Best practices for maximum infection control and patient safety.
Dental visits are essential to oral and overall health, and patients expect that the water used chairside will keep them safe from harm. Are your dental waterlines as clean as they could be?
Maintaining dental waterline quality is critical to infection prevention and control. Dental waterline systems deliver water through narrow plastic tubes to ultrasonic scalers, air/water syringes, dental drills, and more. If harmful microorganisms are allowed to grow and proliferate in waterlines, patients and practitioners can be at risk for anything from respiratory diseases to viral infections.
This article will examine the dangers of poorly maintained dental waterlines, best practices for maximizing waterline hygiene and infection control, and products that help keep patients and practitioners safe.
Why are dental waterline testing and maintenance necessary?
Maintaining waterline quality is an ongoing responsibility in every dental office, but sometimes, the water is not as clean as it should be. An 11-year study of dental unit waterline testing in Saskatchewan showed that 21% of the tests failed. A comprehensive US study of over 22,000 waterline tests found that 31% of treated dental unit waterlines failed.
Why did they fail? They did not meet the EPA and CDC standards for safe drinking water: < 500 colony-forming units (CFU) of heterotrophic bacteria per mL of water. This standard also applies to Canada, and regulations and guidelines for frequency of waterline testing vary by province.
Even though municipal drinking water is generally used in most dental practices, dental unit waterlines can become dangerously contaminated. How does this happen? Contamination from microorganisms such as bacteria, viruses, fungi, and protozoa can come through the lines supplying water to dental instruments, as well as from bottled water systems and even from patient fluids entering the line due to back pressure and inadequate valves. These microorganisms can proliferate in dental waterline systems, leading to hazardous biofilm buildup.
Biofilm builds up for many reasons. Low water flow through the long, narrow tubing allows it to attach to the lines. Extended downtime during off-hours can cause water in the lines and bottles to stagnate and microorganisms to multiply. Additionally, patient saliva and blood can further feed biofilm growth.
Contaminated water in dental unit waterlines can cause infections in patients and practitioners and has been linked to life-threatening legionella, nontuberculous mycobacteria, and pseudomonas aeruginosa infections. But there are ways to control the quality of the water used chairside.
Essential infection control best practices
In general, best practices include treating dental unit waterlines regularly with disinfectants to maintain drinking water standards of < 500 CFU/mL. Dental waterline quality should be tested according to provincial regulations. Unless otherwise stated by the manufacturer, lines should be flushed after each patient for 20-30 seconds and at the end of each day for 2 minutes. They should also be cleaned and maintained according to manufacturer guidelines. For surgical procedures, it is recommended that sterile saline or sterile water be used with sterile single-use syringes or autoclavable syringes. Disposable sterile tubing should also be used since dental waterlines do not provide an aseptic environment.
A 2024 ADA Science and Research study showed that dental professionals recognize the importance of infection control in dental waterlines. Yet, there were “considerable gaps in knowledge and practice that could lead to patient harm.” For patient safety, dental practices should have policies and procedures in place for maintaining dental waterlines, with a designated infection control officer who can educate the rest of the staff and who knows the protocols to follow if one or more lines fail a water test.
Highly effective dental waterline testing and maintenance products
In-Office Dental Waterline Test Kits
Fast, easy, and accurate, these in-office dental waterline test kits ensure chairside water is CDC-compliant. There is no solution to add, and the results appear within 48 to 72 hours. Rather than just showing pass or fail, these tests indicate ranges of CFUs so dental offices can take appropriate action. The economical test kits come in packs of 4, 8, 12, and 24, and since there is no need to send the sample out, the results are confidential.
Dental Waterline Maintenance Tablets
Tasteless, odourless, and safe, these dental waterline maintenance tablets keep lines clean for up to 28 days. Add to dental water bottles when it is time to refill, and the formula stays continuously present in waterlines to inhibit microbial growth. Available in 50-packs for treating 2 L and 750 mL of water, these tablets eliminate the need to empty bottles and purge lines daily and make weekly shock treatments unnecessary.
Dental Waterline Treatment
Requiring just one squirt into a dental water bottle system, this dental waterline treatment effectively eliminates bacteria and other contaminants. It contains no harsh chemicals and is pH-neutral to blend perfectly with the water. An odourless, tasteless, and colourless solution, its non-foaming formulation leaves no residue that may clog lines. Available in a 236 mL bottle with a handy pump, this treatment helps keep waterlines safe and clean.
Conclusion: Vigilant dental waterline management maximizes infection control
Dental practitioners help patients maintain their oral and overall health. Keeping chairside waterlines safe plays a large part. Cleaning, disinfecting, and testing dental waterlines as part of regular infection control protocols will keep patients healthy and smiling.
