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Test FAQ's Dental Unit Waterlines
Frequently Asked Questions (FAQs) On Dental Infection Control -Dental Unit Waterlines


Frequently Asked Questions for Dental Unit Waterlines

Q
Are Mycoplasma pneumoniae bacteria found in dental water units?
QIs there any regulation on the type of water that should be used for oral surgery?
QHow can ozone gas remove existing biofilm?
QDoes OSAP have information as to which products have been cleared by the Food and Drug Administration (FDA) and accepted by the American Dental Association (ADA) for waterline treatment/management?
QWhich type of waterline filters are appropriate for use with dental units?
QWhat types of disinfectants are appropriate for cleaning waterlines?
QCan you recommend a waterline treatment system for a 200-chair clinic that will not require the installation and maintenance of reservoir systems?
QWhere can I get information on managing dental unit waterline contamination?
QOur office uses self-contained water units by adec. We only use Culligan water. We are finding that there are not many water tests to choose from. I would like to know if the water test that we use would have to be one that has to be tested at a qualified lab or are the petri dish type ok that we test in the office?
QOur dental offices are currently using a self-contained (distilled) water system on each dental unit and we are using a weekly waterline treatment (Sterilex) according to manufacturer's instructions. Do we also need to periodically use a testing device? If so, how often? And can you supply me with some resources to research such devices?

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QAre Mycoplasma pneumoniae bacteria found in dental water units?
A
Mycoplasma pneumoniae pneumonia is classified as an atypical pneumonia along with Legionellosis. Unlike Legionella bacteria, however, it has no environmental reservoir and is spread from person to person by inhalation.(1) There is no evidence that M. pneumoniae can be transmitted via dental equipment.References:
(1) CDC/Centers for Disease Control and Prevention. Mycoplasma pneumoniae. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycoplasmapneum_t.htm

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Q
Is there any regulation on the type of water that should be used for oral surgery?
AThe Centers for Disease Control and Prevention (CDC) recommends that:

Sterile solutions (e.g., sterile saline or sterile water) should be used as a coolant/irrigation in the performance of oral surgical procedures where a greater opportunity exists for entry of microorganisms, exogenous and endogenous, into the vascular system and other normally sterile areas that support the oral cavity (e.g., bone or subcutaneous tissue) and increased potential exists for localized or systemic infection (see Oral Surgical Procedures). Conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs because the water-bearing pathway cannot be reliably sterilized. Delivery devices (e.g., bulb syringe or sterile, single-use disposable products) should be used to deliver sterile water (2,121). Oral surgery and implant handpieces, as well as ultrasonic scalers, are commercially available that bypass the dental unit to deliver sterile water or other solutions by using single-use disposable or sterilizable tubing (316). (1)

No federal regulation exists that requires this recommendation be followed, however, for individual states that have adopted the CDC guidelines in compliance with federal legislation, this recommendation may be required. The state licensing agency is the appropriate authority to contact for local regulations (2).

References:
(1) US Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings --- 2003. MMWR Morbid Mortal Weekly Rep 2003;52(RR17):1-61. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm.

(2) The Dental Student Network list of state licensing agencies. Available at http://www.studentdoctor.net/dental/state_boards.html

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QHow can ozone gas remove existing biofilm?
AAs an oxidizing agent, ozone theoretically may affect biofilm detachment over time. Although ozone has demonstrated efficacy against planktonic (free-floating) bacteria and appears to becapable of removing biofilm, no studies demonstrating the effectiveness of ozoneagainst biofilm in dental units have been published.

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QDoes OSAP have information as to which products have been cleared by the Food and Drug Administration (FDA) and accepted by the American Dental Association (ADA) for waterline treatment/management?
AFilters that are specifically designed for use with dental units include micropore in-line filters that must be placed on each water delivery line. In addition, unit filters can be placed close to the control box to filter all lines delivering water to devices. Commercially available devices in this category also release small amounts of antimicrobial agents purported to control biofilm formation. Both types of filters require changing and maintenance according to manufacturer's instructions.

Large-pore diameter filters are provided with most dental units to prevent particulate materials suspended in tap water from entering the dental water systems; these filters have no beneficial effect on the microbiological content of water used in dental treatment.

References:
(1) OSAP Issue Focus: Dental unit water lines.

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Q
Which type of waterline filters are appropriate for use with dental units?
AFilters that are specifically designed for use with dental units include micropore in-line filters that must be placed on each water delivery line. In addition, unit filters can be placed close to the control box to filter all lines delivering water to devices. Commercially available devices in this category also release small amounts of antimicrobial agents purported to control biofilm formation. Both types of filters require changing and maintenance according to manufacturer's instructions.

Large-pore diameter filters are provided with most dental units to prevent particulate materials suspended in tap water from entering the dental water systems; these filters have no beneficial effect on the microbiological content of water used in dental treatment.

References:
(1) OSAP Issue Focus: Dental unit water lines. Available at http://www.osap.org/issues/pages/water/index.htm


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QWhat types of disinfectants are appropriate for cleaning waterlines?
AFor information on products for managing dental unit waterlines, see OSAP's Issue Focus on Dental Unit Waterlines.

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QCan you recommend a waterline treatment system for a 200-chair clinic that will not require the installation and maintenance of reservoir systems?
AOSAP maintains a list of commercially available devices and chemicals for dental unit waterlines as part of its Issue Focus on Dental Unit Waterlines. Always consult and follow the dental unit manufacturer's directions regarding compatibility, operation, care, and maintenance, and always use dental waterline products/agents according to label/device instructions.

