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Frequently Asked Questions:
 

How does patient "suck back" affect waterline contamination?

   

Why is the recurrence of bacteria at 3 to 6 months?
   

Is it necessary to air-dry waterlines?
   

Is there a need for the CDC recommendations of a 3-minute pre-flush before beginning the dental treatment day and a 30-second flush between patients?
   

Is there a need to water-flush unused equipment?
   

Is it possible to treat other water using dental equipment such as the prophy-jet or scaler?
   

It is our belief that the Waterclave Water Purifications System's performance may be enhanced by the de-oxygenation of water while under the influence of high heat and pressure.
   

The quality of city source water is below 200 CFU/ml, what is the concern?
   

Separate water resevoirs are less expensive up front than the Waterclave System and can be as nearly as effective in the small dental practice, WHEN MAINTAINED.
   

Filters start out with a low start-up cost, but again, as the dental unit numbers increase, the cost of filter replacement and labor quickly arrive at the one time expense of the Waterclave System.
   

Systems with continuous chemical contact with the treatment water are designed with a maximum bacterial control level in mind.
   

Should the dental office, clinic or school even be concerned?
 
How does patient "suck back" affect waterline contamination?

With most modern dental equipment the “suck back” phenomenon of patient fluids is not a factor. Though reports have documented oral flora from waterline bacteria, the studies from Waterclave waterline testing demonstrate zero growth over a minimum of 4-6 months. These tested facilities have maintained the continuous patient exposure of a normal dental practice and thus would not allow the 4 to 6 month duration between bacterial recoveries. If there is an oral flora contamination, the concern is toward the installer or manufacturer, occurring when an individual's saliva wets the connectors during the dental unit repair, installation or factory assembly. This should be a request directed to the attention of all manufacturers and service techs.
Why is the recurrence of bacteria at 3 to 6 months?

The best explanation of this situation is that the tubing in the dental unit has numerous blind pockets or dead ends creating a hydrostatic pressure against the chemical soaking solution blocking the affect on the biofilm’s attachment. Notable is the expanding time span between the need for chemical application with the continuous use of the Waterclave System. Naturally, new dental equipment without the establishment of biofilm provides an unlimited time span between chemical applications, as long as the Waterclave System remains employed and the duwls remain unaffected by an outside bacterial influence (i.e. staff, repairmen or part replacement).
Is it necessary to air-dry waterlines?

Air drying duwls produce a result of minor success. Testing results demonstrated a short lived improvement where the reduction of CFUs/ml were reduced by ½ the baseline numbers; thus, if the testing counts were 20,000 CFUs/ml that number dropped to 10,000 and recovered to 20,000 within hours… not nearly the number to comply. Also complete drying of the waterlines is impossible without an alcohol additive or complete dismantling of the waterline. The results collected while the Waterclave System was functional have statistically shown no difference between the recovery of bacteria in the waterline with or without air-drying.
Is there a need for the CDC recommendations of a 3-minute pre-flush before beginning the dental treatment day and a 30-second flush between patients?

The CDC, with the new recommendations of 2004, have dropped the 3-minute pre-flush of water at the beginning of the treatment day after significant studies have demonstrated an inability to achieve the requested goal of >500CFUs/ml. The request by the CDC and Waterclave of 30-second water flushing between patients after dental waterline usage will remain.
Is there a need to water-flush unused equipment?

During unused treatment days there is no benefit to water flush equipment that would not be used on that particular date. Water retained without bacterial presence remains unaffected by prolonged absence of use. The outside influence of the office environment seemed to have no bearing on when the bacterial resurgence appeared.
Is it possible to treat other water using dental equipment such as the prophy-jet or scaler?

It’s just as simple to maintain attached equipment by using the quick-disconnect, designated on the dental units for these devices to deliver the chemical soaking solution during the maintenance protocol. The sampled test results from the prophy-jet and scaler remained similar to that of the treated dental unit waterlines in both the resurgence of bacteria and the 0 growth recovery plated on R2 agar.
It is our belief that the Waterclave Water Purifications System's performance may be enhanced by the de-oxygenation of water while under the influence of high heat and pressure.

The oxygen level exiting the Waterclave Water Purifier is >100 ppm, as opposed to city source water levels at 8,000 to 15,000 ppm. The low number (>100 ppm) may benefit the longevity between chemical applications by retarding the bacteria’s reactivation within the biofilm. This is strictly theory and should be a consideration for further study.
The quality of city source water is below 200 CFU/ml, what is the concern?

