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Dental Unit Waterline Toolkit
 Dental Unit Waterline Toolkit




Research has demonstrated that microbial counts can reach <200,000 colony-forming units (CFU)/mL within 5 days after installation of new dental unit waterlines (305), and levels of microbial contamination <106 CFU/mL of dental unit water have been documented (309,338). These counts can occur because dental unit waterline factors (e.g., system design, flow rates, and materials) promote both bacterial growth and development of biofilm.

Although no epidemiologic evidence indicates a public health
problem, the presence of substantial numbers of pathogens in dental unit waterlines generates concern. Exposing patients or DHCP to water of uncertain microbiological quality, despite the lack of documented adverse health effects, is inconsistent with accepted infection-control principles. Thus in 1995, ADA addressed the dental water concern by asking manufacturers to provide equipment with the ability to deliver treatment water with <200 CFU/mL of unfiltered output from waterlines (339). This threshold was based on the quality assurance standard established for dialysate fluid, to ensure that fluid delivery systems in hemodialysis units have not been colonized by indigenous
waterborne organisms (340).
Standards also exist for safe drinking water quality as established by EPA, the American Public Health Association
(APHA), and the American Water Works Association
(AWWA); they have set limits for heterotrophic bacteria of
<500 CFU/mL of drinking water (341,342). Thus, the number
of bacteria in water used as a coolant/irrigant for nonsurgical
dental procedures should be as low as reasonably
achievable and, at a minimum, <500 CFU/mL, the regulatory
standard for safe drinking water established by EPA and APHA/ AWWA. Source: CDC

Regulations & Guidelines

(1) Guidelines for Infection Control in Dental Health-Care Settings — 2003


(1) Dental Unit Waterlines

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Best Practices
Key Learnings as of February 2016

OSAP Recommendations to Clinicians

Related Articles

(1) Woman Dies After Contracting Legionnaires' Disease From Dentist's Office

(2) MMWR: Notes from the Field: Mycobacterium abscessus Infections Among Patients of a Pediatric Dentistry Practice — Georgia, 2015


Dental Unit Waterlines: Questions and Answers

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Instructional Resources

(1) Guidelines for Infection Control in Dental Health-Care Settings — 2003

Glossary of Terminology

  For the Dentist - Message to My Patients

Fact Sheet

Dental Unit Water Line Fact Sheet
  Troubleshooting Dental Water Quality Problems 
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