DISINFECTION OF DENTAL UNIT WATERLINES USING CLEANCURT AND EUCALYPTUS 1

The Disinfection of Dental Unit Waterlines using CleanCurt and Eucalyptus

Brianna Poff

Lone Star College-Kingwood

DHYG 2201
 DISINFECTION OF DENTAL UNIT WATERLINES USING CLEANCURT AND EUCALYPTUS 2

Annotated Bibliography

Pankhurst, C., & Coulter, W. (2017). Basic guide to infection prevention and control in dentistry

(2nd ed.). Chichester, West Sussex, UK: John Wiley & Sons.

Biofilm itself is very resistant to disinfectants due to its large community of differing

bacteria and its protective organic matrix (Pankhurst et al. 2017). The design of dental unit water

lines plays an immense role in the formation of biofilm. DUWL’s have a high surface area to

volume ratio due to its small and narrow size. Water moves in layers within the water lines.

While water in the center of the line travels the fastest, water closest to the edge of the line

travels the slowest due to friction. The slower speed of water closest to the edge of the lines

leaves bacteria time to colonize in those areas. The majority of contaminants seen in water lines

are gram‐negative aerobic species. (Pankhurst et al. 2017). The ADA recommends that water

used for dental treatments should contain less than 200 CFU/ml of heterotrophic aerobic

organisms (Pankhurst et al. 2017). Most dental units have an average of 130 hours/week of

inactivity where stagnation takes place, increasing the amount of microbes. Flushing DUWL’s

reduces bacterial counts by approximately 97% but cannot remove the biofilm alone (Pankhurst

et al. 2017). Reservoir bottled water systems can be an advantage due to the avoidance of other

possible contaminants when using municipal water. Regular disinfection of the reservoir bottles

and flushing the waterlines with a disinfectant are needed in order to reduce biofilm.

Shajahan, I. F., Kandaswamy, D., Srikanth, P., Narayana, L. L., & Selvarajan, R. (2016, June

12). Dental unit waterlines disinfection using hypochlorous acid-based disinfectant.

Retrieved March 22, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979282/
 DISINFECTION OF DENTAL UNIT WATERLINES USING CLEANCURT AND EUCALYPTUS 3

This study evaluates the efficacy of a dental disinfectant solution known as “CleanCert.”

New dental unit water lines were installed in 13 dental chairs and supplied with tap water.

Treatments using the dental chairs continued for the next 10 days. On the 10th day, 12 of the 13

dental waterlines were treated with 200ml of CleanCert and were left to sit overnight. The

untreated dental unit was referred to as the control tube. The next day all 13 of the waterlines

were flushed out and water was ran through them. The waterlines were removed and 1 inch was

cut from each at random areas, then cut again lengthwise, to expose the inside of the tubes. The

13 samples were fixed in 2% glutaraldehyde and washed in a phosphate buffer. Dehydration

using alcohol was performed for 10 minutes. The final treatment used hexamethyldisilazane for

another 10 minutes. After examination under a scanning electron microscope the control tube

showed mature microbial colonization with continuous filamentous organic matrix (Shajahan et

al. 2016). The remaining 12 waterlines showed a smooth tubing wall and no slime layer or

bacterial cells. Based on the findings, the use of CleanCert for biofilm removal was proven

effective (Shajahan et al. 2016).

Krishnan C.G, A., Ghosh, A., Gurnani, P., Shah, A., Sahu, D., & K, A. (2016). Comparative
Efficacy of Eucalyptus Oil and Commercially Available Disinfectant Against Dental Unit
Waterlines- An Experimental Study. Retrieved March 22, 2019, from
http://www.ijohmr.com/upload/Comparative Efficacy of Eucalyptus Oil and
Commercially Available Disinfectant Against Dental Unit Waterlines- An Experimental
Study.pdf

The efficacy of eucalyptus oil when compared to “Continu” is tested. Disinfection of

each of the 24 handpieces and air water syringes took place using alcohol. Baseline water

samples were then collected and put into sterile containers and stored in a refrigerator. The

eucalyptus oil was extracted after distilling and soaking and was diluted into 3 different
 DISINFECTION OF DENTAL UNIT WATERLINES USING CLEANCURT AND EUCALYPTUS 4

concentrations. 24 dental units were divided into 4 groups of 6. 50 ml of Continu was added to

the reservoir bottle of group 1, group 2 was given 50 ml of 1:1 eucalyptus oil, group 3 was given

