On paper, the difference between clean water and clean waterlines may only be 5 letters. In reality, however, the divide is major. Knowing that there is a difference, why the distinction is so important, what the ADA standards for both are, and how to ensure that your practice meets these guidelines, will make for happier safer patients, and happier safer staff.
WHAT IS THE DIFFERENCE BETWEEN CLEAN WATER, AND CLEAN WATERLINES?
For a host of reasons which we will touch on shortly, dental unit waterlines are the perfect breeding grounds for microorganisms and biofilms. In fact, according to the CDC, even if you have brand new waterlines installed, within just 5 days microbial counts can be as high as 200,000 CFU (Colony Formed Units) per milliliter; That is more than 400 times the recommended amount.
Regardless of the quality of water, dental unit waterlines can become colonized with microorganisms. So, if you have clean water of any kind (tap, distilled, sterile, etc.) in a self-contained water bottle system, it doesn’t much matter if you’re running that water through dirty/untreated water lines. Michael Overmyer, a waterline specialist with Anodia Systems, helps us visualize this point with an analogy about river water:
“Less debris is found in the middle of a free-flowing river versus the sides, where the slow moving water allows debris to cling to the sides of the river banks. Likewise, with dental unit waterlines, clean water may be free-flowing through the center, but a sticky, slimy residue populated with microorganisms forms on the inner walls of waterline tubing.”
– Michael Overmyer
WHY ARE CLEAN WATERLINES IMPORTANT?
The potential harm that stems from dirty waterlines is two-fold. Firstly, people can, and have, gotten seriously sick from high microbial counts in water. This is an especially high risk with senior patients, asthma sufferers, and people with weak immune systems who can’t easily fight off bacteria. Secondly, as the CDC succinctly states,
“Exposing patients or dental healthcare personnel to uncertain microbiological quality is inconsistent with accepted infection-control principles.” [Source]
HOW DO WATERLINES BECOME CONTAMINATED?
Here again, Mr. Overmyer helps us make sense of things by pointing to 5 main factors that tend to lead to contaminated waterlines:
- Small Waterline Tubing: Waterline tubes are only about the width of a spaghetti noodle, which makes it easy for bacteria to build up.
- Stagnant Water: Stagnant water left sitting in waterlines of water bottles for too long tends to form a micro biofilm on the inner walls.
- Oral Suck-Back: Oral suck-back can occur when a patient’s oral fluids are introduced back into the waterlines (ick!). Human saliva contributes to microbial growth.
- Inadvertent Staff Contamination: Staff may leave water sitting in bottles over the weekend, allowing microbial growth. They may also inadvertently touch the pickup tubes that goes inside the dental water bottle, thus contaminating the dental water. While latex gloves are a helpful barrier, they are not 100% sterile.
- Warm Water Temperatures: Warm water temperatures contribute to bacteria growth. During chillier months, offices turn up heat to prevent their pipes from bursting and keep patients happy. Staff may also fill dental water bottles with water that is too warm.
WHAT IS THE ADA/CDC STANDARD FOR CLEAN DENTAL UNIT WATER?
The CDC (Center for Disease Control) and ADA (American Dental Association) both suggest that the number of bacteria in water used for nonsurgical dental procedures should be ≤500 CFU/ml. These are also the regulatory standards for safe drinking water established by the EPA (Environmental Protection Agency).
WHAT PRODUCTS HELP KEEP WATERLINES CLEAN AND ELIMINATE BACTERIA?
Enough talk about the formation of gross biofilm and bacteria, right? Let’s talk about how to eradicate it! Below you will find two detailed waterline cleaning options, along with the benefits and differentiating factors of each product.
1. Patterson Waterline Maintenance Tablets
Patterson Waterline Maintenance Tablets – Shop
Take a look at this short video, which will walk you through how to use the tablets, where to find more information, and what it is that makes this method stand out from other options:
- They contain SDC (silver dihydrogen citrate), a patented key ingredient that attacks microorganisms in 2 different ways – by destroying bacteria from the outside, and from the inside.
- They are non-toxic.
- This product is registered with the EPA, colorless, odorless, and tasteless.
- This method is the most cost-effective solution.
- The tablets bring levels to less than 10 CFU/ml, which is 50 times cleaner than the standard.
2. Mint-A-Kleen Liquid Waterline and Bottle Cleaner
Mint-A-Kleen Liquid Waterline and Bottle Cleaner – Shop
Here is another helpful video, which demonstrates in detail the simple 3-step process of how (and why!) to properly administer Mint-A-Kleen in your practice:
- This is truly a one product solution. No additional shocking of the system is required.
- This liquid formula does double duty, by inducing both a chemical and a physical reaction on the microbial contamination.
- This protocol is easy, and only needs to be administered once per week. Most offices use it on Fridays after their last patient leaves, and flush out any leftover Mint-A-Kleen on Monday before their first patient arrives.
- This product is registered with the EPA.
- Mint-A-Kleen contains glycerin, which serves a dual purpose. Besides cleaning, it helps lubricate and maintain dental equipment, increasing its functionality.
HOW CAN YOU TEST YOUR WATER?
Water tests aren’t mandated, but they are recommended in order for your practice to provide the highest possible standard of care. Several products exist which allow you to test the water yourself, but the most sound tests involve sending samples in to third parties, leaving less room for error. ProEdge Confirm Waterline Tests do just that:
ProEdge Confirm Waterline Test – Shop
This system provides official documentation, which is sent electronically after 72 hours of incubation. Results are easy to interpret, and utilize a simple “pass/fail” format.
There are also schools which are particularly well known for providing Dental Unit Waterline Testing (DUWT), including Loma Linda University’s School of Dentistry in California, and Texas A&M’s Baylor College of Dentistry.
If you have a particular passion for infection control, you can scroll through the complete document assembled by the CDC regarding the “Guidelines for Infection Control in Dental Health-Care Settings.”
Has your office ever failed a Dental Unit Waterline Test? Are you currently taking steps to clean and treat your waterlines? Do you plan to start? Get in touch with us in the comments below!