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5/31/2018 » 6/3/2018
2018 OSAP Annual Conference

Dental Unit Waterline Toolkit
 Dental Unit Waterline Toolkit



Dental unit waterlines (i.e., plastic tubing that carries water to the high-speed handpiece, air/water syringe,and ultrasonic scaler) promote bacterial growth and development of biofilm due to the presence of long narrow-bore tubing, inconsistent flow rates, and the potential for retraction of oral fluids. Dental healthcare personnel and patients could be placed at risk of adverse health effects if water is not appropriately treated.

All dental units should use systems that treat water to meet drinking water standards (i.e., ≤ 500 CFU/mL of heterotrophic water bacteria). Independent reservoirs—or water-bottle systems—alone are not sufficient. Commercial products and devices are available that can improve the quality of water used in dental treatment. Consult with the dental unit manufacturer for appropriate water maintenance methods and recommendations for monitoring dental water quality. During surgical procedures, use only sterile solutions as a coolant/irrigant using an appropriate delivery device, such as a sterile bulb syringe, sterile tubing that bypasses dental unit waterlines, or sterile single-use devices. Source: CDC

Regulations & Guidelines


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

(2) Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care 

(3) Infection Prevention Checklist for Dental Settings Basic Expectations for Safe Care 

(4) Mycobacterium absecessus in Healthcare Settings

(5) Dental Unit Water Quality

(6) Infection Prevention & Control in Dental Settings


(1) Dental Unit Waterlines

DECS (1) US Air Force Dental Evaluation & Consultation Service

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Best Practices





Key Learnings as of December 2017

Biofilm is a thin, slimy film of bacteria that sticks to moist surfaces, such as those inside dental unit waterlines. Biofilm occurs in dental unit waterlines because of the long, small-diameter tubing and low flow rates used in dentistry, the frequent periods of stagnation, and the potential for retraction of oral fluids. As a result, high numbers of common water bacteria can be found in untreated dental unit water systems. A few disease-causing microorganisms found in untreated dental unit water include Legionella, Pseudomonas aeruginosa, and nontuberculous Mycobacterium. Dental health care personnel and patients could be placed at risk of adverse health effects if water is not appropriately treated. Source: CDC

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

Water Management Program

 (1) Developing a water management program to reduce Legionella growth and spread in buildings (same approach can be used for all Opportunistic Pathogens of Premise Plumbing)

(2) Drinking Water Distribution Systems: assessing & reducing risks, National Academies 2006


Dental Unit Waterlines: Questions and Answers

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Instructional Resources

Selected Resources

Glossary of Terminology

  For the Dentist - Message to My Patients
Video (1) State of the Science of Opportunistic Pathogens in Premise Plumbing


Questions to help guide selection of dental waterline devices and chemical treatment options
  Checklist for dental unit water quality improvement
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