Biweekly versus triweekly hydrogen peroxide shock treatment for controlling dental unit waterline contamination: a single-center pilot randomized clinical study.

Authors

Jingcheng Wen, Wenjing Liu, Tianyi Shao, Jing Chang, Yanying Li, Ting Shuai, Xiue Li

Published in

Frontiers in oral health. Volume 7. Pages 1842649. Epub Sep 30, 2026.

Abstract

This single-center pilot randomized clinical study compared the efficacy of biweekly and triweekly 1.41% hydrogen peroxide (H₂O₂) shock treatments, combined with continuous 0.0141% H₂O₂ disinfection, for controlling microbial contamination and biofilm formation in dental unit waterlines (DUWLs).
Eight dental chair units (DCUs) were randomized to Group A (triweekly shock treatment, n = 4) or Group B (biweekly shock treatment, n = 4). After standardized baseline biofilm removal using BRS®, total viable counts (TVCs) and biofilm architecture assessed qualitatively by scanning electron microscopy (SEM), were monitored for 6 weeks. One randomly selected DCU (group A1 and B1) from each group underwent an exploratory additional 6-week observation, with the resulting data analyzed descriptively.
Group B maintained a 100% compliance rate (≤ 100 CFU/mL) throughout the 6-week period, whereas Group A showed a significantly lower compliance rate of 78.47%, with recurrent microbial rebound during the third week of each cycle. Biweekly shock treatment increased the probability of compliance by 21.53 percentage points compared with triweekly treatment (95% CI: 13.74-29.32, Wald χ²  = 29.34, P < 0.001). Significant between-group differences in TVCs emerged by day 17 (P < 0.05). During the 12-week observation, Group B1 remained compliant, whereas Group A1 showed recurrent non-compliant TVCs during the third week of several cycles. SEM observations showed biofilm-like structures in the sampled tubing segment from Group A after 6 weeks, whereas no obvious mature biofilm-like structure was observed in the sampled segment from Group B.
Within the limitations of this single-center pilot study, continuous disinfection with 0.0141% H₂O₂ combined with biweekly 1.41% H₂O₂ shock treatment was associated with more consistent water-quality compliance than triweekly shock treatment after initial BRS® biofilm removal. These preliminary findings require confirmation in larger multicenter, year-round studies incorporating longer follow-up and microbial identification before any change to routine clinical protocols can be considered.

PMID:
42876661
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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