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The CDC warns dentists about rare bacterial infections via waterlines

The U.S. Centers for Disease Control and Prevention has issued an emergency response and preparedness advisory regarding non-tuberculous mycobacteria outbreaks that occurred via dental waterlines.

The agency’s Health Alert Network issued the alert. The alert reminds dentists and dental professionals about the importance of proper sanitation during dental procedures.

According to the CDC, nontuberculous mycobacteria can be defined as “opportunistic disease agents [that place] certain groups at increased risk including those with underlying lung diseases or depressed immune system,”

Although infections are uncommon, the CDC reported that children have contracted non-tuberculous mycobacteria in several cases. According to the American Dental Association, pulpotomies involve the removal of a tooth’s diseased pulp.

According to reports, the outbreaks were reported to have occurred in March 2022. According to the CDC, they originated in a pediatric dental clinic where water treatment had high levels of bacteria.

It was not known which state and city were affected by the outbreaks.

Patients were exposed to nontuberculous mycobacteria through dental unit waterlines. The CDC defined this as “narrow-bore” plastic tubing that carries water through a high-speed handpiece, air/water syringe, and ultrasonic scaler.

The CDC alert stated that an investigation into the cluster is ongoing and that a preliminary site inspection has been done.

Similar outbreaks have occurred at pediatric dental offices in the past. This includes 71 patients in California who contracted odontogenic infections (infections that are present in the teeth or surrounding tissues) and nontuberculous mycobacteria following pulpotomy procedures in 2016.

One year earlier, Georgia had 24 patients who were infected by odontogenic nontuberculous Mycobacteria after the same procedure.

The CDC stated that “the outbreaks in California, Georgia, and Georgia were young children, with ages ranging between 4-8 years.”

“Many of these children had severe infections, including cervical lymphadenitis, mandibular, or maxillary osteomyelitis. They required hospitalization and treatment with intravenous antibiotics and surgery.

The alert stated that complications from their infections included permanent teeth loss, hearing loss, and facial nerve palsy.

When water flow rates are low or stagnant, dental waterline units can be prone to bacteria and biofilm formation.

The CDC stated that “as a consequence, high numbers of common waterborne bacteria can also be found in untreated oral unit water systems.”

“Disease-causing microorganisms can be found in untreated dental units water. These include Legionella, Pseudomonas, aeruginosa, and nontuberculous Mycobacteria (NTM).

The CDC also noted that other dental procedures could pose a risk if they are performed on people who have been exposed to contaminated water. These include incisions and excisions as well as biopsies, periodontal surgery, apical surgery, implant surgeries, tooth extractions, and bone removal.

According to the CDC, dentists and practitioners should not use “sterile solutions” as a coolant, or irrigant, while using “an appropriate delivery device such as a sterile tube that bypasses the dental unit waterlines or sterile single-use instruments.”

For patient safety, the agency recommends that all dental facilities and professionals follow the infection control guidelines for dental settings, monitor water quality, and treat waterlines in dental units.

You can remove biofilm and prevent it from forming with routine sanitation practices. These could include commercial disinfectant products or devices that comply with Environmental Protection Agency regulations for drinking water.

According to the health agency, dental providers should refer to the manufacturer’s instructions before handling dental equipment. This will ensure that they are using the correct methods and effectively maintaining and monitoring dental water quality.

The CDC advised that parents and guardians of children with dental problems should consult a dentist if they suspect an infection.

The CDC stated that signs and symptoms of a postoperative tooth infection could include fever, pain, swelling, and swelling in the mouth and neck.

Talk to your dentist about the infection prevention and control procedures they use and the steps their staff takes to ensure safe treatment.

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