Sains Malaysiana 44(2)(2015): 187–192

A Comparison of Different Disinfectants on the Microbiological Quality of Water from the Dental Unit Waterlines of a Military Hospital

(Perbandingan antara Disinfektan yang Berlainan terhadap Kualiti Mikrobiologi Air

daripada Paip Air Unit Pergigian di Sebuah Hospital Angkatan Tentera)

MEI SIANG MA¹*, ZALINI YUNUS², AHMAD RAZI MOHAMED YUNUS², ZUKRI AHMAD²

& FARIZAH ABDUL FATAH²

¹Dental Specialist Polyclinic, Tuanku Mizan Armed Forces Hospital, No 3, Jln 4/27A,

Seksyen 2, Wangsa Maju, 53300 Kuala Lumpur, Malaysia

²Science and Technology Research Institute for Defence, Kompleks Induk STRIDE

Tmn Bukit Mewah, Fasa 9, 43000 Kajang, Selangor D.E. Malaysia

Diserahkan: 29 Januari 2014/Diterima: 8 Julai 2014

ABSTRACT

Water from the dental unit waterlines (DUWLs) is known to contaminate with microbial from the biofilm that formed in the tubing system. The water quality from DUWLs is important to patients and dental health care professionals as they could be infected either directly from the contaminated water or aerosol that is generated during dental procedures. Suppliers claimed that dental units supplied to the hospital can only use a specific disinfectant which is uneconomic compared with the others. The aims of this study were to evaluate and compare the efficacy of different disinfectant on the water quality of DUWLs. Four disinfectants (Calbenium, A-dec ICX tablet, Dentel 5, Metassys) and distil water were evaluated. 350 mL water sample was collected separately, from the outlet of high-speed handpiece, scaler, 3-ways syringe and cup filler into a sterile thiosulfate bag on the 1st, 2nd, 4th, 8th, 12th and 24th weeks of the study. The samples were tested on the following day for total viable count (TVC). There is significant difference in the efficacies of the different disinfectants. Only one disinfectant consistently produces water quality within the recommended level of American Dental Association (ADA). Within the limitation of this study, it was found that there is alternative disinfectant that can reduce the TVC to the level recommended by ADA. However, the water qualities produced with these disinfectants were not consistent although they did not cause any technical problem to the dental units during the period of study.

Keywords: Dental unit water line; disinfectant; microbial; total viable count

ABSTRAK

Air daripada paip air unit pergigian (DUWL) diketahui umum tercemar dengan mikrob daripada biofilem yang terbentuk di dalam sistem paipnya. Kualiti air daripada DUWL adalah penting untuk kesihatan pesakit dan penjaga kesihatan pergigian profesional kerana mereka boleh dijangkiti sama ada secara langsung daripada penggunaan air yang tercemar atau tidak langsung melalui titisan air yang terjana daripadanya. Pembekal unit pergigian ke hospital memberitahu hanya satu disinfektan khas sahaja yang boleh diguna untuk mengekalkan kualiti air daripada paip air unit pergigian. Harga disinfektan tersebut adalah mahal berbanding dengan yang lain. Tujuan kajian ini dijalankan adalah untuk menilai dan membandingkan keberkesanan disinfektan yang berlainan terhadap kualiti air daripada paip air unit pergigian. Empat disinfektan yang berlainan (Calbenium, A-dec ICX tablet, Dentel 5, Metassys) dan air suling telah dikaji. 350 mL sampel air diambil secara berasingan daripada alatan tangan kelajuan tinggi, pengukur, picagari 3 cara dan cawan pengisi dan dimasukkan ke dalam beg tiosulfat yang steril pada minggu pertama, kedua, empat, dua belas dan dua puluh empat sewaktu kajian dijalankan. Sampel air diuji pada hari yang berikutnya untuk jumlah bilangan boleh hidup (TVC). Terdapat perbezaan yang ketara antara disinfektan yang berlainan daripada segi keberkesanan ke atas kualiti mikrobiogi air. Hanya satu disinfektan sahaja yang secara tekal menghasilkan kualiti air yang disarankan oleh Persatuan Pergigian Amerika (ADA). Hasil daripada kajian ini mendapati ada pilihan disinfektan lain yang boleh menghasilkan TVC ke aras yang disarankan oleh ADA. Walau bagaimanapun, kualiti air yang dihasilkan oleh disinfektan berkenaan tidak konsisten walaupun ia tidak menyebabkan sebarang masalah teknikal pada unit pergigian sepanjang kajian dijalankan.

Kata kunci: Disinfektan; jumlah bilangan boleh hidup; mikrob; paip air unit pergigian

RUJUKAN

American Dental Association (ADA). 1999. Dental unit waterlines: Approaching the year 2000. ADA Council on Scientific Affairs. J. Am. Dent. Ass. 130(11): 1653-1664.

Al-Hiyasat, A.S., Ma'ayeh, S.Y., Hindiyeh, M.Y. & Khader, Y.S. 2007. The presence of Pseudomonas aeruginosa in the dental unit waterline systems of teaching clinics. Int. J. Dent. Hyg.5(1): 36-44.

