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Dental Unit Waterline Toolkit
 Dental Unit Waterline Toolkit



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

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

FDA Dental Unit Waterlines 

Dental Unit Waterlines

DECS US Air Force Dental Evaluation & Consultation Service
OSAP Dental Unit Water Quality: Organization for Safety, Asepsis and Prevention White Paper and Recommendations– 2018

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Best Practices





Key Learnings

OSAP has issued a White Paper about Dental Unit Water Quality which canbe accessed here
Dental health care personnel should use water that meets environmental protection agency regulatory standards for drinking water (i.e., ≤500 colony forming units (CFU)/mL of heterotrophic water bacteria) for non-surgical dental treatment output water. Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the quality of dental water. Commercial devices and procedures designed for this purpose include:
-Self-contained water systems (e.g., independent water reservoir) combined with chemical treatment (e.g., periodic or continuous chemical germicide treatment protocols).

-Systems designed for single-chair or entire-practice waterlines that purify or treat incoming water to remove or inactivate microorganisms.

-Combinations of these methods.


For surgical procedures, sterile saline or sterile water should be used as a coolant/irrigant. Conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs containing sterile water because the water-bearing pathway cannot be reliably sterilized. Appropriate delivery devices (e.g., bulb syringe; sterile, single-use disposable products; or sterile water delivery systems that bypass the dental unit by using sterile single-use disposable or sterilizable tubing) should be used to deliver sterile water during surgery. 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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