Dental Unit Waterlines: The Good, Bad, and the Ugly - Mike Rust + Kellie Thimmes


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Sep 10 2020 60 mins  

Water is the lifeline of your dental practice. If your dental unit waterlines are covered in biofilm, you’re in trouble. How do you test your water lines properly? How do you treat your systems? What do you do if you don’t have a closed system? With the heightened awareness of spreading germs due to the Coronavirus crisis, it’s more important than ever to be mindful of prevention in your practice. In this episode of Talking with the Toothcop, Dwight and I chat with Mike Rust and Kellie Thimmes from ProEdge Dental about what dentists can—and should be doing—to prevent infections.

Outline of This Episode

  • [0:21] Mike Rust + Kellie Thimmes on the Toothcop
  • [1:19] What people don’t know about Kellie + Mike
  • [4:27] How to test your water lines properly
  • [11:40] The CDC will revise dental infection control guidelines
  • [20:40] Indicators that a dental office does or doesn’t care
  • [28:28] Where does the problem originate?
  • [31:58] Pro Edge’s new Flow-Cytometry technology
  • [38:15] The Anaheim case that changed everything
  • [42:01] What could happen when the CDC reviews their guidelines?
  • [43:33] What do you do about open systems
  • [55:17] UV disinfection technology
  • [58:25] How to connect with Mike + Kellie

Why biofilms originate in water lines

Biofilms usually form in waterlines because they’re small, plastic, and the water sits stagnant. The bacteria sits there and thrives. It can also be found in anything with a filtration system—which can remove solids (like minerals and chlorine) but not small bacteria. So everything just sits there in their little pod and it’s the perfect breeding ground for bacteria. That’s why it’s so important to purge anything connected to your waterline unit. The extra flow of water in between patients helps move the germicide through the system and helps keep it clean—and prevents biofilms.

The Texas dental board recently relaxed its Cavitron regulations to allow dentists to start using them again. Most dentists haven’t been using them since mid-march of 2020. Why? Kellie points out that firstly, they create aerosols. Secondly, water lines tend to hold a lot of bacteria. Dentists don’t want to worry about COVID and other bacteria. It’s also because Cavitrons are harder to shock. The failure rate is over 50% and they have higher counts of CFU’s than any other water line.

How to properly test your dental unit waterlines

You have to collect the water for the test from the right place. 9/10 times dentists that say they’re testing pull a sample from an air-water syringe. But dentists should be testing from the dirtiest thing(s) in the dental practice: a water sample from the Cavitron or Ultrasonic. If you’re passing your water test with samples from those you know you’re doing well.

Kellie recommends taking a collective sample from each room in your dental practice If there’s a failure, then you shock everything. Both Kellie and Mike advise using an aseptic technique when you’re taking a sample. Take the handpiece off and use a new air water syringe tip. It’s not as messy and easier to collect the sample. Test your water as if you were doing it for a new patient.

Are the current infection control guidelines enough?

It was recently announced that the CDC will be revising dental infection control guidelines—which has been overdue for a while. It makes you question: Are the current guidelines as effective as we think they are? The CDC recommends periodic testing but doesn’t define the timeline. They say to defer to the manufacturer's instructions. You have to monitor your water regularly—at least quarterly if not monthly. Kellie and Mike agree that you must use an EPA approved shock product.

If you’re not aware, the EPA regulates drinking water standards and anything that could impact groundwater. The FDA regulates medical devices (they review and approve). Everything you use in the dental office is a medical device. For you to use it, the manufacturer had to get approval from the FDA. Whenever you deviate or use a device other than its intended use, it’s considered off-label use.

There are a lot of treatments for removing biofilm, so you have to find what works for your practice. Follow the IFUs for the products you’ve chosen and ask for help if you need it. Kellie states “I wish there was a magic bullet, but there’s just not. It’s called waterline maintenance for a reason—because it takes work.” If you’re committed to monitoring, you’ll get better results.

What are indicators that a dental office is doing what they’re supposed to for infection prevention? Listen to hear their take!

Sometimes you have to humanize the problem

The case that happened in Anaheim, CA impacted 71 families. 70 of the kids had major surgeries and some lost parts of their jaw from preventable infections. All because ONE dentist office didn’t properly test or treat their water lines.

Some dentists don’t want to test because if they find out there’s a problem then they have to do something about it. But it is your responsibility to know. You have to humanize the problem. It’s not about devices—it’s about those child’s faces.

No dentist goes to work and says “I want to hurt someone today.” But do they go to work today and say “I want to make sure that we don’t hurt anybody, ever.” It’s a huge difference. That’s why it’s so important that the CDC reviews its guidelines.

What to do if you have an open water system

Many older dental offices still use city water and can’t introduce a germicide or antimicrobial into the system. You can treat your water, but you can’t efficiently shock the water. What do they do? You should retrofit your open systems so you can shock the water. Add a closed bottle system for $200 a chair + labor. In 10 minutes you can shock them with bleach and sleep at night. You just have to take the time to do it.

Recently, In Corpus Christi Texas, they had water-boil advisories. Municipal water was contaminated. If you don’t have a closed system, that effectively shuts down your practice. It’ll cost you way more than converting your dental unit to closed bottles. Plus, you have to keep tabs on your city's boiled water advisories.

Keep listening to hear our conversation about tap water versus distilled water and what Kellie and Mike recommend using.

Pro Edge’s new Flow-Cytometry water testing technology

Proedge has launched a Flo™ Dental Unit Waterline Testing Service Kit that allows you to get same or next-day test results. It takes one hour for them to process the results. They’re counting the bacterial cells in the water with laser technology and fluorescent dye. Why does it matter so much? Other tests can take days or even weeks to get results.

Some practices have to remain closed when their water lines are being tested—only to find out they failed. That means they have to shock their systems, restest, and wait all over again. No longer. The price of this test is only a couple percent more. It’s a premium service without the premium price. Check out the resources for a link to an amazing deal on this new product. I want people to do the testing, work with good people, and save money while doing it.

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