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Austria

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Canada

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Denmark

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England

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Clark A, Bacterial colonization of dental units and the nasal flora of dental personnel. Proc Roy Soc Med 67:1269-70, 1974.

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Germany

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New Zealand

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United States

Abel LC, Miller RL et al, Studies on dental aerobiology: IV. Bacterial contamination of water delivered by dental units. J Dent Res 50(6):1567-9, 1971.

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Pseudomonas aeruginosa

Mayo JA, Oertling KM et al, Bacterial biofilm: A source of contamination in dental air-water syringes. Clin Prev Dent 12(2):13-20, 1990.

Williams JF, Johnston AM et al, Microbial contamination of dental unit waterlines. JADA 124:59-65, 1993.

Blake GC, The incidence and control of bacterial infection of dental units and ultrasonic scalers. Br Dent J 115:413-16, 1963

Kellett M and Holbrook WP, Bacterial contamination of dental handpieces. J Dent 8:249-53, 1980.

Fitzgibbon EJ, Bartzokas CA et al, The source, frequency and extent of bacterial contaminations of dental water systems. Br Dent J 157:98-101, 1984.

Martin MV, The significance of the bacterial contamination of the dental unit water systems. Br Dent J 163:15204, 1987.

Tippett BF, Edwards JL and Jenkinson HF, Bacterial contamination of dental unit water lines- a possible source of cross-infection. N Z Dent J 84:112-3.

Rosen S, Ramos E et al, Pathogenic microflora in the water lines leading to the dental handpiece. Transmissions 9 (2) (abstract):2, 1994.

Legionella pneumophila

Williams JF, Johnston AM et al, Microbial contamination of dental unit waterlines. JADA 124:59-65, 1993.

Challacombe SJ, and Fernandes LL, Detecting Legionella pneumophila in water systems: A comparison of various dental units. JADA 126:603-8, 1985.

Reinthaler FF and Mascher F, Legionella pneumophila in dental units. Zbl Bakt Hyg B 183:86-8, 1986.

Oppenheim BA, Sefton AM et al, Widespread Legionella pneumophila contamination of dental stations in a dental school without apparent human infection. Epid Inf 99:159-66, 1987.

Luck PC, Bender L et al, Analysis of a hospital ward warm water supply over a three-year period using genomic long-range mapping techniques and monoclonal antibodies. Appl Environ Microbiol 57:3226-31, 1991.

Rosen S, Ramos E et al, Pathogenic microflora in the water lines leading to the dental handpiece. Transmissions 9 (2) (abstract):2, 1994.

Atlas RM, Williams JF et al, Legionella contamination of dental-unit waters. Appl Environ Microbiol 61:1208-13, 1995.

Klebsiella pneumoniae

Williams JF, Johnston AM et al, Microbial contamination of dental unit waterlines. JADA 124:59-65, 1993.

Furuhashi M and Miyamae T, Prevention of bacterial contamination of water in dental units. J Hosp Infect 6:81-8, 1985.

High rates of upper respiratory infections

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Scheid RC, Kim CK et al, Reduction of microbes in handpieces by flushing before use.

Rates of seropositivity for legionella antibodies among dental professionals higher than general population

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Reinthaler FF, Mascher F et al, Serological examinations for antibodies against Legionella species in dental personnel. J Dent Res 67:942-3, 1988.

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Transmission of pathogenic bacteria to patients and workers

Martin MV, The significance of the bacterial contamination of the dental unit water systems. Br Dent J 163:15204, 1987.

Clark A, Bacterial colonization of dental units and the nasal flora of dental personnel. Proc Roy Soc Med 67:1269-70, 1974.

Ely EW, Stump TE et al, Thoracic complications of dental surgical procedures: hazards of the dental drill. Am J Med 95:456-65, 1993.

Dental unit water associated pseudomonas infections

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Dental water associated legionella infections

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Atlas RM, Williams JF et al, Legionella contamination of dental-unit waters. Appl Environ Microbiol 61:1208-13, 1995.

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Dental water associated non-tuberculous mycobacterium infections

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Waterline flushing is ineffective method to control bacterial contamination

Gross A, Devine MJ and Cutright DE, Microbial contamination of dental units and ultrasonic scalers. Periodontol 47:670-3, 1976.

Santiago JI, Huntington MK et al, Microbial contamination of dental unit water lines: short and long-term effects of flushing. Gen Den 45:528-535, 1994.

Williams HN, Quimby H et al, Evaluation and use of a low nutrient medium and reduced incubation temperature to study bacterial contamination in the water supply of dental units. Can J Microbiol 40:127-131, 1994.

Chlorine treatments do not remove existing biofilm

Whitehouse RLS, Peters E et al, Influence of biofilms on microbial contamination in dental unit water. J Dent 19:290-5, 1991.

Bacteria develop resistance to high levels of chlorine

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King CH, Shotts EB et al, Survival of coliforms and bacterial pathogens within protozoa during chlorination. Appl Environ Microbiol 54:3023-3033, 1988.

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Pankhurst CL, Philpott-Howard JN et al, The efficacy of chlorination and filtration in the control and eradication of Legionella from dental chair water systems. J Host Infect 16: 9-18, 1990.

Biofilm bacteria are 3,000 times less susceptible to chlorine treatment

LeChevallier MW, Cawthon CD et al, Factors promoting survival of bacteria in chlorinated water supplies. Appl Environ Microbiol 54:649-654, 1988.

Chlorine reacts with biofilm material and produces high levels of carcinogenic trihalomethanes not allowed in drinking water

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