Biofilms augment the number of free-living amoebae in dental unit waterlines

Freshwater amoebae are ubiquitous. Some species can cause infections in humans while others can ingest and protect opportunistic bacteria. Although the presence of free-living amoebae in various water sources has been reported, few studies have looked at their concentration, which may be clinically relevant, especially if they are present in healthcare devices. A simple technique was used to detect, observe, and evaluate the concentration of free-living amoebae in dental unit and tap water samples. Fifty-three water samples were collected from 35 dental units (air/water syringes) and 18 water taps. The technique was based on the ability of waterborne bacteria to create a biofilm and serve as substratum for the development of amoebae naturally present in the water samples. Laboratory-grown freshwater biofilms support the proliferation of a wide variety of free-living amoebae. All the dental unit water samples tested contained amoebae at concentrations up to 330/mL, or more than 300 times the concentration in tap water from the same source. Hartmanella, Vanella, and Vahlkampfia spp. were the most frequently encountered. Naegleria and Acanthamoeba spp. were also present in 40% of the samples. Four of the samples collected from dental units, but none from water taps, contained amoebae able to proliferate at 44 degrees C. Biofilms that form inside some dental instruments can considerably increase the concentration of free-living amoebae, some of which are potential human pathogens.