Practice Tips #120: Are You Sure Your Office is Water Compliant?

Dental Patient


Since 2003, the Centers for Disease Control (CDC) has had comprehensive published guidelines for dental water infection prevention. With well-established scientific basis, following these guidelines has been supported by the American Dental Association (ADA), Food & Drug Administration (FDA), Organization for Safety, Asepsis, and Prevention (OSAP), and nearly 80% of dental boards across the United States.

As patient-safety-champions, dedicated dental professionals having a complete understanding of these recommendations can be the difference between your practice operating with high standards or it operating with those standards compromised.


The CDC Guidelines for Infection Control in Dental Health-Care Settings – 2003 have four key recommendations for practices when it comes to dental water safety:

However, it can be helpful to divide these into three pillars.

1. Surgical Water 

For all surgical procedures, which the ADA defines as “those that involve the incision, excision, or reflection of tissue that exposes normally sterile areas of the oral cavity”, require sterile water and sterile water delivery systems.

Confirmed by the ADA, using sterile water within dental units is not adequate. As soon as sterile water enters a dental unit, it is highly likely to be contaminated. Both sterile water and delivery systems (sterile syringe or single-use disposable products) need to be used for every surgical procedure.

2. Dental Unit Water

For all other procedures, dental unit water should meet or exceed the EPA standard for safe drinking water with ≤500 Colony Forming Units(CFU) per milliliter (mL) of heterotrophic water bacteria. While the CDC identifies a handful of proven strategies to reach this threshold, a practice should utilize all or a combination of these strategies.

Research shows that untreated dental unit waterlines with chemical germicides are unlikely to remain clean. In fact, a study found that even in brand new waterlines, contamination can develop upwards of 200,000 CFU/mL in less than 5 days.

Regardless of the treatment protocol chosen, the ≤500 CFU/mL should be met.

3. Verification of Compliance

The next question is, how do you know? How do you know if your treatment is meeting the ≤500 CFU/mL standard?

It’s a great question.

A study cited in a peer-reviewed article “Treating & Monitoring Dental Unit Water Lines” by John A. Molinari, PhD and Nancy Dewhirst, RDH, BS, revealed that 31% of treated waterlines still failed to meet the ≤ 500 CFU/mL standard and some treatment solutions performed significantly worse.

While treatment of dental unit waterlines is a vital aspect of dental water safety, it alone is not a guarantee. Test waterlines regularly to ensure an effective protocol.

Additionally, testing demonstrates compliance with documentation. That documentation is your practice’s protection should there ever be an inspection, complaint, or infection. To prove compliance, practices should keep documentation and records on hand. Make record of standard operating procedures (SOPs), team education, and waterline test results proving their protocol has been effective.


The CDC, ADA, FDA, and OSAP recommend testing as frequently as your dental unit and treatment product manufacturer recommend.

If no frequency recommendations exist, or are unclear, OSAP’s 2018 Recommendations state that practices should monitor water quality “at least monthly on each dental unit or device... If monitoring results indicate water quality is acceptable for two consecutive monthly cycles, the frequency of testing may be reduced, but should not be less than every three months (p. 11, 17).”

For you, it is about making sure every patient gets the best care. For your practice, it’s about making sure it is complying with industry standards.

Too many practices have been in the headlines in recent years for breaches or worse — infections. Make sure your practice is in compliance with these three pillars to ensure the safety of your patients and practice.

Here are a few products to help you maintain office water compliant:

BluTab Cleaning Tablets

Mail-In Water Tests In-Office Water Tests


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