Effects of iodine in microbial control of dental treatment water.

Objective: To determine the effects of low levels of iodine constantly present in the dental unit water system on microbial control of dental treatment water and biofilm control.

Materials And Methods: This study used a dental unit water system simulator with eight dental unit waterline systems built to scale and function, each controlled via computer. Each of the eight units was operated independently, four units supplied with self-contained water reservoirs and four units supplied with municipal water. Four units were precleaned to remove biofilm buildup. The study had a well-balanced design with equal representation (variables) of presence/absence of biofilms, selfcontained reservoirs for introduction of treatment water, source water directly connected to municipal water source and iodinated cartridges within the self-contained reservoirs and between municipal water and dental unit. Point-of-use iodinated resin cartridges (IRC) were retrofitted proximal to handpiece and air/ water syringe tip lines in four units, and iodinated resin water cartridges (IRSWC) were fitted to the other four units at the source water output. Heterotrophic plate counts were performed at baseline and twice weekly for a period of 6 weeks. One representative waterline sample was taken from each group at baseline and end-of-study to analyze changes in biofilm status using scanning electron microscopy.

Results: Waterlines not previously contaminated with biofilms did not show organization of biofilm matrix in units equipped with IRSWC. Constantly present low levels of iodine, demonstrated some disruption of biofilms in waterlines already contaminated with mature biofilms. All groups showed contamination levels < 500 cfu/ml (colony forming units per milliliter) consistent with the CDC and ADA guidelines.

Conclusion: In this 6 weeks study, IRSWC equipped waterlines showed disruption of established biofilms, controlled formation of new biofilms in clean lines and rendered the dental treatment water < 500 cfu/ml. Point-of-use iodinated resin cartridges were also effective in controlling contamination in the dental treatment water.

Clinical Significance: Dental unit water systems that are in use get contaminated with microbes and biofilms in weeks of being put into use. These biofilms contaminate the treatment water thereby putting patients and staff at risk of infection by predominantly gram-negative microbes. Biofilms in the water systems must be cleaned periodically with a strong decontaminant and the dental treatment source water needs to be modified with a low-grade antimicrobial that can preserve the water quality yet safe to humans. In this translational research study, we evaluate the effects of elemental iodine dissolved in water flowing through an iodine containing cartridge in controlling biofilm and dental treatment water contamination using a dental unit water system simulator, prior to clinical utilization.