http://us.adec.com/~/media/Adec/Page%20Hero%20I mages/Products/DeliverySystems/Adec500/Traditional/500Traditional-Hand.jpg
• 1/16 th to 1/8 th inch in diameter
• Large surface to volume ratio (low flow rate)
• Delivers water to handpieces and air/water syringes
• Water sits stagnant in lines overnight and weekends
• Optimal breeding ground for microorganisms
• Plastic hydrophobic surface

• Well organized microbial communities that adhere to wet surfaces
• Communicates via fluid channels to support bacterial growth
• Protective slime layer which makes it difficult to eradicate

Streptococcus mitis
Streptococcus salivarius
Enterococci
Staphylococcus cohnii
Staphylococcus warneri A
Klebsiella (Enterobacter) aerogenes
Bacillus subtilis
Pseudomonas spp.
Streptococcus
(Entercoccus) faecalis
Enterobacter cloacae
Pseudomonas aeruginosa
Alcaligenes faecalis
Mycobacterium spp.
Cladosporium spp.
Cephalosporium spp.
Aeromonas spp.
Legionella pneumophila
Acinetobacter spp.
Flavobacterium spp.
Moraxella spp.
Ralstonia pickettii

Most Gram-negative species in DUWLs are generally nonpathogenic
Potentially pathogenic microorganisms:
Pseudomonas aeruginosa causes oral infections
Legionella pneumophilacauses pneumonia
Few cases of crossinfections linked to DUWLs http://www.dentalindia.com/wlbf.jpg

Chemo patient with
Pseudomonas aeruginosa infection
Patient infected with
Legionella pneumophila http://www.intechopen.com/source/ht ml/46278/media/fig4.png
http://jmm.sgmjournals.org/content/59/10/1
242/F1.large.jpg

In 2012, ABC
News reported that an 82-yearold woman dies of Legionnaire’s disease after dental visit.

• Municipal water piped into dental unit
• Suck-back of saliva into line
• Lack of antiretraction valves
• Contamination from independent bottled water systems
• 300 times more amoebae found in DUWLs than in tap water

• There are currently no laws that set standards for the quality of water
• 1995- ADA challenged industries to produce systems that reduce bacteria levels
• Cleaner than tap water
(500 CFU/ml) http://www.thenextdds.com/uploadedImage s/The_Next_DDS/Articles/3338650.jpg

• Flush water lines for:
• 30 seconds at beginning and end of day
• 20-30 seconds after each patient
• Do not use dental unit water for surgical procedures http://www.ada.org/en/member-center/oral-health-topics/dental-unit-waterlines

• Improve the design of new dental equipment
• Design accessories to adapt to older units
• Take responsibility off HCW http://www.l
wtech.edu/i mages/Ace damics/Den tal/Dental_
Assistant.jp
g

• Minimize and prevent biofilm formations
• Improve the safety and quality of dental unit water
• Remove bacteria from tubing surface
• Decrease potential source of cross contaminations
• Easy procedures that can be performed daily http://trustwater.com/wpcontent/uploads/2012/02/teeth.jpg

Autoclavable or disposable pathways
Flushing waterlines
Filtration system
Independent reservoirs
Sterile water delivery system
Chemical treatment
Chlorination
Biocides and chemical disinfectants
Peroxide, Ozone UV

The Waterclave http://www.aquasept.com/wpcontent/uploads/2012/04/cass ette.jpg
http://vertassets.blob.core.windows.net/i mage/1a88ed98/1a88ed98-2e3f-11d3-
9a4b-00a0c9c83afb/aquasafe.jpg
http://www.dentalaegis.com/m edia/20301 http://www.waterclave.com/I mages/waterclave6.jpg

Remove handpieces, air/water syringes, and ultrasonic scalers
Flush lines:
Beginning of day for 60 seconds
Between patients for 20-30 seconds
At end of day for 60 seconds

May temporarily reduce the level of microbes in the waterlines
Reduces patient-borne microbes that may have entered the handpiece via suck-back
Reduces the build up of biofilms in the DUWLs
Inexpensive and easy to do

Pink
On Fridays:
Fill bucket with 2 pumps
Purevac and water
(1 ounce/1 quart)
Suction with low and high-speed suction
• A powerful cleaning solution that:
• Destroys microorganisms
• Dissolves tough debris
• Keeps evacuation lines open
• Prevents build-up
• Helps system operate properly and efficiently http://www.net32.com/images/evacuati on/sultan-purevac-21113.jpg

Inhibits growth of microorganisms in
DUWLs
Nontoxic, odorless, tasteless
Has no effect on enamel or bonding
• Add 10 BluTabs to 19 liters of water (1 tablet / 2 liters H2O)
• Fill individual dental unit water bottles with treated solution https://www.safcodental.com/catalog/infectioncontrol/waterline-purification/blutab

1.
ADA: America’s leading advocate for oral health [Internet].Chicago: American Dental Association; C 1859-
2014. Oral Health Topic Dental Unit Waterlines; April 2012 [cited 2014 November 1]. Available from: http://www.ada.org/en/member-center/oral-health-topics/dental-unit-waterlines
2.
Bednarsh HS, Eklund KJ, Mills S. OSAP- Dental Unit Waterlines: Check Your Dental Unit Water IQ [Internet].
American Dental Hygienists’ Association; 1997 [cited 2014 Nov 18];10(9). Available from: http://www.osap.org/?page=Issues_DUWL_7
3.
BluTab [Internet]. Safco Dental Supply; 2014 [cited 2014 Nov 19]. Available from: https://www.safcodental.com/catalog/infection-control/waterline-purification/blutab
4.
Dallolio L, Scuderi A, Rini M, Valente S, Farruggia P, Sabattini M, Pasquinelli G, Acacci A, Roncarati G, Leoni E.
Effect of different disinfection protocols on microbial and biofilm contamination of dental unit waterlines in community dental practices. Environ Res Public Health [Internet]. 2014 Feb 18 [cited 2014 Nov 18]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945585/
5.
Garg SK, Mittal S, Kaur P. Dental unit waterline management: historical perspectives and current trends. J
Investig Clin Dent [Internet]. 2012 Feb 19 [cited 2014 Nov 18];3(4):247-52.
1.
Purevac Evacuation System Cleaner [Internet]. Sultan Healthcare; 2014 [cited 2014 Nov 19]. Available from: http://www.sultanhc.com/sw/swchannel/productcatalogcf_v2/internet/model.asp?ProductMasterID=297561&P arentID=215652&SWID=1
2.
Tyagi S, Kulkarni P, Prasad K. Science regarding dental unit waterlines (DUWL): A review. Ann Essences Dent
[Internet]. 2010 Jul-Sept [cited 2014 Nov 18];2(3):117-22.
1. Watanabe E., Agostinho AM., Matsumoto W., Ito IY. Dental unit water: bacterial decontamination of old and new dental units by flushing water. International Journal of Dental Hygiene 2008; 6: 56-62.

https://www.youtube.com/watch?v=6LpX3bItNI8&f eature=youtu.be