Biofilm

They thoroughly and totally pervade our lives. We eat them, we breathe them, they live in our bodies, and we can not live without them. They have been found miles deep in the earth and at the bottom of the deepest ocean. In the wrong place with the wrong kind they can cause you to sicken and even die. I speak of course of bacteria.

With the ability that bacteria has to find and exploit each little niche in the environment it is no surprise that I have found myself battling them continually over the last 25 years.

In the early 1980s the dental delivery systems in use could not have been better designed as housing for bacterial if that had been the original intention. By this time the large Ritter and SS White delivery systems with the belt drive handpieces on their tops were on the way out and we were in the time of the plastic delivery system. Strange as it may seem the older units with lots of metal piping and rubber hosing did not support the growth of bacteria. Furthermore the speed of the old belt drive drills did not require water cooling so water lines were kept to a minimum. If the mouth needed to be flushed the dental unit had a glass of water sitting on it from which the patient would take a mouth full, swish, and spit into the cuspidor. The water to fill the glass was delivered in naturally bacteria resistant copper and brass piping. If the dentist did use his water syringe the water was supplied in a rubber tube that must have also been bacteria resistant since I never had to clean one.

Enter the highspeed handpiece with its critical need for coolant water and everything began to change. The era of the plastic dental unit had begun. Water was being supplied from the municipal water system but once to the unit all the piping was done in vinyl and polyurethane plastic tubing. Bacteria loves plastic water lines. The first infection of bacteria builds a housing development on the inside of the hoses called a polysaccharide matrix. After this matrix is in place a flush of Clorox is very much like cutting the grass. As soon as the Clorox is gone the bacteria emerges from hiding and goes on growing. A further complication was that almost no dental units used a clean water system. Even if the clinic wanted to flush Clorox into its water lines it could not since they were hooked directly to the building water lines. The usual procedure was to wait until the bacteria totally clogged off a water line to a syringe or a handpiece and then call R-Tech.

There was no question in anyone’s mind that a problem existed. We developed techniques to clean the water lines and many clinics put us on routine maintenance schedules so that their lines would be as clean as possible. We began to use check valves in handpiece lines to minimize the introduction of patient induced bacteria into the lines. While the bacteria in the water lines was a nuisance it wasn’t in most cases a threat to the health of the patient. We all take in bacteria every day and in most cases they are benign or can be dealt with by the body’s defenses.

Some of our more proactive clinics began to install clean water systems so that they could routinely run a Clorox rinse through the line. While this did not eliminate the bacteria or the matrix in which they lived it was a good control and at least kept the number of service calls down.

While the problem of the bacteria in the plastic water lines of the dental units had been present since the 1970’s it really didn’t come to the attention of the public until the late 1980’s when one or more of the TV networks investigative programs like 60 Minutes ran exposé’s on Dentistry’s Dirty Little Secret.

Over night patients were asking hard questions and demanding cleaner water and handpieces that had been sterilized. I remember wondering if the people criticizing the dental profession were as concerned about the spoons and forks they ate off in restaurants that had only been dipped in warm soapy water between diners. For good or bad the train had left the station and sterilization and water control had to be addressed. At this time many of the handpieces in use were not designed for repeated sterilization. New handpieces had to be bought and new techniques had to be developed to keep the handpieces lubricated and durable through multiple sterilization cycles. Millie and I tried to do our part inventing and patenting the handpiece flush station now marketed by DCI International which helped prolong handpiece life by providing proper lubrication and cleaning of handpieces before and after sterilization.

Gradually over the next several years almost everyone went to clean water systems and began Cloroxing their lines on a regular basis. We still did not have a solution to the problem of the bacterial matrix and the fast recovery of the bacteria in the lines but when done on a regular basis with handpiece sterilization bacterial counts could be kept within safe levels. Now that a market was available for a dental water line cleaner the chemists began to come up with better and better chemicals to clean and treat the water lines. Today most of the cleaners not only kill the bacteria but also dissolve the polysaccharide matrix thus greatly lengthening the recovery time of the bacteria. Also the new chemicals do not corrode and damage the metal parts of the delivery system as fast as Clorox. Some manufacturers have even developed plastic tubing that is resistant to bacterial growth.

Today the modern dental operatory with its clean water system, anti-retraction valves, water line treatment chemicals and handpiece sterilization is cleaner and safer than ever before. We at R-Tech have gone from four or five clogged water line calls a week to perhaps four or five a year.

While I am sure we have not heard the last from our constant bacterial companions we have won this battle. We have the technology at this point to very effectively control the bacterial counts in your water lines. If you wish to verify that you are doing the right things to be part of this solution here are the things to check.

#1. No water that goes into a patients mount should be fed by a line attached to the city water system. Clean Water Systems are a must for the proper control of your water quality.

#2. A water line treatment plan should be in effect. Each chemical manufacture has their own instructions for proper procedures. We recommend a product called Mint-A-Clean because of its ease of use, effectiveness, and minimal impact to the metal valves and fittings of the dental units.

#3. All handpieces and attachments should be sterilized. Be sure to follow lubrication and flushing procedures to maximize the life of your turbines. Syringe tips should be flushed and sterilized or disposable tips can be used.

#4 While the new bio resistant plastic hoses are nice they are not considered a necessity if the #1 and #2 are followed.

Please call any of the technicians at R-Tech if you have any questions on improving your water control or treatment plans.

R-Tech Dental DUWL Power Point Presentation

-John