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Update on dental unit waterlines: Webinar recap

Nov. 12, 2020
Managing dental unit waterlines is more important than ever during a pandemic. RDH magazine and Air Techniques provide the latest information on keeping patients and clinicians safe.

RDH and Air Techniques recently partnered to provide the first of the COVID-19 roundtable discussions. The discussions are designed to highlight the latest technologies that can increase clinician safety, time management, and improve the patient experience. This webinar featured industry experts Amanda Hill, RDH, and Michelle Strange, MSDH, RDH, who are both practicing clinically.

Discussions were built on the following questions:

1. What is the best way to clean the chair after a dental appointment?

The upholstery on dental chairs can be compromised by harsh disinfectants. An effective way to prevent cross-contamination and not damage upholstery is to place a plastic barrier over the chair. Using a mild soap-and-water mix on the chair upholstery and base is an effective way to clean the chair, especially when a plastic chair barrier is used. Air Techniques offers a vinyl cleaner that safely cleans all vinyl and artificial leather. The Monarch vinyl cleaner removes stubborn stains, spots, and discoloration and is suitable for all covers made of artificial leather.

2. What can be found in waterlines that are not effectively managed?

The bacterial cells and other microbes form a protective slime layer, creating a resistant biofilm. Biofilm can be found in all places where moisture meets a suitable solid surface. Dental waterlines provide the perfect conditions for biofilm to thrive. Low water pressure, low flow rates, and frequent periods of stagnation can increase accumulation of the bacteria.1 These contaminated lines can negatively impact the community both in and out of the dental office. Additionally, lines can provide backflow to patients and have the potential to increase the bacteria being aerosolized.

3. How often should waterlines be shocked?

Shocking waterlines is important to reduce resistant microbial growth in our dental lines. The Centers for Disease Control and Prevention guidelines for infection control in dentistry2 state that the best way for maintaining acceptable water quality, which is considered <500 CFU/ml, is to monitor the lines frequently. Monitoring of dental water quality can be performed by using commercial self-contained test kits or commercial water-testing laboratories.1 Waterlines can be shocked every one to three months depending on the daily methods of decontamination and the testing results of the waterlines. Studies have shown that within five days, bacteria counts can grow to 200,000 CFU/ml.1

4. Does it matter how the waterline cleaner is being delivered?

Yes, when we are running our lines, we want to ensure that the device we are connected to allows the line cleaner to spread throughout the edges of the lines and is not being pulled directly down the middle of the line. To achieve the full coverage of the lines, there needs to be an adequate distribution of the product, and this can be achieved through a dispenser designed for both high- and low-speed suctions. The Monarch Clean Stream Evacuation System Cleaner is designed for daily cleaning. It penetrates and helps remove line buildup and includes a dispensing system that evenly distributes the solution. Additionally, the dispensing system is enough for multiple operatories and will not tip over while you move onto the next task as you run your lines. The product has no harsh aroma, is nonfoaming, pH- balanced, noncorrosive, and leaves a pleasant scent. The slight smell allows the product to be used during office hours.

5. Can you run the slow-speed and high-speed suction at the same time when cleaning the lines?

Yes, you can run both at the same time with the Monarch Clean Stream Evacuation System.

6. What would you recommend for clinicians who are using a bucket to run their lines?

Utilizing a bucket to drop the HVE and slow-speed suctions into is not an effective way to clean the lines. Without using a proper dispenser, the waterline cleaners are being pulled straight up, without touching the sides of the tubing.

7. What is the simplest way to reduce bacteria in the lines?

Flushing the lines in the beginning of the day, in between patients, and running a line cleaner at the end of the day are the best ways to reduce bacteria in the lines. The flushing action reduces the biofilm in the lines to make it sedentary. Testing the lines is also important to understand what frequency of shocking should take place.

For additional information on the Air Techniques Monarch line, visit https://www.airtechniques.com/. An infection control coordinator is advised for each practice to provide compliance with all infection control recommendations and protocols specific to the techniques that are being utilized. The Organization for Safety Asepsis and Prevention (OSAP) is a growing community of clinicians, educators, researchers, and industry representatives who advocate for safe and infection-free delivery of oral health care. OSAP is a remarkable resource for all infection control questions.


  1. Barbeau J, Tanguay R, Faucher E, et al. Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62:3954-3959.
  2. Centers for Disease Control and Prevention. Infection prevention & control in dental settings. Last reviewed Apr. 28, 2020. https://www.cdc.gov/oralhealth/infectioncontrol/index.html

Amber Auger, MPH, RDH, is a practicing dental hygienist and clinical innovations implementation specialist. With 14 years of experience in the dental industry, Auger works with practices to provide customized protocols, to refocus on the patient experience, and to utilize systemic approaches to periodontal therapy. She is a regular contributor to RDH magazine, a featured author for DentistryIQ, and host of #AskAmberRDH. Auger also provides preventive services abroad yearly and is always willing to have dental professionals join her team. She can be reached at [email protected].