Your Dental Unit Waterlines & Amalgam Separation: What You Should Know

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YOUR DENTAL UNIT WATERLINES AND AMALGAM SEPARATION

What You Should Know Written by Lisa Germain, DDS, MScD

Waterlines

To deliver water of optimal microbiologic quality, dental unit waterlines must be maintained regularly. Colonization of microorganisms within the waterlines may not pose a concern for healthy individuals, but it may place elderly or immunecompromised patients at unnecessary risk. Although infection associated with microbial contamination of waterlines appears to be rare, dental unit waterlines have been shown to harbor a wide variety of microorganisms including bacteria, fungi, and protozoans in numbers sufficient to cause illness. These microorganisms colonize and replicate on the interior surfaces of the waterline tubing forming biofilms. Biofilms can serve as a reservoir, amplifying the numbers of free-floating microorganisms in the water. The Centers for Disease Control and Prevention (CDC) recommends that dental unit water used in nonsurgical procedures measure ≤500 CFU/ml. This is the standard set for drinking water by the Environmental Protection Agency (EPA). To deliver water of this quality, dental unit waterline systems designed for general dental practice must be regularly maintained, via water treatment and monitoring, performed according to the manufacturer’s instructions. While they will not eliminate biofilms, there are several methods for improving dental unit water quality. However, practitioners should always consult with the manufacturer of their dental units before initiating any waterline treatment protocol. 1. Follow current OSAP, ADA, and CDC recommendations to flush lines for several minutes each morning. Flush handpieces with air/water for 20 to 30 seconds between patient appointments. Installing sterilized handpieces and sterile or disposable syringe tips after flushing will reduce cross-contamination.

2. Always obtain and follow the dental unit manufacturer’s

4. Avoid heating dental unit water. While it was common to heat water to increase patient comfort, warming the water may amplify biofilm formation and select organisms pre-adapted to growth in a human host.

5. Consider using a separate water reservoir system to eliminate the inflow of municipal water into the dental unit. In addition to having better control over the quality of the source water used in patient care, it would eliminate interruptions in dental care when “boil-water” notices are issued by local health authorities. Contact the manufacturer of the dental unit for a compatible system and treatment protocols before undertaking this step.

6. Use sterile solutions for all surgical irrigations. Additionally, ensure that only heat-sterilized/sterile-disposable bulb syringes or sterile water delivery devices are employed to deliver the sterile water.

7. Educate and train oral healthcare workers on effective treatment measures to ensure compliance and minimize risks to equipment and personnel.

8. Monitor scientific and technological developments in this area to identify improved technical approaches as they become available.

9. Cooperate with the oral healthcare industry to develop and validate standard protocols for maintaining and monitoring dental unit waterlines.

10. Because insufficient data currently exist to establish the effectiveness of all available methods as used in the dental office, it is important to ensure that any sterile water system or device marketed to improve dental water quality has been cleared for market by the U.S. Food and Drug Administration (FDA).

11. Staff compliance with whatever water treatment approach is chosen by the dental practice is very important. Staff input as to the choice and maintenance is crucial for any success achieved.

Biofilm Parasites

recommendations for treating dental unit waterlines. Implementing protocols not recommended by the unit manufacturer could cause equipment damage and void warranties.

3. If recommended by the dental unit manufacturer, install and maintain anti- retraction valves to prevent oral fluids from being drawn into dental waterlines.

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The DC Impression | Q1 . 2019 Specials & Promotions | Not responsible for typographical errors


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