{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T19:18:40Z","timestamp":1772738320911,"version":"3.50.1"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006360","name":"Bundesministerium f\u00c3\u00bcr Wirtschaft und Energie","doi-asserted-by":"publisher","award":["KK5162201CR0"],"award-info":[{"award-number":["KK5162201CR0"]}],"id":[{"id":"10.13039\/501100006360","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006360","name":"Bundesministerium f\u00c3\u00bcr Wirtschaft und Energie","doi-asserted-by":"publisher","award":["KK5162201CR0"],"award-info":[{"award-number":["KK5162201CR0"]}],"id":[{"id":"10.13039\/501100006360","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Dental chair unit (DCU) waterlines are often microbiologically contaminated. This poses infection risks for patients and dental staff if they are not regularly rinsed and disinfected. This clinical hygiene study evaluated chlorine dioxide (ClO\u2082) rinsing protocols for microbial and biofilm reduction in DCUs. Automated protocols were tested with varying ClO\u2082 concentrations and flushing frequencies. Flow cytometry and agar culturing were used to assess microbial load. Continuous low-dose rinsing (1.2\u2009mg\/L ClO\u2082) achieved sustainable microbial reduction (up to 2.51 log\u2081\u2080), whereas single high-dose shock disinfections (22.7\u2009mg\/L) resulted in transient reductions. ClO\u2082 was effective in biofilm removal, but its depletion during stagnation highlights the need for continuous application. ClO\n                    <jats:sub>2<\/jats:sub>\n                    seems to be a suitable disinfectant for removing both microbiological contamination and biofilms of DCUs; however, depletion effects of active ClO\n                    <jats:sub>2<\/jats:sub>\n                    were evident underlining the importance of a stable permanent ClO\n                    <jats:sub>2<\/jats:sub>\n                    application. Our results prove that permanent low-dose ClO\n                    <jats:sub>2<\/jats:sub>\n                    application of DCU waterlines is recommended for sustainable water disinfection. A high-concentrated shock disinfection on a periodically basis can be used for biofilm removal, which was demonstrated with experimentally grown biofilm of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    .\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0342347","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T18:35:12Z","timestamp":1772735712000},"page":"e0342347","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chlorine dioxide flushing protocols for microbial reduction in dental chair units"],"prefix":"10.1371","volume":"21","author":[{"given":"Julian","family":"Winkler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susann","family":"Herzog","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Dahlhaus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arndt","family":"Matschulat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmut","family":"Uhlmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Mellmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1373-8763","authenticated-orcid":true,"given":"Thorsten","family":"Kuczius","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"issue":"9","key":"pone.0342347.ref001","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.jdent.2007.07.005","article-title":"Microbial biofilm formation in DUWS and their control using disinfectants","volume":"35","author":"JT Walker","year":"2007","journal-title":"J Dent"},{"issue":"1","key":"pone.0342347.ref002","doi-asserted-by":"crossref","first-page":"2223477","DOI":"10.1080\/20002297.2023.2223477","article-title":"First water safety plan approach applied to a Dental Clinic complex: identification of new risk factors associated with Legionella and P. aeruginosa contamination, using a novel sampling, maintenance and management program","volume":"15","author":"F Marino","year":"2023","journal-title":"J Oral Microbiol"},{"issue":"11","key":"pone.0342347.ref003","doi-asserted-by":"crossref","first-page":"3954","DOI":"10.1128\/aem.62.11.3954-3959.1996","article-title":"Multiparametric analysis of waterline contamination in dental units","volume":"62","author":"J Barbeau","year":"1996","journal-title":"Appl Environ Microbiol"},{"issue":"10","key":"pone.0342347.ref004","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.2217\/fmb.11.104","article-title":"Management of dental unit waterline biofilms in the 21st century","volume":"6","author":"MJ O\u2019Donnell","year":"2011","journal-title":"Future Microbiol"},{"issue":"4","key":"pone.0342347.ref005","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1875-595X.1998.tb00697.x","article-title":"Microbial contamination of dental unit waterlines: the scientific argument","volume":"48","author":"CL Pankhurst","year":"1998","journal-title":"Int Dent J"},{"issue":"2","key":"pone.0342347.ref006","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2021-001685","article-title":"Managing dental unit waterlines: a quality improvement programme","volume":"11","author":"F Umer","year":"2022","journal-title":"BMJ Open Qual"},{"key":"pone.0342347.ref007","doi-asserted-by":"crossref","first-page":"117205","DOI":"10.1016\/j.watres.2021.117205","article-title":"The microbiological load and microbiome of the Dutch dental unit; 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