Fear-free waterline maintenance

Maintaining a dental practice’s waterline system is extremely important to patient and provider safety, but it doesn’t have to be complicated.

Mar 1st, 2019

The topic of waterline maintenance is an intimidating one for many dental professionals. In the first installment of her series on waterline safety last month, Noel Kelsch, MS, RDHAP, wrote that, “When new findings and regulations come forward, finding out if you are in compliance be daunting—like opening a can of worms. Finding out you have an issue and addressing it can be a defining moment.”1

Microbes are all around us, and most of the time, healthy patients aren’t adversely affected by microbes present in dental unit water systems (DUWS).1 However, a 2012 article in the Journal of Oral Microbiology stated that the likelihood of an infection associated with dental care in the developed world “being detected, reported, documented and published is small,” so “healthcare-associated infections are under-reported in literature from the developed world.”2 It may be that infections occur much more often than we think. Since then, there have been a few highly publicized outbreaks of disease linked to DUWS, and patients are more aware of water safety than they were in the past.

In 2016, I wrote about an outbreak ofMycobacterium abscessusinfections in California children that was definitively linked to a pediatric practice’s water system by health authorities. By the time the outbreak ended, at least 68 children had contracted this serious infection, all of them after a pulpotomy. Sixty-eight patients required hospitalization at some point, and some of them even lost sections of their jaws or permanent teeth.3,4

This tragic and upsetting outbreak shows how vital safe water is to the practice of dentistry. The good news is that waterline maintenance doesn’t have to be difficult, especially once a practice gets in the swing of things. In this month’s installment, Kelsch shares her own college’s experience with tackling a waterline issue head on, and how you can use the lessons learned in your own practice.

Amelia Williamson DeStefano



1. Kelsch N. A practical guide for testing dental unit waterlines: Part 1.RDH magazine website. https://www.rdhmag.com/articles/print/
volume-39/issue-2/content/a-practical-guide-for-testing-dental-unit-waterlines-part-1.html. Published February 1, 2019. Accessed February 18, 2019.

2. Laheij AM, Kistler JO, Belibasakis GN, Välimaa H, de Soet JJ, European Oral Microbiology Workshop (EOMW) 2011. Healthcare-associated viral and bacterial infections in dentistry.J Oral Microbiol. 2012;4:10.3402/jom.v4i0.17659.

3. DeStefano AW. Dental water system linked to severe oral infections in California children.DentistryIQ website. https://www.dentistryiq.com/articles/2016/09/dental-water-system-linked-to-life-threatening-oral-infections-in-california-children.html. Published September 29, 2016. Updated October 10, 2016. Accessed February 18, 2019.

4. Perkes C. Anaheim dental clinic where children contracted serious infections to reopen Monday.Orange County Register website. https://www.ocregister.com/2017/04/18/anaheim-dental-clinic-where-children-contracted-serious-infections-to-reopen-monday/. Published April 18, 2017. Updated April 19, 2017. Accessed February 18, 2019.

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