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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.

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

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

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

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

000. . narrow-bore tubing that provides cooling and irrigating water to dental hand instruments.000 (colony forming units) CFUs/ml have been documented.000 to 10. primarily centre on the formation of ³microbial biofilm´ along the walls of the long .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.

DUWL Contamination Dynamics Input: Water quality Waterline: Biofilm Output: Retraction and Backflow .

.Close up of dental tube opening. 24-1 Copyright 2003. Elsevier Science (USA). Fig. All rights reserved.

Elsevier Science (USA). .A cross-section of a dental unit waterline illustrating the formation of biofilm on the inside wall of a dental tube. Fig. All rights reserved. 24-2 Copyright 2003.

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

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. .*3 Environmental Infection Control Both ³water-borne´ and ³human´ oral microbes have been found in dental unit water. indicating that both ³incoming community water´ and ³patient¶s mouths´ are sources of these microbes.

The Center for Disease Control.Use of a high-velocity evacuation should be considered to minimize the spread of spray. -.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 . . splatter and aerosols generated during treatment procedures. USA (CDC) has recommended that : -.

-. . and -.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 .

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

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. the dental unit manufacturer should be consulted to establish an appropriate maintenance routine. Routine maintenance of anti-retraction valves is necessary to ensure effectiveness .

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

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

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

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