We would like to thank Dr. Boothe for his commentary. As stated in our article, the purpose of the Sept. 29, 2000, workshop was to critically review the scientific literature on the subject of dental unit waterlines and attempt to determine the evidence basis for management of DUWL contamination, and the potential health risks, if any, of using contaminated water as a coolant in dental procedures.
The ultimate goal of the workshop was to determine if a research agenda in the area of DUWLs should be pursued, and what questions should be asked.
Dr. Boothe is correct. No disease transmission arising from DUWL microbial contamination has been conclusively documented. However, there is irrefutable scientific evidence that the water delivered to most dental patients is of poor microbiological quality, and would often fail to pass drinking water standards.
If water is unsafe to drink, how can one ethically use that water for irrigation, cooling and lubrication in the mouth of a patient? Although no "clear and present danger" exists, exposing patients or dental personnel to water of uncertain microbiological quality is not consistent with universally accepted infection control principles that are recommended by the ADA and the Centers for Disease Control and Prevention’s Office of Safety & Asepsis Procedures.
While the majority of the microbial contamination is probably harmless, pathogens such as Legionella pneumophila and Pseudomonas aeruginosa are frequently isolated from DUWLs. These and other organisms that form into biofilm are playing a major role in the development of human diseases such as periodontitis, prostatitis, prosthetic joint infection, endocarditis and infection from biofilm forming on indwelling catheters.1 Therefore, it seems prudent to reduce the level of biofilm exposure and contamination whenever possible.
First and foremost, we must do no harm! While no direct evidence of disease resulting from DUWL contamination has been documented, issues such as developing microbial resistance, increasing numbers of immunocompromised patients seeking oral health care and implication of biofilm with disease in other health settings dictate reduction and/or elimination of biofilm exposure whenever possible.
Fortunately, efficacious, cost-effective methodologies to treat DUWLs are available, and should be utilized on a routine basis. More study in this area is warranted, as research into understanding the dynamics of biofilm is critical to management of biofilm-related disease.
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