Community Magazine May 2012

For many people, going to the dentist is already a traumatic experience. Now imagine that the water used during most dental procedures was so laden with bacteria, that it’s compared to stagnant pond water! Investigations revealed startling levels of bacteria in the water used for dental procedures. Almost 90 percent of the water samples tested did not meet federal drinking water standards. Why is dental water often full of bacteria? The problem stems from the design of the water lines that feed the dental tools. The tubes that hold the water used in procedures run underneath the chair and are tied to all the equipment visible in the office. When the instruments are not in use, the water sits inside the tubing and stagnates. The small number of environmental bacteria naturally found in city drinking water quickly multiply and cling to the walls of the tubing. When the equipment is used again, the bacteria can be flushed into the mouths of patients. The University of Louisville Dental School tested the water from more than 60 dental offices across the nation, and found that it contained environmental bacteria which are generally not harmful to most people. Still, you shouldn’t be exposed to these levels of bacteria when you’re in a healthcare facility. And, although the bacteria do not generally pose a significant health risk, they can potentially cause disease, especially to those with weak immune systems. Biofilms are microscopic communities that consist primarily of naturally occurring water bacteria and fungi. They form thin layers on virtually all surfaces, including dental water delivery systems. These common microbes or germs accumulate inside things like showerheads, faucets and fountains, and in the thin tubes used to deliver water in dental treatment. Will biofilms harm me? In our environment, we are exposed to countless germs or bacteria. Ordinarily, exposure to these common microbes does not cause an infection or a disease, but when a person’s immune system is compromised because of age, smoking, heavy drinking, being a transplant or cancer patient or because of HIV infection, he or she may have more difficulty fighting off the invading germs. This is why the American Dental Association encourages patients who may have weakened immune systems to inform their dentist at the beginning of any treatment. That way, the patient and dentist together can make the right treatment decisions. How serious is the risk? The University of Louisville studied water samples collected from 28 dental facilities in six U.S. states and found significant levels of Legionella pneumophila bacteria. The Lancet medical journal describes a case report of an 82-year-old woman who died of Legionnaires’ disease (severe pneumonia) after becoming infected with Legionella pneumophila in her dentist’s office. Legionella pneumophila is a Gram-negative bacterium found in manmade water systems and in natural water environments. The source of these highly virulent bacteria which inhabit the dental unit water lines is in the city water system. The normal water treatment procedures done to the water we drink from the tap are proving inadequate in dealing with a wide variety of these “super bugs.” The bacteria can infect individuals by inhalation or microaspiration of aerosolized water causing Pontiac fever (a flu-like disease) or Legionnaires’ disease. Other leading sources of the Legionnaires infection include spas, fountains, air- conditioning systems, and hot-water systems. So, the next time you sit in the dentist’s chair, you may want to ask, “What do you do here to clean the dental water line?” Is the in my Dentist’s Office Safe? JACQUES DOUECK, DDS THEMOSTEFFECTIVEWAYSFORDENTISTS TO DEAL WITH WATER SAFETY INCLUDE:  Using chemical treatments to flush out the lines every day.  Using sterile water instead of the city water supply in the dental unit waterline.  Using a continuous flow of ozonated water or chlorhexidine as a disinfecting treatment.  Flushing all outlets daily and before each dental treatment.  Using water filters upstream of the instruments.  Monitoring the safety of the waterline annually. Unfortunately, unless the dental office staff are on top of this problem – most dentists are probably still using contaminated water in their offices. In our office, as the Ozonated water sits in the waterline, biofilm will be killed, layer by layer. Before each patient’s treatment, the lines are flushed of the dead bacteria, preventing their migration into the patient’s mouth. 76 COMMUNITY MAGAZINE