MAINTAINING QUALITY

OF THE DENTAL UNIT

WATER SYSTEM

DR TAN SOON CHIA

PEGAWAI PERGIGIAN UG52
KLINIK PERGIGIAN PASIR PINJI
 Introduction

 1963, microbiological contamination of water in

dental lines
 Occupational hazards
 Immunocopromised patients
 Guidelines to ensure acceptable biological quality for
waterlines
 Source of bacteria
 Incoming water

 Patient’s mouth
 Components

 Dental Unit Waterline(DUWL)

 Incoming water
 As coolant and irrigant
 Triple syringe, handpiece, scaler and cup filter
 Dental Suction System(DSS)
 Outgoing water
 Dental Suction Unit
 Spitoon
 Standards

 Haemodylisis unit ≤200 cfu/ml

 DUWS ≤500 cfu/ml non surgical procedures
 For surgical procedures, sterile solution be used as
coolant and/or irrigants
Contamination of Dental Unit Water
System

 Backflow from dental unit

 Microbes from mouth and from water
 Replicated on the interior surfaces of the DUWL tubing which
furnishes water for cooling and irrigant
 Tap water entering the dental unit 15-20 colony forming units of
bacteria per ml
 Water coming out, microorganism level ranging from few
thousand to a few hundred thousand cfu/ml. It may reach one
million cfu/ml
 Repeated disinfection needed
 Inevitable due to complex dental unit design – stagnation of
water
 Strategies

 Periodic training to staff

 Involve manufacturers in training and educating
members of profession in maintaining their dental
unit water system
 Check list
 Review guidelines every 5 years
 Non-Surgical Procedures
 Generally waterlines should be disinfected at least once a week
with an approved biocides
 Alcohols
 ethanol, isopropanol, microzif AF, Purevac
 Phenols
 Dettol(chloroxylenol), Pulijet, Thymol
 Aldehydes
 Glutaraldehydes, Ortho-phthalaldehyde, cidex
 Quartenary ammonium compouds
 Dimethyl or benzyl dimethyl ammonium chloride eg aspiramatic,
alproject-D, Orotol Plus, Instrunet Aspiration
 Hydrogen peroxide
 Dentosept-P, Sterilex Ultra for DUWLs, Oxygenol 6 (oxidising agent)
 Natural ones
 Gobble Plus 9 bacillus microorganisms & lactic acid
 Caution when use

 Biocides with effect on mercury release from

amalgam
 Sodium hypochlorite
 commercial bleaches, chlorox(oxidising agent))
 Sodium dichloroisocyanate
 Ethylenediaminetetraacetic acid(EDTA)
 Peracetic acid(oxydising agent)
 Anti microbials
 0.12% chlorhexidine gluconate (bio2000)
 Chlorhexida 5

 Chlorhexidine gluconate 5%, ethanol 10%

 120 ml
 12 ml CHX dilute with 488ml of distilled water.
 12ml + 488ml = 500ml
 0.12% CHX recommended as biocides.
 Dental Unit Waterlines

 Disinfecting distilled water supply container attached

to water distiller
 Empty distilled water container fixed to water distiller
before each new distillation
 Wash and disinfect the container with biocides before
each distillation
 Label date of distillation on container
 Do not store distilled water for more than 6 days
 Cleaning of Distilled Water
Containers

 Label ‘ DISTILLED WATER’ on container

 Prepare fresh biocide solution
 Pour the solution into the container and agitate to ensure
that the solution touches every portion of the interior of
the water container
 Allow the solution to sit in the bottom of the container for
at least 10 minutes
 Pour out the biocides solution and rinse the container with
clean water.
 Use glove when handling water containers to avoid
contamination of the water system with skin organism.
 B) Once a week treatment regime
 Prepare fresh biocide as recommended
 Remove IWR and discard residual water
 Replace IWR and air purge all water lines
 Fill IWR to the top with biocide solution
 Load all lines with biocide
 Allow all biocide solution to stand for the recommended time
 Remove IWR and discard biocide in sink and rinse with copious
amounts of water
 Replace empty IWR and air purge to remove residual biocide
 Fill IWR with 500 ml of distilled water and flush all lines until IWR
is empty
 Continue to air purge until there are no trace of water on gloved
hands
 Refill with distilled water just before next clinical use.
Independent Water Reservoir (IWR)