Blake, G.C. 1963. The incidence and control of bacterial infection of dental units and ultrasonic scalers. Br. Dent. J. 115: 413-416.

Fots, P., Westfall, H., Snyder, I., Miler, R. & Mutchler, B. 1985. Prevalence of legionella-specific IgG and IgM antibody in a dental clinic population. J. Dent. Res. 64: 1382-1385.

Kathariya, M.D., Kashinath, P.S., Kulkarni, S., Singh, D., Akkareddy, B. & Kathariya, R. 2013. Evaluation of bacterial contamination of dental unit waterlines and the efficacy of commercially available disinfectants. Int. J. Pub. Health Dentistry 4(1): 23-28.

Kettering, J.D., Munoz-Voveros, C.A., Stephens, J.A., Naylor, W.P. & Zhang, W. 2002. Reducing bacterial counts in dental unit waterlines: Distilled water vs antimicrobial agents. Journal of the California Dental Association 30(10): 725-741.

Liaqat, I. & Sabri, A.N. 2011. Biofilm, dental unit waterline and its control. Afr. J. Cln. and Exper. Microbiol.12(1): 15-21.

Liaqat, I. & Sabri, A.N. 2008. Effects of biocides on biofilm bacteria from dental unit waterline biofilms. Curr. Microbiol.56: 619-624.

Ma, M.S., Zalini, Y., Ahmad, R.M.Y., Zukri, A. & Haryanti, T. 2012. The microbiological quality of water from dental unit waterlines in Malaysian Armed Forces dental centres. Arch. Orofac. Sci. 7(1): 14-20.

Mavridou, A., Kamma, J., Mandilara, G., Delaportas, P. & Komioti, F. 2006. Microbial risk assessment of dental unit water systems in general dental practice in Greece. Water Sci. Technol. 54(3): 269-273.

Mayo, J.A., Villarubia, C. & Culotta, J. 2002. Hemolytic bacteria in water from the dental air-water syringe. J. Dent. Hyg.76: 151-156.

McDowell, J.W., Paulson, D.S. & Mitchell, J.A. 2004. A simulated-use evaluation of a strategy for preventing biofilm formation in dental unit waterline. The Journal of the American Dental Association 135(6): 799-805.

Pankhurst, C.L. 2003. Risk assessment of dental unit waterline contamination. Primary Dental Care 10: 5-10.

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. Primary Dental Care 12(2): 53-63.

Reinthaler, F.F., Mascher, F. & Stunzner, D. 1988. Serological examinations for antibodies against Legionella species in dental personnel. J. Dent. Res. 67: 942-943.

Schel, A.J., Marsh, P.D., Bradshaw, D.J., Finney, M., Fulford, M.R., Frandsen, E., Østergaard, E., ten Cate, J.M., Moorer, W.R., Mavridou, A., Kamma, J.J., Mandilara, G., Stösser, L., Kneist, S., Araujo, R., Contreras, N., Goroncy-Bermes, P., O’Mullane, D., Burke, F., O’Reilly, P., Hourigan, G., O’Sullivan, M., Holman, R. & Walker, J.T. 2006. Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union. Applied and Environmental Microbiology 72(2): 1380-1387.

Singh, R., Stine, O.C., Smith, D.L., Spitznagel, J.K., Labib, M.E. & Williams, H.N. 2003. Microbial diversity of biofilms in dental unit waterlines. Appl. Environ. Microbiol. 69(6): 3412-3420.

Szymanka, J. 2003. Biofilm and dental unit waterlines. Ann. Agric. Environ. Med. 10(2): 151-157.

Szymanska, J. & Dutkiewicz, J. 2008. Concentration and species composition of aerobic and facultatively anaerobic bacteria released to the air of a dental operation area before and after disinfection of dental unit waterlines. Ann. Agric. Environ. Med. 15: 301-307.

Tall, B.D., William, H.N., Gearge, K.S., Gray, R.T. & Walch, M. 1995. Bacterial succession within a biofilm in water supply lines of dental air-water syringes. Canadian Journal of Microbiology 41: 647-654.

Walker, J.T., Bradshaw, D.J., Bennett, A.M., Fulford, M.R., Martin, M.V. & Marsh, P.D. 2000. Microbial biofilm formation and contamination of dental-unit water systems in general dental practice. Appl. Environ. Microbiol. 66(8): 3363-3367.

Williams, H.N., Kelly, J., Folineo, D., Williams, G.C., Hawley, C.L. & Sinbiski, J. 1994. Assessing microbial contamination in clean water dental units and compliance with disinfection protocol. J. Am. Dent. Assoc. 125: 1205-1211.

Wirthlin, M.R. & Marshall, G.W. Jr. 2001. Evaluation of ultrasonic scaling unit waterline contamination after use of chlorine dioxide mouthrinse lavage. J. Periodontol. 72(3): 401-410.

*Pengarang untuk surat-menyurat; email: drliana@gmail.com