1887

Abstract

Dental waterlines contain large numbers of Gram-negative bacteria. Endotoxin, a component of such organisms, has significant health implications. Paired samples of dental unit water and the aerosols generated during dental procedures were collected, and assayed for bacteria and endotoxin levels, using heterotrophic plate counts and the amoebocyte lysate test. Consistent with published studies, the extent of bacterial contamination in the dental waters sampled for this investigation surpassed the levels associated with potable water, with counts in excess of 2.0×10 c.f.u. ml in some samples. Correspondingly high concentrations of endotoxin [up to 15 000 endotoxin units (EU) ml] were present in the water. A statistically significant Spearman correlation coefficient of =0.94 between endotoxin (EU ml) and bacterial load (c.f.u. ml) was demonstrated. All of the aerosol samples contained detectable endotoxin. Further studies of the consequences of dental endotoxin exposure, and evaluation of means to prevent exposure, are warranted.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.47231-0
2007-09-01
2019-11-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/56/9/1230.html?itemId=/content/journal/jmm/10.1099/jmm.0.47231-0&mimeType=html&fmt=ahah

References

  1. APHA ( 1985; ). Standard Methods for the Examination of Water and Wastewater, 16th edn. Washington, DC: American Public Health Association.
  2. Atlas, R. M., Williams, J. F. & Huntington, M. K. ( 1995; ). Legionella contamination of dental-unit waters. Appl Environ Microbiol 61, 1208–1213.
    [Google Scholar]
  3. Bourassa, N., Grenier, D., Mayrand, D., Morin, J. & Dufour, L. ( 1995; ). Bacterial analysis of dental unit waterlines. J Dent Res 74, 153
    [Google Scholar]
  4. Castellan, R. M., Olenchock, S. A., Kinsley, K. B. & Hankinson, J. L. ( 1987; ). Inhaled endotoxin and decreased spirometric values. An exposure–response relation for cotton dust. N Engl J Med 317, 605–610.[CrossRef]
    [Google Scholar]
  5. CDC ( 1993; ). Recommended infection control practices for dentistry. MMWR Morb Mortal Wkly Rep 42, 1–12.
    [Google Scholar]
  6. Costerton, J. W., Cheng, K. J., Geesey, G. G., Ladd, T. I., Nickel, J. C., Dasgupta, M. & Marrie, T. J. ( 1987; ). Bacterial biofilms in nature and disease. Annu Rev Microbiol 41, 435–464.[CrossRef]
    [Google Scholar]
  7. Danner, R. L., Elin, R. J. & Hosseini, J. M. ( 1991; ). Endotoxemia in human septic shock. Chest 99, 169–175.[CrossRef]
    [Google Scholar]
  8. Egawa, K., Klein, T. W., Yamamoto, Y., Newton, C. A. & Friedman, H. ( 1992; ). Enhanced growth restriction of Legionella pneumophila in endotoxin-treated macrophages. Proc Soc Exp Biol Med 200, 338–342.[CrossRef]
    [Google Scholar]
  9. Flaherty, D. K., Deck, F. H., Cooper, J., Bishop, K., Winzenburger, P. A., Smith, L. R., Bynum, L. & Witmer, W. B. ( 1984; ). Bacterial endotoxin isolated from a water spray humidification system as a putative agent of occupation-related lung disease. Infect Immun 43, 206–212.