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QWhere can I get information on managing dental unit waterline contamination?
AOSAP's Issue Focus on Dental Unit Waterlines contains a wealth of information, including background, links to research and other resources, and lists of commercially available devices.Always consult with and follow the instructions of the dental unit manufacturer with regard to operation, care, maintenance, and treatment of waterlines in your unit. Further, always use all dental waterline products/agents according to label directions.

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QOur office uses self-contained water units by adec. We only use Culligan water. We are finding that there are not many water tests to choose from. I would like to know if the water test that we use would have to be one that has to be tested at a qualified lab or are the petri dish type ok that we test in the office?
AOSAP does not recommend, endorse, nor promote products, however, we can provide you with general information concerning dental water line testing. Currently, we are not aware of any regulations that mandate dental unit water (DUW) be tested only through a qualified lab. Although that is an option, in-office testing is available to dental facilities.


The authors of From Policy to Practice: OSAP's Guide to the Guidelines state that you should consult the manufacturer of your dental unit or water delivery system to find out how to best maintain treatment water quality (less than 500 CFU/mL) and how often to monitor dental unit water. (1)

The Center's For Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings also state that 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. (2)

Monitoring the dental water quality can be performed by using commercial water-testing laboratories. Some laboratories provide specialized services to the dental profession, but any commercial water-testing lab can enumerate water bacteria present in a sample. Another option is to perform self-water testing using in-office test kits.

Further information on in-office water testing kits/testing samplers may be obtained from the following companies:

1. Millipore Corp.:

http://millipore.com/publications.nsf/docs/TB094

2. Micrylium:

http://www.micrylium.com/products.php?ID=18&col=pID

OSAP provides a great deal of information concerning dental unit waterlines, including links to additional resources. The information may be viewed at:

http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=24

OSAP's FAQ's concerning dental unit waterlines may be viewed at:

http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=26#waterquality

Additional information may be viewed at:

1) The United States Air Force Dental Evaluation & Consultation Service also provides information on DUW and products that may be viewed at:

https://decs.nhgl.med.navy.mil/infc.htm

https://decs.nhgl.med.navy.mil/2QTR04/incontrolfactsheet5.htm

https://nhgl.med.navy.mil/2QTR05/QAic2.htm#wmf

2) The American Dental Association has additional information that may be viewed at:

http://www.ada.org/prof/resources/topics/waterlines/index.asp


3) An excellent article, "Infection Control Report: Waterlines, Striving For Clean Lines", by Chris Miller, PhD appears in the September 2003 issue of Dental Products Report. This is a free monthly publication and the articles are also posted on their website.

To view the entire article to go: http://www.dentalproducts.net/xml/display.asp?file=1415

The dental products report is a free service, however, you must register first to gain access to the articles.

Resources:

1) From Policy to Practice: OSAP's Guide to the Guidelines. Published by OSAP.
Copyright 2004

2) CDC: Infection Control Guidelines for Dental Healthcare Facilities:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm


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QOur dental offices are currently using a self-contained (distilled) water system on each dental unit and we are using a weekly waterline treatment (Sterilex) according to manufacturer's instructions. Do we also need to periodically use a testing device? If so, how often? And can you supply me with some resources to research such devices?
A
OSAP does not recommend, endorse, nor promote products, however, we can provide you with general information concerning dental water line testing. Currently, we are not aware of any regulations that mandate dental unit water (DUW) be tested only through a qualified lab. Although that is an option, in-office testing is available to dental facilities.


The authors of From Policy to Practice: OSAP's Guide to the Guidelines state that you should consult the manufacturer of your dental unit or water delivery system to find out how to best maintain treatment water quality (less than 500 CFU/mL) and how often to monitor dental unit water. (1)

The Center's For Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings also state that 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. (2)

Monitoring the dental water quality can be performed by using commercial water-testing laboratories. Some laboratories provide specialized services to the dental profession, but any commercial water-testing lab can enumerate water bacteria present in a sample. Another option is to perform self-water testing using in-office test kits.

Further information on in-office water testing kits/testing samplers may be obtained from the following companies:

1. Millipore Corp.:

http://millipore.com/publications.nsf/docs/TB094

2. Micrylium:

http://www.micrylium.com/products.php?ID=18&col=pID

OSAP provides a great deal of information concerning dental unit waterlines, including links to additional resources. The information may be viewed at:

http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=24

OSAP's FAQ's concerning dental unit waterlines may be viewed at:

http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=26#waterquality

Additional information may be viewed at:

1) The United States Air Force Dental Evaluation & Consultation Service also provides information on DUW and products that may be viewed at:

https://decs.nhgl.med.navy.mil/infc.htm

https://decs.nhgl.med.navy.mil/2QTR04/incontrolfactsheet5.htm

https://nhgl.med.navy.mil/2QTR05/QAic2.htm#wmf

2) The American Dental Association has additional information that may be viewed at:

http://www.ada.org/prof/resources/topics/waterlines/index.asp


3) An excellent article, "Infection Control Report: Waterlines, Striving For Clean Lines", by Chris Miller, PhD appears in the September 2003 issue of Dental Products Report. This is a free monthly publication and the articles are also posted on their website.

To view the entire article to go: http://www.dentalproducts.net/xml/display.asp?file=1415

The dental products report is a free service, however, you must register first to gain access to the articles.

Resources:

1) From Policy to Practice: OSAP's Guide to the Guidelines. Published by OSAP.
Copyright 2004

2) CDC: Infection Control Guidelines for Dental Healthcare Facilities:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm


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