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.

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

If the colonists are not immediately separated from the 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. they can anchor themselves more permanently using cell adhesion molecules such as pilli.

*1. e. bacteria. protozoa and algae. Biofilms are present on the teeth of most animals as dental plaque. Biofilms can contain many different types of microorganism.2 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. where they may become responsible for tooth decay.g. . archaea.

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

narrow-bore tubing that provides cooling and irrigating water to dental hand instruments.Biofilms in Dentistry Dental Unit Waterline (DUWL) Contamination : The current problem with the water quality used in dental clinical setups. Levels of microbial contamination as high as 10.000. primarily centre on the formation of ³microbial biofilm´ along the walls of the long .000 to 10.000 (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. Elsevier Science (USA). All rights reserved. . 24-1 Copyright 2003.

Fig. 24-2 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.

Elsevier Science (USA).Magnification of biofilm formation on the walls of the tube. 24-3 Copyright 2003. All rights reserved. . Fig.

Most of the microbes detected are of very low pathogenicity or are ³opportunistic pathogens´ that cause harmful infections only under special conditions or in immunocompromised people. . indicating that both ³incoming community water´ and ³patient¶s mouths´ are sources of these microbes.*3 Environmental Infection Control Both ³water-borne´ and ³human´ oral microbes have been found in dental unit water.

. splatter and aerosols generated during treatment procedures.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. USA (CDC) has recommended that : -. -.The Center for Disease Control.

Sterile saline or sterile water should be used as a coolant/irrigator when surgical procedures involving the cutting of bone are performed.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 -.-.

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

the dental unit manufacturer should be consulted to establish an appropriate maintenance routine. Routine maintenance of anti-retraction valves is necessary to ensure effectiveness . anti-retraction valves (one-way flow check valves) should be installed to prevent cross-infection. .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 .

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.Other reusable intraoral instruments attached to. Manufacturer¶s directions should be followed to ensure effectiveness of the process as well as longevity of the instruments. .

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

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

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