 A)Daily Regime
 Remove IWR and discard residual water after the last
patient of the day
 Wash IWR with biocides
 Invert empty bottle to store
 Replace IWR each morning
 Refill only with distilled water
 Flush all lines(without attachments) with distilled water
for 1 minute each morning before first patient.
Prepare Fresh Biocides
Remove IWR and Discard Residual
Water
Replace IWR and Air Purge All
Waterlines
Fill IWR to the Top with Biocides
Load All Lines with Biocides
Remove IWR and Discard, Rinse with
Copious of Water
Replace IWR and Air Purge
Fill IWR with 500 ml Distilled Water
and Flush All Lines
Air Purge till No Trace of Water on
Glove
Dental Devices
 Handpiece
 Insert handpiece and flush for one minute at the start
of the day
 Flush for a minimum of 30 seconds after each patient
 Wipe handpiece with alcohol after each patient
 Remove handpiece and sterilise (preferably in
pouches in a vacuum autoclave)
 Triple Syringe

 Insert triple syringe and flush for one minute at the

start of the day
 Flush for a minimum of 30 seconds after each patient
 Disinfect triple syringe with alcohol after each patient
 Remove and sterilise triple syringe tip after the last
patient
 Use disposable syringe whenever possible
 Ultrasonic Scaler

 Attach/ Insert scaler and flush for one minute at the start of the
day
 Remove scaler tip after every patient
 Clean and sterilise scaler tip
 Flush scaler handpiece for a minimum of 30 seconds after each
patient
 Wipe scaler handpiece with alcohol after each patient
 Remove and sterilise scaler handpiece after the last patient(
preferably in pouches in vacuum autoclave)
 Remove and sterilise scaler handpiece after each patient if
possible
Dental Suction System
 Saliva Ejector

 Use disposable saliva ejector

 Tubing

 Flush suction tubing with approved biocide at the beginning of

the day, at the end of the morning session and at the end of the
day
 Flush suction tubing using distilled water after disinfection
 Flush suction tubing with water after every patient.
 Note during tx
 Prevent patient from closing their lip tightly around the tip of the
saliva ejector
 Avoid positioning the length of suction tubing holding the tip
above the patient’s mouth
 Avoid using saliva ejector simultaneously with other( high
volume) evacuating equipment.
Components that DO Not Enter
Patients Mouth
 Cup Fillers

 Disinfect cup filler tip with an approved biocide

 Flush cup fillers for 1 minute at the beginning of the
day before filling cup for the first patient
Handles or Dental Unit Attachments of
Saliva Ejectors, High-Speed Air
Evacuators, and air/water syringes

 Change barriers after each patient

 If not covered with barriers during use, clean and
disinfect after each patient
Surgical Procedures
 All disinfection/ sterilisation process apply for non-
surgical and surgical procedures. However surgical
procedures require the following :
 Use sterile solution(saline or water) as a coolant/ irrigant
in surgical procedures
 Use sterile, single –use disposable products to deliver
coolant/ irrigant, where possible
 Apply appropriate sterilisation techniques if using any
other delivery devices
CHECKLISTS
Pengendalian Harian Saliran Air Kerusi Pergigian

Tanggalkan botol air suling

Buang sisa air suling pada

penghujung hari rawatan

Cuci botol air suling dengan biocides

( bilas dengan air suling)

Terlangkupkan botol dan keringkan

Pada keesokkan hari, isi air suling

Alirkan semua saluran air pada unit

pergigian selama 1 minit sebelum pesakit
Pengendalian Mingguan Saliran Air Kerusi Pergigian

Sediakan biocides

Buang sisa air suling pada

penghujung hari rawatan

Pasangkan IWR dan keluarkan

semua air

Isi penuh IWR dengan biocides

Alirkan semua saluran pada unit

pergigian dengan biocides dan
biarkan pada masa yang ditetapkan

Buka IWR dan tuangkan semua biocide

Pasang IWR pada unit pergigian dan

alirkan sehingga kering

Isi IWR dengan 500 ml distilled

water dan alirkan pada semua
saluran air unit pergigian

Pastikan tiada sisa air pada glove

Buka IWR dan terbalikkan dan

keringkan

Tutup unit pergigian

Terima Kasih