What’s in your dental waterlines?
You’ve seen the pictures and you’ve read the headlines – asking this question is something we’d all rather avoid.
Waterline contamination is a danger that few dental professionals understand – and even fewer want to spend time worrying about it.
But safe and clean dental unit waterlines are essential for the function of your practice. The narrow structure of waterlines provides the perfect environment to grow an dangerous obstacle to great patient care: Biofilm.
What is Biofilm?
Biofilms are heterogeneous clusters of microorganisms that colonize within dental waterlines. They stick to the inside of waterlines and release harmful microbes into the patient treatment water that flows through your dental waterlines and into your patient’s mouth.
The microorganisms that form biofilms include fungi, bacteria, protozoans, Legionella, Pseudomonas Aeruginosa, and nontuberculous Mycobacterium. These microorganisms feed off of each other, and when they come together to form biofilms they easily spread and become very difficult to remove from dental waterlines.
(Credit: Ora, Inc. http://www.oraclinical.com/articles/biomes-biofilm-and-ocular-surface)
Why are Dental Waterlines Good Environments for Biofilm Growth?
Biofilms thrive in stagnant water. Water sits still in between use, patient visits, and overnight, giving biofilms the perfect opportunity to multiply. During a patient visit, the intermittent flow allows the biofilm to easily spread and form new colonies.
Long and Narrow Waterline Structure:
The length of dental unit waterlines offers many areas for biofilm to grow. The narrow diameter of dental waterlines causes water to constantly come into contact with the biofilms attached to the inner walls.
How Dangerous is Biofilm?
Biofilms threaten dental patients and practices alike. A 2016 outbreak caused mycobacterial infections in 72 children and was linked to contaminated dental waterlines in a Southern California pediatric dental clinic. This 10-practice dental service organization is no longer practicing and is involved in heavy litigation. Another incident occurred in 2011 when an 82-year-old Italian woman died of Legionnaires Disease because of airborne dental waterline contamination. And another in Georgia led to 20 children getting Mycobacterium abscessus infections.
These cases have led to more treatment and testing by top dental professionals, new guidelines from regulatory agencies, and even legislation regulating dental water treatment and monitoring in California (Learn more: California Legislation AB1277: What We Know So Far)
The bottom line is that biofilms endanger dental patients. Practices looking to offer the best care need to be informed.
The CDC Standard of Care
In order to effectively manage biofilm counts, the ADA and CDC have put forth a standard of care recommending dental water must be less than or equal to 500 Colony Forming Units of Heterotrophic Bacteria (Biofilms) per Milliliter (or 500 CFU/mL) for procedures. These are the same safety standards used for drinking water.
Meeting and exceeding the 500 CFU/mL standard ensures patient protection.
It should be noted here that even if your water is tested and is less than 500 CFU/mL, biofilm can grow very rapidly. We recommend that any office with a line measured above 200 CFU/mL implement a shock protocol immediately.
Achieving 500 CFU/mL
The first and most important step for achieving the 500 CFU/mL standard is to test your waterlines. While implementing effective shocking and treatment solutions are necessary aspects of dental waterline maintenance, consistent dental waterline testing is the only way to check if your dental waterlines are safe for patients.
After completing over 100,000 dental water tests, ProEdge Dental Water Labs statistics reveal that 30% of treated waterlines and 100% of non-treated waterlines fail to meet the CDC guidelines. Additionally, 61% of practices test multiple water sources have at least one water sample fail.
These statistics are for two reasons: treatment effectiveness and improper use. Based on over 20,000 waterline tests, some treatment products fail as much as 82% of the time.
Simply implementing a dental waterline treatment procedure does not mean that your dental unit waterlines will be safe. Dental unit waterline testing is necessary to make sure that your dental water treatment protocol is working, and that you exceed the 500 CFU/mL standard.
How Often Should I Test My Dental Waterlines?
Studies have shown that biofilm growth can continue 1-3 months after a treatment product is implemented into dental waterlines. Because of this, the Organization for Safety, Asepsis, and Prevention (OSAP) suggests quarterly waterline testing and various other waterline maintenance procedures call for even more frequent testing practices.
The team at ProEdge suggests checking with your water maintenance treatment manufacturer’s instructions, but in general, no less than quarterly testing to ensure your practice and patients are protected.
Developing a Safe Water Treatment Protocol
There are a number of treatment options available and we’ve seen many of them be successful. However, not all protocols are created equal. On average, 30% of waterlines fail to meet the standard, and some treatment products perform significantly worse.
Should your dental practice fail a water test, you can know that you are not alone. Of all practices that test, more than 60% of these practices have at least one water source that fails.
However, it is also essential that you take this seriously. Contaminated waterlines put patients at risk of serious, potentially life-threatening infections, and could do damage to any clinic.
Once your test results are in, we have dental water experts who will work with you until you achieve safe water. We’ll work with your team to help diagnose the problem and determine the best next steps. You’ll get the training, resources, and expert guidance to treat effectively.
Despite what is often assumed, treating your dental water often requires more than a once-per-year product installation. Water that actually passes testing includes consistent dental waterline testing, proper shocking procedures, and correct use of treatment products.
How to Test Your Waterlines
There are a few dental waterline testing options available for dental professionals. Accuracy, of course, is everything when it comes to testing.
ProEdge Dental Water Labs utilize a simple, 5-Step Mail-In testing method that provides you a fast, independent, and completely accurate report on the safety of each dental water source you test. We utilize a testing method that neutralizes any anti-microbials still present in your water sample vials to ensure you get a definitive view of your practice’s water safety.
The ProEdge Testing 5 Step Process:
- Take a water sample directly from each dental unit waterline
- Use FedEx overnight to ship water samples to ProEdge Dental Water Labs (Included in most packages)
- Utilizing the Heterotrophic Plate Count Method (HPC), ProEdge will process your water samples in our lab
- Complete Test Results Report will be emailed to you within 7 days
- Free Consultation with a ProEdge Water Expert to ensure water safety
We’re Here to Help
We like water science, of course, but we love helping dedicated dental professionals. Our expert staff has tested over 100,000 waterlines and provided expert consultations to the vast majority of those. We know what works and we know what doesn’t work. And we want to help you provide the best standard of care for your patients.
Whether pass or fail, our team will work with you as long as needed to ensure your water is clean. In fact, we promise to take dental water safety off your worry list. Go on and test us.
Protect Your Patients