Lauritano D, Nardone M, Gaudio R M, Candotto V, Carinci F
Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Ministry of Public Health, Rome, Italy.
Oral Implantol (Rome). 2017 Nov 30;10(3):283-288. doi: 10.11138/orl/2017.10.3.283. eCollection 2017 Jul-Sep.
The aerosol produced during the use of dental instruments can spread pathogens potentially harmful to health. Most of the pathogens found in hydraulic system are Gram-negative aerobic heterotrophic environmental bacterial species exhibiting very low pathogenicity, although they may be of concern in the treatment of vulnerable patients, such as immunocompromised, medically compromised individuals and dental team. Dental team can be exposed to pathogenic microorganisms including cytomegalovirus, hepatitis B virus, hepatitis C virus, herpes simplex virus and Legionella spp. Legionella spp. are ubiquitous in hydraulic system, in fact surveys have shown that the percentage of samples taken at different dental chairs that were positive for Legionella spp. and ranged from 0 to 100%. The concentration of Legionella spp. in hydraulic system may reach 1000 organisms per ml. The primary route of Legionella spp. transmission is inhalation or aspiration of environmentally contaminated aerosols. All dentists are required to conduct a statutory risk assessment of their hydraulic system, in fact to comply with their legal duties, dentists must identify and assess the sources of risk and prepare a scheme for preventing and controlling risks. Moreover, they must monitor the quality of their hydraulic system at least annually to ensure that they are "legionellae free".
牙科器械使用过程中产生的气溶胶可传播对健康有潜在危害的病原体。在水系统中发现的大多数病原体是革兰氏阴性需氧异养环境细菌，致病性很低，不过在治疗脆弱患者（如免疫功能低下者、患有其他疾病的个体以及牙科团队成员）时可能令人担忧。牙科团队可能接触到包括巨细胞病毒、乙型肝炎病毒、丙型肝炎病毒、单纯疱疹病毒和军团菌属在内的致病微生物。军团菌属在水系统中普遍存在，事实上，调查显示，在不同牙科治疗椅采集的样本中，军团菌属呈阳性的比例从0%到100%不等。水系统中军团菌属的浓度可能达到每毫升1000个菌体。军团菌属传播的主要途径是吸入或误吸受环境污染的气溶胶。所有牙医都必须对其水系统进行法定风险评估，事实上，为履行其法律职责，牙医必须识别和评估风险来源，并制定风险预防和控制方案。此外，他们必须至少每年监测一次水系统的质量，以确保其“无军团菌”。
