1. Bio- Film

2. INTRODUCTION
A lot of stress is given today towards infection control in Dental Practice. This change was after the AIDS pandemic and we dealing with vectors such as blood and saliva.
Recently concerns have been raised about bacterial growth which form Biofilms in slowly moving waterlines in the Dental chair and water in such waterlines is being considered as the third vector.

3. Biofilms are microbial communities on submerged surfaces in aqueous environment usually found in flowing systems.
Described by Coghlan(1996) as “Slime City”
In the dental units first reported in 1963 in Great Britain by Dr.G.C.Blake

4. There are two Dental unit waterlines:1.
MAIN RESOVOIR
BASIN JUNCTION BLOCK
SPITUNE TUMBLER SUCTION BOTTLE
TROLLY JUNCTION BLOCK 2.
BOOSTER BOTTLE
RETRACTION VALVE
THREE WAY SYRINGE
AEROTER

5. Biology Physics Geometry
Dental unit waterlines have a Complex Design and water provides moist Environment for the formation of Biofilms.
Biology Physics Geometry
Surface colonization
Flow
Larger surface area.
I just cant go with the flow anymore!
Thinking of joining the biofilm

6. Why should we care about biofilms

7. A range of opportunistic pathogens have been reported to be associated with dental unit water systems causing nosocomial infections in dental patients.
Concerns have been raised not only for the patients but also about the safety of dental health care workers.

8. Case Report
Increased seropositive response to anti- legionella in dental workers, fatal leigionellosis in dentist in California.

9. To assess the bacterial contamination of dental unit water system in dental clinics and dental institutions in Mysore.
To assess the knowledge and practices of dentists regarding contamination of waterlines.
AIMS AND OBJECTIVES

10. MATERIAL AND METHODS
As per random sampling, one Dental Institution and fifty private clinics, in Mysore city were selected for the study.
Data on the awareness about the contamination of waterlines was collected with the help of questionnaire distributed among 58 Dentists, among which 50 were private practioners and 8 were Head of each Departments in the Dental Institution.
Questionnaire

11. The questions were related to practices regarding contamination and maintenance of the DUWL.
Also prior permission was obtained from the dental practioners and concerned authorities.

12. Collection of water samples:
16 water samples were collected 8 from the Dental Institution i.e. 1 from each Dental Department and 8 from private Clinic Dental unit waterlines.
As per laboratory guidelines about 100ml of water was collected from air water syringes of the dental units in the morning hours after flushing the water for 20 sec and stored in sterile bottles containing 18mg of sodium thiosulphate which neutralized the effect of residual chlorine.

13. Within an hour following collection, samples were centrifuged at 4000 rpm for 5 min and were serially diluted 10 fold and plated on agar culture media for quantitative analysis.
Samples were analyzed in Ganesh water analysis Laboratory in Mysore city

14. Results were analyzed using SPSS software
Results were analyzed using SPSS software. Statistical methods used were:
Cross tabs procedure (Contingency coefficient test)
Descriptive statistics
Independent samples ‘t’ test
STATISTICAL ANALYSIS

15. RESULTS

16. Response in percentage according to type of water used in Dental unit waterlines

17. Percentage of population carrying out periodic cleaning

18. Response in percentage according to frequency of cleaning the waterlines

19. Response in Percentage towards periodic assessment for contamination of the dental unit waterlines

20. Percentage of response towards training and education for maintenance of Dental unit waterlines

21. Related Questions
Response Related Questions Response
TYPE OF WATER USED
Tap water
Private Practioners
Dental Institution
Softened
Distilled
PERIODIC ASSESSMENT % Y
52%
58%
12% NECESSARY %-N
19%
29%
PERIODIC CLEANING
FREQUENCY
Once
Everyday
47%-y CONTINUED TRAINING AND % Agreed
53%-n EDUCATION % Disagreed
NECESSARY
67%
33%

22. ADA(1996)
dental water should contain no more than 200 CFU/ml of heterotrophic bacteria in unfiltered output.

23. BACTERIAL COUNT CFU/ML IN DENTAL INSTITUTION

24. BACTERIAL COUNT CFU/ML IN DENTAL INSTITUTION AND PRIVATE CLINICS.

25. Discussion:
Bacterial Contamination of water delivered by Dental air –water syringe is a universal problem for Dental units.

26. This study shows that there is lack of awareness about contamination of Dental unit waterlines among dentists in Mysore city.
The Dentists in the Dental Institutions are aware of the contamination of the waterlines although are not practicing any contamination control measures.

27. When water samples were subjected to Bacterial count estimation we found that on an average all the water samples had high level of bacterial count. Most of them were gram negative heterotrophic aerobic organisms all counts exceeding the ADA recommendations.
This is similar to the studies conducted by Dr. Edward E. Putnins, University of British Columbia where he examined 9 dental units and 95% of units exceeded ADA standards.

28. A study was conducted by Richard. R. Carpey et al
A study was conducted by Richard .R.Carpey et al.They found that by using separate water systems as well as by performing a weekly 1:10 sodium hypochlorite treatment with 10 minutes of contact time followed by the use of softened water, it is possible to achieve desired results.

29. CONCLUSION:
This study therefore shows the need to to create more awareness about contamination control measures and techniques among Dentists regarding the Dental unit waterlines.

30. Suggestions: For Dentists Usage of sterile water.
Flushing of waterlines daily before and after Dental treatments and sec between patients
Periodic chemical treatment

31. 6.Having training and education regarding proper usage and operation of Dental Machinery.
7.Moniter scientific and technological developments in this area.

32. MANUFACTURERS
Manufacturing company to develop methods to control biofilms in DUWLs.
1.To install and maintain antiretraction valves of better quality to prevent fluids from being withdrawn in DUWLs
2.Research for better sterile solutions. Recently Use of silver ions solution to paint the waterlines.

33. RESEARCH 1.To define the natural history of biofilms.
2.Alternative devices for monitoring the microbial quality of water.

34. “Soon, one of your patients will ask about your water disinfection protocol, and you will want to proudly tell him or her exactly what it is.”

35. REFERENCES:
1.Dr.Poonam Bogra,Dr.N,aveen Gupta,Dr.Sameer Makkar.Biofilms in Dental Unit Waterlines.A Review.JIDA
2.Richard et al.The Dental unit waterline controversy;defusing the myths,defining the solutions.J.Am.Dent.Asso.131: ,2000.
3.Shearer B.G:Biofilm and the dental office.J.Am.Dent.Assos.127:181-89,1996.

36. 4.Fayle S.A,Pollard M.A:Decontamination of Dental unit water systems:a review of current recommendations.Br Dent J.181:369-72,1996.
5.Is mouth rinsing before dental procedures worthwhile. J.Am.Dent.Assos.123:75-80,1992.
6.Walker JT.Microbial evaluation of Dental Unit Water systems in General dental practice in Europe.Eur J Oral Sci.112: ,2004.

37. Thank you