Dental units: an environmental study of sources of potentially pathogenic mycobacteria.

SETTING

Infections caused by non-tuberculous mycobacteria (NTM) are generally thought to be acquired from environmental sources. However, little is known about the situations in which transmission occurs.

OBJECTIVE

In an attempt to identify situations of relevant contact with NTM we investigated the water to which patients are exposed during dental treatment.

DESIGN

The concentration and species of NTM were determined in 43 cooling and spray water samples from 21 dental units in ten offices. In addition, mycobacterial colonization of 16 biofilm samples from the waterlines of two dental units was investigated.

RESULTS

The mean NTM concentration in the water samples was 365 colony-forming units (cfu) per mL, exceeding the mean drinking water concentration by a factor of almost 400. In the biofilm samples the mean NTM density amounted to 1165 cfu/cm2. The species identified included Mycobacterium gordonae, M. flavescens, M. chelonae, 'M. chelonae-like organism' and M. simiae.

CONCLUSION

High numbers of NTM may be swallowed, inhaled or inoculated into oral wounds during dental treatment, possibly resulting in colonization, sensitization or infection. Mycobacterial proliferation in biofilms forming within dental units may explain the extent of NTM contamination of dental spray and cooling water.