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Frequently
Asked Questions - Dental Unit Water Lines
"Why
is this a problem if people aren't getting sick?"
- There is no definitive proof of disease transmission via DUWL;
however, there is significant circumstantial evidence to warrant
concern. Specifically, there are cases where dental professionals
have been infected with Legionella and appearance of antibodies
to Legionella in dental personnel is more than 10 times
greater than for the general population.
- The number of immune compromised individuals is increasing and
opportunistic organism such as Pseudomonas species can
cause infection in these people. What we don't know, and it is
very difficult to prove, is whether or not a compromised individual
who gets sick 2-3 weeks following dental treatment was exposed
to the microorganism in the operatory.
- As health care practitioners, our patients trust us to treat
them with water that meets or exceeds the standards established
for drinking water.
"Why can't I just use bottled water?"
- Most bottled water is treated with ozone to reduce microbial
contamination but it is not sterile and the independent water
system of your dental unit does not use sterile bottles. Also,
the lines themselves have never been sterilized. Thus, biofilms
will form from contamination of the water source and you still
have the patient derived organisms to control.
- A reminder that distilled water is not labeled "sterile"; although,
the microbial load is generally small and the nutrients are depleted
so biofilm growth is slowed but not prevented.
"Isn't this just another needless expense?"
- First of all improving the quality of patient care is not a
needless exercise, but then Joseph Lister heard some of the same
arguments when he started performing antiseptic surgery.
- Costs to control DUWL biofilms can be kept very low, in the
area of a few dollars per week.
"How often do I need to test my water lines
for biofilms and planktonic organisms?"
- Virtually every untreated line will have elevated levels of
bacteria and routine cleaning will bring them within guidelines.
We recommend that a precleaning baseline be established followed
by a 2 and 4 week sample set to verify your procedures.
- Once the lines are compliant and the practice has a routine
maintenance plan, we find that semi-annual sampling is sufficient
to monitor effectiveness of your procedures. However, at this
time there are no definitive guidelines for sampling frequency.
"Can my patients get HIV or Hepatitis
from DUWL biofilms?"
- These are viral diseases and for the viruses to grow and for
many to survive viable human cells are needed. No living human
cells have been found in DUWL biofilms; thus, viruses cannot grow
and are not part of the biofilm.
- The only way viruses could be transfered by water lines would
be via excessive handpiece suck-back in which sufficient virus
filled saliva was trapped in the line and then sprayed into on
open wound of the next patient's mouth.
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