50 ml of 1:10 eucalyptus oil, and group 4 was given 50 ml of 1:100 eucalyptus oil (Krishnan et

al. 2016). The disinfectants were ran for 2 minutes and the unit was left to sit overnight. Water

samples were taken at the beginning of the following day. Afterwards, reservoirs were filled with

water and treatments proceeded. This routine was performed for 1 week. Afterwards, the samples

were placed on agar dishes and incubated. After 5 days the CFU/ml were obtained. Group 1,

which was given Continu, presented with a mean value of 0.001 in the reduction of bacterial

count. Group 2, 0.010. Group 3, 0.274, and group 4, 0.098 (Krishnan et al. 2016). Group 2’s

results were the closest to Continu. Eucalyptus was then proven effective against disinfection

when compared to Continu (Krishnan et al. 2016). Eucalyptus is said to be a natural, safe, and

cost effective substitute to chemical disinfectants (Krishnan et al. 2016).

Discussion

The number of dental units used for each study varied, with Shajahan et al. (2016) using

13 dental units and Krishnan et al. (2016) using 24 dental units. Shajahan et al. (2016) installed

new dental water lines in all 13 units, whereas Krishnan et al. (2016) did not, and instead

disinfected all 24 of the unit’s handpieces and air water syringes prior to the treatment and

obtaining of the samples. The CleanCurt used in Shajahan et al. (2016) is a chemical disinfectant,

and the eucalyptus in Krishnan et al. (2016) was used as a natural disinfectant. Shajahan et al.

(2016) focused solely on the results CleanCurt had whereas Krishnan et al. (2016) compared

their results of Eucalyptus to another disinfectant named Continu. Shajahan et al. (2016)’s

administration and sampling of the disinfectant differed from that of Krishnan et al. (2016).

Krishnan et al. (2016) had 3 different ratios of eucalyptus that was administered into units of
 DISINFECTION OF DENTAL UNIT WATERLINES USING CLEANCURT AND EUCALYPTUS 5

differing groups in order to test which ratio was more effective when compared to Continu. On

the other hand, Shajahan et al. (2016) used 200ml of CleanCurt for every unit and did not

compare its results to another disinfectant product. As stated before, the sampling of the two

studies also differed, but the number of samples obtained over the course of the study differed as

well. Krishnan et al. (2016) treated the units with Continu and Eucalyptus and then proceeded to

obtain water samples from each unit every day for 7 days. Shajahan et al. (2016) obtained only

one sample from each unit after 10 consecutive days of treating with CleanCurt. Another

difference between the two studies is the way in which the samples were obtained. Shajahan et

al. (2016) cut 1 inch of the DUWL’s and viewed them under a microscope whereas Krishnan et

al. (2016) did not cut the water lines and instead obtained water samples and tested them. A

similarity between the two is that both studies added their products to the reservoir bottles and

ran the water lines for 2 minutes. The products were then left to sit in the units over night. Both

products tested in the two studies were also proven effective in the disinfection of dental unit

water lines.
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References

Krishnan C.G, A., Ghosh, A., Gurnani, P., Shah, A., Sahu, D., & K, A. (2016). Comparative
Efficacy of Eucalyptus Oil and Commercially Available Disinfectant Against Dental Unit
Waterlines- An Experimental Study. Retrieved March 22, 2019, from
http://www.ijohmr.com/upload/Comparative Efficacy of Eucalyptus Oil and
Commercially Available Disinfectant Against Dental Unit Waterlines- An Experimental
Study.pdf

Pankhurst, C., & Coulter, W. (2017). Basic guide to infection prevention and control in dentistry
(2nd ed.). Chichester, West Sussex, UK: John Wiley & Sons.

Shajahan, I. F., Kandaswamy, D., Srikanth, P., Narayana, L. L., & Selvarajan, R. (2016, June

12). Dental unit waterlines disinfection using hypochlorous acid-based disinfectant.

Retrieved March 22, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979282/