and antibacterial efficacy of silver dressings. J Wound Care 2005;14:155-160.
- 62 Hashimoto H, Ono N, Monden K, Kumon H, Shiba T, Adachi T, Kaneko K. Basic study on anti-bacterial urethral catheter. II. Potency of a new anti-bacterial catheter and its durability in experimental models. The Journal of the Japanese Association of Infectious Diseases (Kansenshogaku Zasshi) 2000;74:441-449.
- 63 Hashimoto H. Evaluation of the anti-biofilm effect of a new anti-bacterial silver citrate/lecithin coating in an in-vitro experimental system using a modified Robbins device. The Journal of the Japanese Association of Infectious Diseases (Kansenshogaku Zasshi) 2001;75:678-685.
- 64 Puttaiah R, Siebert J, Chen P. Release of disinfection-byproducts during NaOCl use on contaminated dental unit water systems. Annual Meeting of the Organization for Safety and Asepsis Procedures, Providence, RI, abstract #9807; June 18-21, 1998.
- 65 Reasoner DJ, Geldreich EE. A new medium for enumeration and subculture of bacteria from potable water. Appl Environ Microbiol 1985;49:1-7.
- 66 American Water Works Association's “Standard Methods for Examination of Water and Wastewater”, 20th Edition.
- 1998 67. de Carvalho CCCR, da Fonseca MR. Assessment of threedimensional biofilm structure using an optical microscope. Biotechniques 2007;42:616-620.
- 68 Shearer BG. Biofilm and the dental office. J Am Dent Assoc 1996;127:181-189.
- 69 ADA Council of Scientific Affairs. Dental unit waterlines: Approaching the year 2000. J Am Dent Assoc 1999;130:1653- 1664.
- 70 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;132:1287-1291.
- 71 Szymanska J. Antifungal efficacy of hydrogen peroxide in dental unit waterline disinfection. Ann Agric Environ Med 2006;13:313–317.
- 72 Charaf UK. A model biofilm for efficacy assessment of antimicrobials (publication number - WO/2000/077162). World Intellectual Property Organization, International Bureau (http://www.wipo.int/pctdb/images4/PCT-PAGES/ 2000/512000/00077162/00077162.pdf). Lin, Svoboda, Giletto, Seibert, Puttaiah