    [Google Scholar]
  10. Fotos, P. G., Westfall, H. N., Snyder, I. S., Miller, R. W. & Mutchler, B. M. ( 1985; ). Prevalence of Legionella-specific IgG and IgM antibody in a dental clinic population. J Dent Res 64, 1382–1385.[CrossRef]
    [Google Scholar]
  11. Fulford, M. R., Walker, J. T., Martin, M. V. & Marsh, P. D. ( 2004; ). Total viable counts, ATP, and endotoxin levels as potential markers of microbial contamination of dental unit water systems. Br Dent J 196, 157–159.[CrossRef]
    [Google Scholar]
  12. Graham, P. & Brass, N. J. ( 1994; ). Multiple organ dysfunction: pathophysiology and therapeutic modalities. Crit Care Nurs Q 16, 8–15.[CrossRef]
    [Google Scholar]
  13. Herbert, A., Carvalheiro, M., Rubenowitz, E., Bake, B. & Rylander, R. ( 1992; ). Reduction of alveolar-capillary diffusion after inhalation of endotoxin in normal subjects. Chest 102, 1095–1098.[CrossRef]
    [Google Scholar]
  14. Hugenholtz, P. & Fuerst, J. A. ( 1992; ). Heterotrophic bacteria in an air-handling system. Appl Environ Microbiol 58, 3914–3920.
    [Google Scholar]
  15. Lipp, A. ( 2003; ). The effectiveness of surgical face masks: what the literature shows. Nurs Times 99, 22–24.
    [Google Scholar]
  16. Mamolen, M., Lewis, D. M., Blanchet, M. A., Satink, F. J. & Vogt, R. L. ( 1993; ). Investigation of a outbreak of “humidifier fever” in a print shop. Am J Ind Med 23, 483–490.[CrossRef]
    [Google Scholar]
  17. Mayo, J. A. & Brown, C. E. ( 1999; ). Effect of in-line bacteriological filters on numbers of heterotrophic bacteria in water emitted from non-autoclavable dental air-water syringes. Am J Dent 12, 256–260.
    [Google Scholar]
  18. Mayo, J. A., Oertling, K. M. & Andrieu, S. ( 1990; ). Bacterial biofilm: a source of contamination in dental air-water syringes. Clin Prev Dent 12, 13–20.
    [Google Scholar]
  19. Michel, O., Kips, J., Duchateau, J., Vertongen, F., Robert, L., Collet, H., Pauwels, R. & Sergysels, R. ( 1996; ). Severity of asthma is related to endotoxin in house dust. Am J Respir Crit Care Med 154, 1641–1646.[CrossRef]
    [Google Scholar]
  20. Mills, S. E. & Karpay, R. I. ( 2002; ). Dental waterlines and biofilm – searching for solutions. Compend Contin Educ Dent 23, 237–240, 242, 244.
    [Google Scholar]
  21. Molhave, L. & Krzyzanowski, M. ( 2003; ). The right to healthy indoor air: status by 2002. Indoor Air 13, 50–53.[CrossRef]
    [Google Scholar]
  22. Natanson, C., Hoffman, W. D., Suffredini, A. F., Eichacker, P. Q. & Danner, R. L. ( 1994; ). Selected treatment strategies for septic shock based on proposed mechanisms of pathogenesis. Ann Intern Med 120, 771–783.[CrossRef]
    [Google Scholar]
  23. Odeh, M. ( 1994; ). Endotoxin and tumor necrosis factor-α in the pathogenesis of hepatic encephalopathy. J Clin Gastroenterol 19, 146–153.[CrossRef]
    [Google Scholar]
  24. Pankhurst, C. L. & Philpott-Howard, J. N. ( 1993; ). The microbiological quality of water in dental chair units. J Hosp Infect 23, 167–174.[CrossRef]
    [Google Scholar]
  25. Pankhurst, C. L., Coulter, W., Philpott-Howard, J. N., Surman-Lee, S., Warburton, F. & Challacombe, S. ( 2005; ). Evaluation of the potential risk of occupational asthma in dentists exposed to contaminated dental unit waterlines. Prim Dent Care 12, 53–59.[CrossRef]
    [Google Scholar]
  26. Putnins, E. E., DiGiovanni, D. & Bhullar, A. S. ( 2001; ). Dental unit waterline contamination and its possible implications during periodontal surgery. J Periodontol 72, 393–400.[CrossRef]
    [Google Scholar]
  27. Reinthaler, F. F., Mascher, F. & Stunzner, D. ( 1988; ). Serological examination for antibodies against Legionella species in dental personnel. J Dent Res 67, 942–943.[CrossRef]
    [Google Scholar]
  28. Roth, R. I., Levin, F. C. & Levin, J. ( 1990; ). Optimization of detection of bacterial endotoxin in plasma with the Limulus test. J Lab Clin Med 116, 153–161.
