Abstract
Aim: The objective of this study was to evaluate the infectious risk associated with dental unit water by assessing microbial contamination, identifying contributing factors, and proposing preventive measures to ensure the safety of patients and staff. Material and Methods: A cross-sectional descriptive observational study was conducted in Tunisia utilizing an online questionnaire. Distributed to dentists and dental students, the survey assessed their knowledge, training, and practices concerning water-related infection risks in dental chair units. Results: Among the 82 participants, most demonstrated a lack of awareness regarding waterborne infection risks and failed to implement recommended disinfection protocols. Only 29% were aware of the Ministry of Health’s circular 31bis-2023. Water quality testing (both chemical and microbiological) was infrequent, and vital practices such as flushing, disinfection, and traceability of maintenance actions were inconsistently applied. Discussion: The findings reveal substantial gaps in infection control awareness and adherence within the dental sector. Limited training and inadequate enforcement of existing guidelines necessitate urgent reforms, including enhanced professional education, standardized hygiene protocols, and more stringent regulatory oversight to ensure the safety of both patients and providers. Conclusion: Further studies involving a larger sample of dentists, complemented by field visits, are required.
References
References
Walker JT, Bradshaw DJ, Finney M, Fulford MR, Roberts AP, Manchester M, et al.
Microbial biofilm formation and contamination of dental-unit water systems in general dental practice.
Appl Environ Microbiol. 2000;66(8):3363-7.
https://doi.org/10.1128/AEM.66.8.3363-3367.2000
Wirthlin MR, Marshall GW Jr, Rowland RW.
Formation and decontamination of biofilms in dental unit waterlines. J Periodontol. 2003;74(11):1595-609.
https://doi.org/10.1902/jop.2003.74.11.1595
Epstein JB, Chong S, Le ND.
A survey of infection control practices among dentists in British Columbia. J Can Dent Assoc. 2000;66(10):556-61.
Barbeau J, Tanguay R, Faucher E, Avezard C, Trudel L, Côté L, et al.
Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62(11):3954-9.
https://doi.org/10.1128/aem.62.11.3954-3959.1996
Coleman DC, O'Donnell MJ, Shore AC, Swan J, Russell RJ. Biofilm problems in dental unit water systems and its practical control. J Appl Microbiol. 2009;106(5):1424-37.
https://doi.org/10.1111/j.1365-2672.2008.04100.x
European Society of Clinical Microbiology and Infectious Diseases.
Guidelines for prevention of infection and decontamination of dental unit waterlines. Clin Microbiol Infect. 2016;22 Suppl 5:S4-S11.
INEAS.
Fiches techniques de gestion des infections associées aux soins dans les centres de santé de base et centres intermédiaires.
Les guides de l'INEAS. Juin 2018.
CDC.
Guidelines for infection control in dental health-care settings-2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
INEAS.
Les bonnes pratiques de gestion du risque infectieux dans les structures de santé de la première ligne.
Les Guides de l'INEAS. Juin 2018
Bayani M, Raisolvaezin K, Almasi-Hashiani A, Mirhoseini SH.
Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta- analysis.
BMC Oral Health. 2023;23:158.
CDC.
Best Practices for Dental Unit Water Quality. CDC Health Care Providers. 15 mai 2024.
Baudet A, Clément C.
La qualité microbiologique de l'eau des units dentaires. L'Information Dentaire. 2021;20:14-9.
FDI World Dental Federation.
Dental Unit Water Systems and Microbial Contamination.
Adopted by FDI General Assembly May 2005, revised September 2016 in Poznań, Poland.
Khajezadeh M, Mohseni F, Khaledi A, Firoozeh A.
Contamination of dental unit water lines (DUWL) with Legionella pneumophila and Pseudomonas aeruginosa: A Middle East systematic review and meta-analysis.
Eur J Microbiol Immunol. 2022;12(4):93-9.
Puttaiah R, Miller K, Bedi R, Shetty S, Almas K.
Comparison of the efficacy of dental unit waterline treatments on biofilm formation in vitro.
Int Dent J. 2011;61(1):28-32.
https://doi.org/10.1111/j.1875-595X.2011.00046.x
Barbot V, Robert A, Rodier MH, Imbert C.
Update on infectious risks associated with dental unit waterlines. FEMS Immunol Med Microbiol. 2012;65(2):196-204.
https://doi.org/10.1111/j.1574-695X.2012.00971.x
O'Donnell MJ, Boyle MA, Russell RJ, Coleman DC. Management of dental unit waterline biofilms in the 21st century. Future Microbiol. 2011;6(10):1209-26.
https://doi.org/10.2217/fmb.11.104
Costa D, Girard R, Boussadi H, et al.
Water quality in dental units: comparative study of standard dental units and a new dental unit with a continuous water disinfection system.
Int J Hyg Environ Health. 2009;212(4):386-92
Ministère de la Santé Tunisien.
Guide technique « Qualité et sécurité des eaux en milieu de soins ».
Direction de l'Hygiène du Milieu et de la Protection de l'Environnement. Janvier 2023.
US Food and Drug Administration.
Dental Unit Waterlines.
Content current as of: 04 septembre 2018
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Safa Jemli , Marwa Baccar, Wissal Rejeb