The dental community needs to see this in bold print: “ WHAT GOES INTO THE DENTAL UNIT IS NOT WHAT EXITS THE DENTAL PORTS”. It’s a simple issue but the dentist being unfamiliar with the problem does not understand the architecture of biofilm and the habitat within the dental unit waterlines. Water, even of 0 growth potential, cannot reverse a preexisting biofilm history. Chemical intervention to remove the biofilm from the dental unit waterlines is a necessary compliment that creates an environment where water with 0 growth potential will not encourage biofilm reformation. City source water with less than 500 CFUs/ml will exponentially expand in numbers within hours to an unacceptable level, after being delivered to the stagnant confines of the dental unit waterline. The difference between the Waterclave system and the city source water is that the Waterclave System will deliver 0 CFUs/ml consistently to the dental unit waterlines and because of this will not influence the tubing environment with bacterial forming biofilm.
Separate water resevoirs are less expensive up front than the Waterclave System and can be as nearly as effective in the small dental practice, WHEN MAINTAINED.

The time spent treating each dental unit water reservoir is 10 minutes to introduce a soaking solution and approximately 10 minutes to remove it. However, it has been our experience that as the number of dental units and maintenance time increased the inability to control staff error and disinterest also increased, thus lending to the dental unit waterline failure. The dental staff must be concerned with the three sources of bacterial contamination when using the water reservoir system: 1.cleansing of the water reservoir. 2. Application and removal of the chemical soaking solution to and from the dental unit waterlines. 3. Handling of the water used for dental treatment. Any lapse in one of these stages in treatment protocol restarts the cycle of biofilm formation. Six to 40 dental units is the range that the Waterclave Unit will provide its worth in time saving labor, along with cost effectiveness. The centrally located Waterclave delivers a continuous 0 growth water coolant without staff involvement and the periodic (4-8 months) chemical soaking solution is introduced without the staff having to hand-deliver it to every dental unit. Since this system is on demand from a single device the need to cleanse bottle reservoirs is eliminated.
Filters start out with a low start-up cost, but again, as the dental unit numbers increase, the cost of filter replacement and labor quickly arrive at the one time expense of the Waterclave System.

The failure rate of the filter is dependent upon the quality of water entering the system and the biofilm architecture within the dental unit waterlines. It must be realized that the filter is merely a damming structure offering no improvement to the up or down-line contamination. The maintenance of the after filter waterline must be monitored, and if necessary, chemically treated. The staff again must be concerned with multiple points of contamination including; filter replacement attachment (daily or weekly), the inlet water bacterial potency and chemical maintenance of the post filter waterline (as often as the replacement of filters). The Waterclave Water Purifier removes the variability of the water quality, erasing the need for the filter installation. The chemical intervention is a constant for all waterline systems and filters are no exception. The difference with a filter is the location of the chemical placement at the individual dental unit or waterline. This unit to unit treatment, liken to that of the water reservoir, is time consuming and becomes more likely to fail with increased unit numbers and handling.
Systems with continuous chemical contact with the treatment water are designed with a maximum bacterial control level in mind.

Increased bacterial numbers beyond the device's ability can adapt to the chemicals short fall and become more resistant and continue to expand at the original exponential value. Expanded chemical treatment with a separate chemical soaking solution may be needed for periodic control of existing biofilm due to the continuous chemical inadequacies. Another concern is the allergic reaction by the patient or staff member, as the chemicals become part of the air-borne spatter from patient treatment. Most of these devices are for single dental unit treatment and can approximate, at a minimum, $1000.00 per unit in cost. One device at each dental unit can easily surpass the cost of the Waterclave System within the larger dental practice.
Should the dental office, clinic or school even be concerned?

The ADA created a waterline request in 1995, for the year 2000 to account for a concern that was first perceived 30 years earlier and the CDC followed in 2004 with their request for >500CFUs/ml. Dentistry has evolved on many fronts in infection control creating an environment that meets or betters that of any other healthcare field. Waterline biofilm is part of the circle of infection control that, if broken, becomes a bacterial compromise of a healthy treatment site and an uncertain area of responsible patient care. Continuing to advance the profession by maintaining a healthy treatment barrier is why the dental profession must address bacterial numbers that consistently produce water coolant that is not fit for consumption. As a practicing dentist, I find it difficult to believe that many of the dental learning institutions have approached this with only passing concern and have led their students to, at best, ignore the problem and at worst, echo the sentiment of “Where are the bodies?” Like so many sources of contamination within our practices, the dental unit waterline is out of sight and out of mind. The patient expectations should not be misled when they assume treatment water coolant attains at least the quality of a glass of tap water.
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Overland Park, Kansas 66209
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