    [Google Scholar]
  29. Santiago, J. I., Johnston, A. M., Williams, J. F. & Huntington, M. K. ( 1994; ). Microbial contamination of dental unit waterlines: short- and long-term effects of flushing. J Acad Gen Dent 42, 528–535.
    [Google Scholar]
  30. Shibayama, Y. ( 1992; ). Role of lipid peroxidation in enhancement of endotoxin hepatotoxicity. Exp Toxicol Pathol 44, 205–208.[CrossRef]
    [Google Scholar]
  31. Stevens, R. & Palmigianob, P. ( 1995; ). The European Union: its compliance and activities within the fields of outdoor and indoor air quality. Indoor Built Environ 4, 344–354.[CrossRef]
    [Google Scholar]
  32. Suffredini, A. F., Fromm, R. E. & Parker, M. M. ( 1989; ). The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 321, 280–287.[CrossRef]
    [Google Scholar]
  33. Szymanska, J. ( 2005a; ). Exposure to bacterial endotoxin during conservative dental treatment. Ann Agric Environ Med 12, 137–139.
    [Google Scholar]
  34. Szymanska, J. ( 2005b; ). Endotoxin levels as a potential marker of concentration of Gram-negative bacteria in water effluent from dental units and in dental aerosols. Ann Agric Environ Med 12, 229–232.
    [Google Scholar]
  35. Teeuw, K. B., Vandenbroucke-Grauls, C. M. & Verhoef, J. ( 1994; ). Airborne Gram-negative bacteria and endotoxin in sick building syndrome. Arch Intern Med 154, 2339–2345.[CrossRef]
    [Google Scholar]
  36. Trope, M., Chow, E. & Nissan, R. ( 1995; ). In vitro endotoxin penetration of coronally unsealed endodontically treated teeth. Endod Dent Traumatol 11, 90–94.[CrossRef]
    [Google Scholar]
  37. Trudeau, W. L. & Fernandez-Caldas, E. ( 1994; ). Identifying and measuring indoor biologic agents. J Allergy Clin Immunol 94, 393–400.[CrossRef]
    [Google Scholar]
  38. Turner, A. G. & Hill, N. F. ( 1975; ). Calibration of the Anderson 2000 disposable air sampler. Am Ind Hyg Assoc J 36, 447–451.[CrossRef]
    [Google Scholar]
  39. Tyler, J. W., Welles, E. G., Erskine, R. J., Lin, H. C., Williams, M. A., Spano, J. S., Gaslin, J. T. & McClure, K. A. ( 1994; ). Clinical and clinicopathologic changes in cows with endotoxin-induced mastitis treated with small volumes of isotonic or hypertonic sodium chloride administered intravenously. Am J Vet Res 55, 278–287.
    [Google Scholar]
  40. USDHHS ( 1987; ). Guidelines on validation of the Limulus amebocyte lysate test as an end-product endotoxin test for human and animal parenteral drugs, biological products, and medical devices. Washington, DC: US Department of Health and Human Services, Food and Drug Administration.
  41. van Deventer, S. J. H., Buller, H. R., TenCate, J. W., Aarden, L. A., Hack, C. E. & Sturk, A. ( 1990; ). Experimental endotoxemia in humans: analysis of cytokine release and coagulation, fibrinolytic, and complement pathways. Blood 76, 2520–2526.
    [Google Scholar]
  42. Williams, J. F., Johnston, A. M., Johnson, B., Huntington, M. K. & Mackenzie, C. D. ( 1993; ). Microbial contamination of dental unit water lines: prevalence, intensity and microbiological characteristics. J Am Dent Assoc 124, 59–65.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.47231-0
Loading
/content/journal/jmm/10.1099/jmm.0.47231-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error