| FAQ - Dental Unit Waterlines - 2013
Do we need to send in tests to test the water from our water lines and if so how often?
Ask OSAP does not review, evaluate, certify, recommend or endorse products. If you have further questions about procedures, specific products and their compatibility regarding your dental unit, it is recommended that you contact the manufacturer of your dental unit.
The 2003 CDC guidelines for infection control in dentistry states as follows:
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.1
Compliance of water in routine dental procedures with current drinking U.S. Environmental Protection Agency water standards (fewer than 500 CFU of heterotrophic water bacteria).1
Dentists should consult with the manufacturer of their dental unit or water delivery system to determine the best method for maintaining acceptable water quality (i.e., <500 CFU/mL) and
the recommended frequency of monitoring. Monitoring of dental water quality can be performed by using commercial selfcontained test kits or commercial water-testing laboratories.
VIII. Dental Unit Waterlines, Biofilm, and Water Quality
A. General Recommendations
1. Use water that meets EPA regulatory standards for drinking water (i.e., <500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water (IB, IC) (341,342).
2. Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the recommended quality of dental water (II) (339).
3. Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product (II).
4. Discharge water and air for a minimum of 20– 30 seconds after each patient, from any device connected to the dental water system that enters the patient’s mouth (e.g., handpieces, ultrasonic scalers, and air/water syringes) (II) (2,311,344).
5. Consult with the dental unit manufacturer on the need for periodic maintenance of antiretraction mechanisms (IB) (2,311).1
The US Environmental Protection Agency (EPA) sets regulatory standards for drinking water.
The American Dental Association’s (ADA’s) Statement on Dental Unit Waterlines states as follows:
Water Quality Monitoring: It is important that waterline treatment schedules include water quality monitoring. Simple and inexpensive methods to estimate the number of free-floating heterotrophic bacteria in dental unit water are available. A well-designed water quality indicator should be self-contained and easy to use in-office; accurately detect a wide concentration range and type of aerobic mesophilic heterotrophic waterborne bacteria within a reasonable incubation time at room temperature; and be relatively inexpensive to use. In addition to in-office testing kits, laboratories across the U.S. also offer mail-in testing services.2
The ADA also states the following regarding dental unit water quality:
The only way to know that a dental unit waterline cleaning regimen is effective is to test the water coming out of the unit. Dental unit water testing products and services are used to monitor the dental unit water quality. Testing is usually done using three samples of water taken from the same dental unit. Dental equipment (e.g. handpieces) should be removed before the samples are taken. It is important that you do not contaminate the water during sampling; therefore, wear gloves and follow the directions for the particular product or service carefully.3
Suggested further reading includes:
Statement on Dental Unit Waterlines
Dental unit waterlines -- infection control includes safe dental unit water
In summary, your dental unit manufacturer should be contacted for further information on methods and equipment for monitoring dental unit water quality.
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on April 17, 2013.
2) American Dental Association. Statement on Dental Unit Waterlines. http://www.ada.org/1856.aspx Accessed on April 17, 2013.
3) American Dental Association. Dental Unit Water Quality. http://www.ada.org/sections/professionalResources/pdfs/cleaning_waterlines.pdf Accessed on April 17, 2013.
4) Dentistry IQ. Dental unit waterlines -- infection control includes safe dental unit water
http://www.dentistryiq.com/articles/2009/11/dental-unit-waterlines.html Accessed on April 17, 2013.