BIOFILMS

Introduction to Biofilms :
A biofilm is a complex aggregation of microorganisms, which is usually slimy in nature, and is covered by a protective and adhesive matrix.

Single-celled organisms generally exhibit two distinct modes of behavior. The first is the familiar free floating, or planktonic, form in which single cells float or swim independently in some liquid medium. The second is an attached state in which cells are closely packed and firmly attached to each other and usually a solid surface.

Formation
Formation of a biofilm begins with the attachment of free-floating microorganisms to a surface. These first colonists adhere to the surface initially through weak, reversible van der Waals forces. If the colonists are not immediately separated from the surface, they can anchor themselves more permanently using cell adhesion molecules such as pilli.

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The first colonists facilitate the arrival of other cells by providing more diverse adhesion sites and begins to build the matrix that holds the biofilm together.

Biofilms can contain many different types of microorganism, e.g. bacteria, archaea, protozoa and algae. Biofilms are present on the teeth of most animals as dental plaque, where they may become responsible for tooth decay.

Biofilms and infectious diseases

Biofilms have been found to be involved in a wide variety of microbial infections in the body, by one estimate 80% of all infections. Infectious processes in which biofilms have been implicated include common problems such as urinary tract infections, middle-ear infections, formation of dental plaque, gingivitis, coating contact lenses, and less common but more lethal processes such as endocarditis, infections in cystic fibrosis, and infections of permanent indwelling devices such as joint prostheses and heart valves.

Biofilms in Dentistry
Dental Unit Waterline (DUWL) Contamination :
The current problem with the water quality used in dental clinical setups, primarily centre on the formation of microbial biofilm along the walls of the long , narrow-bore tubing that provides cooling and irrigating water to dental hand instruments. Levels of microbial contamination as high as 10,000 to 10,000,000 (colony forming units) CFUs/ml have been documented.

DUWL Contamination Dynamics

Input: Water quality

Waterline: Biofilm

Output: Retraction and Backflow

Close up of dental tube opening.

Fig. 24-1

Copyright 2003, Elsevier Science (USA). All rights reserved.

A cross-section of a dental unit waterline illustrating the formation of biofilm on the inside wall of a dental tube.

Fig. 24-2

Copyright 2003, Elsevier Science (USA). All rights reserved.

Magnification of biofilm formation on the walls of the tube.

Fig. 24-3

Copyright 2003, Elsevier Science (USA). All rights reserved.

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Environmental Infection Control

Both water-borne and human oral microbes have been found in dental unit water, indicating that both incoming community water and patients mouths are sources of these microbes. Most of the microbes detected are of very low pathogenicity or are opportunistic pathogens that cause harmful infections only under special conditions or in immunocompromised people.

The Center for Disease Control, USA (CDC) has recommended that :

-- High-speed hand-pieces should be flushed to discharge water and air for a minimum of 20 to 30 seconds after use on each patient ; -- Use of a high-velocity evacuation should be considered to minimize the spread of spray, splatter and aerosols generated during treatment procedures;

-- Overnight or weekend microbial accumulation in water lines can be reduced substantially by removing the hand-piece and allowing water lines to run and discharge water for several minutes at the beginning of each clinic day ; and -- Sterile saline or sterile water should be used as a coolant/irrigator when surgical procedures involving the cutting of bone are performed.

Hard surfaces disinfection : Potentially infective patients must be seen at the end of the day. All instruments must be autoclaved. All hard surfaces shall be cleaned and disinfected with a disinfectant. Protection : CDC recommends that all high-risk areas (eg., bracket table, light handles , X-ray unit heads, counter tops, etc., ) are protected by disposable covers or cloths, which are washed prior to reuse. The protection should be removed by gloved hands and safely discarded, after each patient.

Special Considerations : Dental hand-pieces and other devices attached to air and water lines : Since there is a tendency that fluids and materials from the patients oral cavity may flow back into the hand-piece and water lines , anti-retraction valves (one-way flow check valves) should be installed to prevent cross-infection. Routine maintenance of anti-retraction valves is necessary to ensure effectiveness ; the dental unit manufacturer should be consulted to establish an appropriate maintenance routine.

Other reusable intraoral instruments attached to, but removable from, the dental unit air or water lines (such as ultrasonic scaler tips and component parts and air/water syringe tips) : These should be cleaned and sterilized after treatment of each patient in the same manner as hand-pieces. Manufacturers directions should be followed to ensure effectiveness of the process as well as longevity of the instruments.

Single-use disposable instruments (eg., prophylaxis cups and brushes ; saliva ejectors) should be used for one patient only and discarded appropriately. These items are neither designed nor intended to be cleaned, disinfected, or sterilized for reuse.

Preprocedural mouth rinse with an antimicrobial product (ie., chlorhexidine gluconate, povidone iodine) can reduce the level of microorganisms in aerosols and splatter generated during routine dental procedures with rotary instruments (ie., dental handpieces, ultrasonic scalers).

Thank You