A range of opportunistic pathogens have been associated with dental unit water systems (DUWS), particularly in the biofilms that can line the tubing. This study therefore aimed to assess the microbiology of DUWS and biofilms in general dental practices across seven European countries, including the United Kingdom (UK), Ireland (IRL), Greece (GR), Spain (ES), Germany (D), Denmark (DK) and the Netherlands (NL). Water supplied by 51% of 237 dental unit water lines exceeded current American Dental Association recommendations of < or = 200 colony-forming units (CFU) ml(-1). Microbiological loading of the source waters was between 0 (Denmark, the Netherlands and Spain) and 4.67 (IRL) log CFU ml(-1); water line samples from the DUWS ranged from 1.52 (ES) to 2.79 (GR) log CFU ml(-1); and biofilm counts ranged from 1.49 (GR) to 3.22 (DK) log CFU.cm(-2). Opportunistic pathogens such as legionellae (DK and ES), including Legionella pneumophila SG1 (DK and GR), and Mycobacterium spp. (DK, NL, GR, D and ES) were recovered occasionally. Presumptive oral streptococci (ES and NL), oral anaerobes (GR), Candida spp. (UK, NL and ES) and blood (GR and IRL) were detected at relatively low frequencies, but their presence indicated a failure of the 3-in-1 antiretraction valve, leading to back siphonage of oral fluids into the water and biofilm phase. These findings confirm that a substantial proportion of DUWS have high levels of microbial contamination, irrespective of country, type of equipment and source water. The study emphasizes the need for effective mechanisms to reduce the microbial burden within DUWS, and highlights the risk of occupational exposure and cross-infection in general dental practice.

Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Association's guideline of <200 CFU · ml ؊1 for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n ‫؍‬ 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4-to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU · ml ؊1 . Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU · ml ؊1 , although occasional high values (up to 4.88 log CFU · ml ؊1 ) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.

Hand disinfection is an important measure to prevent transmission of norovirus (formerly called Norwalk-like viruses) from hands or environmental surfaces to other objects. Therefore, three types of alcohol (ethanol, 1-and 2-propanol) were examined for their virus-inactivating properties against feline calicivirus (FCV) as a surrogate for norovirus. Tests were performed as quantitative suspension assays or as in vivo experiments with artificially contaminated fingertips. The in vitro experiments showed that 1-propanol was more effective than ethanol and 2-propanol for the inactivation of FCV: in tests with the 50 and 70% solutions of the different alcohols, a 10 4 -fold reduction was observed with 1-propanol after 30 s, whereas the other alcohols were effective only after 3 min contact time. The greatest efficacy did not occur at the highest concentrations (80%). The following concentrations (extrapolated data) showed the greatest virusinactivating properties in the suspension test: ethanol 67%, 2-propanol 58% (exposure times of 1 min) and 1-propanol 60% (exposure time of 30 s). The results from fingertips experiments with 70 and 90% solutions and an application time of 30 s confirmed these findings: the 70% alcoholic solutions were more effective than the 90% solutions. In contrast to the suspension tests, 70% ethanol showed the greatest efficacy in vivo with a log 10 reduction factor (RF) of 3.78 compared with 70% 1-propanol (RF 3.58), 70% 2-propanol (RF 2.15) and hard water (RF 1.23). Ethanol and 1-propanol-based solutions with a high alcohol content thus appear most effective.

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