>On immunocompromised individuals and their susceptibility to infections from contaminated dental unit waterlines."It's just not prudent public health practice to expose patients during dental treatment to water that wouldn't pass standards for swimming pool water."
Symposium sound bytes - Notable quotes from the 1998 OSAP Annual Symposium - Jennifer Cleveland Center for Disease Control and Prevention (CDC).
"...Populations at risk of opportunistic infections include HlV-positive individuals, the immune-suppressed (i.e., organ-transplant or cancer patients), diabetics, smokers, alcoholics, the elderly, and persons with other chronic organic disorders."
Gomolka, K. lmproving dental-unit water quality: 'Research & developments' in controlling biofilms. Dental Products Report. pp: 115-118. September 1997.
"It is deemed ethically unacceptable to knowingly expose patients to contaminated water..."
Pankhurst, C. and Johnson N. Microbial contamination of dental unit waterlines: the scientific argument*. International Dental Journal. 48, pp: 359-368. 1998. *Initiated by and report approved by the FDI Commission.
"In patient populations we are finding increasing numbers of patients with diminished resistance to overt and opportunistic pathogens. This population includes some persons with HIV infection but also elderly people, smokers, alcoholics, organ transplant and cancer patients, diabetics, and persons with other chronic organic disorders."
Gomolka, K. OSAP '96: Improving dental unit water quality. Part II. Dental Products Report. pp: 103-107. September 1996.
"the presence of high concentrations of opportunistic pathogens in DUWL and increasing numbers of immunocompromised people in the population increases the potential for disease transmission. Those who may be at risk include the elderly, pregnant women, smokers, people with HIV or AIDS, organ transplant recipients, people who have had radiation therapy and people taking immunosuppressive medications."
Karpay, R., Plamondon, T., Mills, S. and Dove, B. Validation of an in-office dental unit water monitoring technique. JADA. 129, pp: 207-211. February 1998.
"Pseudomonas aeruginosa was transferred from the (dental) unit to the patient in all cases."
Martin, M.V., The significance of the bacterial contamination of dental unit water Systems Dental Journal. pp: 152-153. September 1987
"Pseudomonas aeruginosa strains were found both in water from the dental equipment and in the CF (cystic fibrosis) patients' sputum."
Jensen, E.T., Giwercman, B., Ojeniyi, B., Bangsborgl, Hansen, A.§, Koch, C.§, Fiehn, N.-E. l, and Hoiby. Epidemiology of pseudomonas aeruginosa in cystic fibrosis and the possible role of contamination by dental equipment. Journal of Hospital Infection. 36. pp: 117-121. 1997.
"Based on the findings from our study, we concluded that a statistically significant decrease in lung function was observed in subjects with a history of active asthma after undergoing dental treatment."
Mathew, T. et. al. Effect of dental treatment on the lung function of children with asthma. JADA. 129, pp: 1120-1128. August 1998.
"If one of your patients becomes ill as a result of exposure to a pathogen or bacteria that is later found in your dental unit water, you are at risk of being held responsible for your patient's illness and associated compensatory damages."
Crane, M., Finn, L. and Wojcicki, P. What you need to know to minimize vour liability risk. Dental Malpractice Prevention. Vol. 1, No. 2. pp: 2-3. April 1997.
>Conditions of at risk patients which make them more susceptible to infection from contaminated dental water* >
AIDS
Children
Drug Therapy
Immunosuppressive Medication
HeartConditions Pregnancy
Cystic Fibrosis
Radiation therapy
Cancer
Diabetes
Lupus
Asthma
Elderly
Organ Transplants
Chemotherapy
Life threatening diseases
Leukemia
Tuberculosis (Tb)
Systemic diseases
Smoking
Alcoholism
Organisms found in unfiltered dental water that attack weakened immune systems*
BACTERIA FUNGI PROTOZOA · Acinetobacter
· Mycobacterium avium
· Actinomyces
· Nocardia spp.
· Flavobacterium
· Alcaligenes
· Pasteurella spp.
· Bacteroides
· Peptostreptococcus
· Caulobacter
· Pseudomonas aeruginosa
· Moraxella spp.
