Byte by Byte: Cleanly flowing

With no water there would be no dentistry as we currently know it. Even if it might be just a small spritz, water plays an important part of just about every procedure a dentist or hygienist might perform.

Therefore, it is necessary that every practice feel confident that water being used is safe. We recently spoke with Dr. Charles John Palenik, the new Director of Research and Scientific Affairs for OSAP, and he shared his thoughts on how new and existing practices could setup and maintain their office water systems.

Q: What’s the first thing a practice needs to consider when setting up the water system?  
A: Water usually comes into the office from a municipal water system or from a private well. Water is an essential. I would try to use the highest quality water possible. First, I would install a water distilling unit or some type of system that reduces the mineral content and odors. Treated water is not just for making coffee or ironing your clothes, it also is kinder to your equipment. The better the quality of the water, the longer the equipment will last.

So, the first steps are to have adequate pressure and some kind of distillation or purification system. That can be done at a relatively modest cost. There are a number of fairly inexpensive units available. Although amounts vary, water use by a single dentist office for patient treatment averages 6 to 8 gallons a day, a fairly small demand.

Q: Does the type of dentistry being practiced impact the practice’s water needs?  
A: If you are going to perform general dentistry, tap water is acceptable as long as the water is potable (drinking water quality). However, when performing surgical procedures (incision, excision or reflection of tissue that exposes normally sterile areas of the oral cavity) sterile saline or water is required.

Q: How clean does the water need to be?  
A: The goal is to have a system that consistently provides water containing less than 500 colony forming units of bacteria per mL (potable/drinking water quality). Most bacteria in drinking water are gran-negative rods, which upon death release endotoxins (pyrogens). Lower numbers of bacteria present in the water decreases the chances of diseases transmission and also reduces the amount of inflammation causing endotoxin present. Proper water supports every dental office’s infection prevention program.

Q: What type of water maintenance systems are currently available to dental practices?

A: Currently, there are several approaches used-independent water reservoirs (AKA self-contained systems); antimicrobial agents delivered from independent reservoirs, added directly to the treatment water or used to treat water prior to entering the dental unit; filters, which usually remove free-floating microbes, but in one case, also can remove endotoxins; and sterile water delivery systems consisting of an autoclavable or disposable apparatus filled with sterile water that bypasses the dental unit’s waterline system. Always check with your unit’s manufacturer for their recommendations to maintain water quality.

Q: Are there any factors that are easy to overlook that may come back to haunt a practice?  
A: Probably the piece of equipment that is most problematic is the power scalers, which may not always be connected to the dental unit or may have their own water reservoirs. There is the possibility that during unit line cleaning, the power scalers are not involved.

Q: What type of documentation should a practice be doing?  
A: You always need to be ready to defend yourself through the use of proper, yet practical procedures and documentation. You have to have information indicating you have a plan for properly maintaining your water system and written proof (e.g., test results) to support that.