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Dental Water Line Infection Control: A Work In Progress

Dental Water Line Infection Control: A Work In Progress
by John A. Molinari, PhD

Although effective, user-friendly choices are available to meet the challenge of infection control for dental water lines, it is ultimately up to individual dentists and dental personnel to choose and use them correctly.

The first report describing high concentrations of bacteria in dental handpiece water lines was published in the British Medical Journal by Blake in 1963. (1) Subsequent studies have built on this pioneer investigation by (a) looking at mechanisms of microbial biofilm formation, (b) demonstrating that the long, narrow plastic lines used to deliver water and air during patient treatment provide both optimal growth environments for microbial colonization and a potential health hazard by releasing contaminated water into patients' mouths and the air, (c) identifying multiple classes of microorganisms in dental water samples, (d) developing effective approaches to treat dental unit water lines (DUWL) and reduce bacterial colonization, and (e) developing analytical systems to monitor water quality.

Many of the scientific and technological advances relating to microbial contamination of DUWL came about following reports by the Centers for Disease Control and Prevention (CDC) describing outbreaks in communities and hospitals caused by waterborne pathogens. These included bacteria such as Legionella pneumophila, Escherichia coli, Pseudomonas sp., and a highly resistant protozoan, Cryptosporidium parvum. With specific regard to dentistry, potential human pathogens, including Pseudomonas, Klebsiella, Legionella, and nontuberculous Mycobacterium species, have been isolated from dental water supplies. These and most other microbes detected in dental water systems originate from the public water supply and do not usually present a high disease risk for healthy persons. However, these organisms could potentially cause infection and clinical illness in immune-compromised individuals. The challenge presented by contaminated DUWL has unfortunately shifted in recent years from the "potential" infection category to "documented" cross-infection and illness. Since 2012 there have been three reported instances of dental patients contracting potentially life-threatening infections after receiving treatment with heavily colonized water in practices.

Read full article on Dental Economics.