· Klebsiella pneumoniae
· Pseudomonas cepacia
· Proteus vulgaris
· Lactobacillus
· Salmonella typhimurium
· Legionella
· Streptococcus spp.
· Penicillium
-Cladosporium
· Alternaria
· Scopulariopsis
· Acanthamoeba
· Cryptosporidium
· Microsporidium
· Giardia
*Williams. J.. Molinari. J.. Andrews. N. Microbial Contamination of Dental Unit Waterlines: Origins and Characteristics. Compendium, vol. 17:6 pp538-557. June 1996.
>>Frequently Asked Questions on HIV/AIDS and Dental Unit Water Line Problems
(Q) What are the principal concerns regarding AIDS patients receiving dental care?
(A) HIV positive individuals often develop oral lesions or periodontal disease as their earliest clinical problem. Therefore, the first health-care professional they may see is the dentist. The concerns are two-fold: (1) exposure of immunocompromised patients to pathogens from the dental water line, and (2) cross-contamination of viral and bacterial infections from AIDS patients to subsequent dental patients.
(Q) What dangers are presented by the dental unit water?
(A)Two inhabitants of the dental line can be particularly problematic for AIDS patients: Legionella and Pseudomonas, both frequently present in high numbers in dental unit water. Because of their impaired immun e capabilities, AIDS patients are especially susceptible to respiratory infections, such as thos caused by the Legionella bacterium. Pseudomonas, just one of many species of opportunists that thrive in the dental unit water line, strikes when the immune system is weakened, creating respiratory and systemic infections. In AIDS patients, multiple infections can combine to form a life-threatening crisis.
(Q) How could HIV get into the dental unit water line?
(A) Most HIV positive patients have virus present in their saliva, inside cells that have been sloughed off the lining of the mouth or gums. During many dental procedures, virusinfected white ablood cells are also released into the mouth; in dental units without a 100% effective anti-retraction valve, these cells can be sucked back into the water line. (Research has shown that the failure rate of anti-retraction valves is very high.)
Once inside the water line, the virus cannot multiply, but it can survive long enough to be transmitted to subsequent patients.
(Q) I always autoclave my handpieces. Doesn't that thake care of any contamination?
(A) Definitely not. Because of the narrow inner diameter of the water line, just lml of sucked-back water and salliva can fill as much as 4 linear feet of tubing. Autoclaving the handpiece, syringe or scaler is ineffective if contaminated water is then passed through the instrument to the next patient.
(Q) Can Other infections carried by AIDS patients invade the water line?
(A) AIDS patients are commonly affected by tuberculosis and shed TB bacteria at a much higher rate than others infected with the disease. This represents a great hazard to health care workers and patients alike, and can be a serious source of potential contamination of the dental line, if suckback is occurring.
(Q) How does the Clearline Plus cartridge eliminate cross-contamination?
(A)The Clearline Plus cartridge acts as a barrier, preventing cells infected with virus from travelling back up the waterline. The installation of the cartridge also provides easy periodic access to the section of line closest to the handpiece, allowing disinfectant flushing or replacement as needed. Between patients, a small injection of disinfectant into the cartridge will kill the trapped contaminants. We recommend 1 ml of any proprietary chlorhexidine oral rinse solution.
If your practice is specifically designed to treat AIDS or other immunocompromised patients, an extra measure of protection can be achieved by changing the Clearline Plus cartridge after every patient.
>Potential disease manifestations from exposure to contaminated dental water**Williams. J.. Molinari. J.. Andrews. N. Microbial Contamination of Dental Unit Waterlines: Origins and Characteristics. Compendium, vol. 17:6 pp538-557. June 1996
Legionnaires' disease
Caries progression
Bronchitis
Chronic pneumonia
Abscesses
Meningitis
Chronic lung disease
Severe dehydration
Acute pneumonia
Conjunctivitis
Diarrhea
Endocarditis
Urinary tract infections
Wound infections
Allergic respiratory reactions
Gastrointestinal infection
Septicemia
Respiratory infections
Bacteremia
For more information on this product, contact your regular dental supply dealer or Aqua Technology at 1-(800) 478-7342. We will be happy to provide you with any additional technical or operational information you may need to begin integrating the Clearline Plus microfiltration system into your dental waterlines.
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