The Biggest Unknown Risk to Your Organization: Water

dental water safety

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What lurks beneath the surface of a dental unit waterline can damage your organization’s reputation and increase liability for potential litigations.

Historically, dental unit waterline (DUWL) compliance has been neglected within the industry. Market data and product usage suggest a mere 13-17% of dental offices are waterline compliant. Assumptions on water quality based on treatments used have created a false hope, opening the door to litigations, and become exponentially amplified when the office at fault is within a DSO. In fact, in “Treating and Monitoring Dental Water” by Nancy Dewhirst, RDH, BS, and John A. Molinari, PhD, share that1:

  • 31% of treated dental unit waterlines still failed to meet CDC standards.

  • 61% of practices had at least one failed dental unit waterline.

  • 100% of treatment products had failures – fail rates ranged from 23-42%.

Without a proper waterline maintenance protocol in place, you will never know whether or not your offices are at risk.

The Impact of DUWL-Borne Outbreaks

The recent CDC HAN health alert on October 31, 2022, for example, was not complete negligence by the dental office2. They were treating their water with tablets. The issue was deeper than that (literally) as testing revealed bacteria counts well exceeding the standard for safe drinking water.

A whistleblower in Richmond, VA alerted the Virginia Department of Health Professionals on January 17, 2018, with information regarding negligence on waterline maintenance practices in the office3. Tests revealed bacteria counts 13 times higher than the 500 CFU/mL standard.

The Anaheim, CA outbreak in 2016 was a similar story, with over 200 filed lawsuits and 71 documented instances of Mycobacterium Abscessus, the Orange County Health Care Agency (OCHCA) and California Department of Health discovered the office had neglected to test and verify that their water was safe4.

The Atlanta, GA outbreak in 2015, impacting 24 patients with Mycobacterium Abscessus, was due to neglected dental water5.

Sadly, these situations are entirely preventable.

The Industries’ Attention on DUWLs and Increased Pressure to Maintain Compliance

Risk mitigation as it relates to waterline compliance has become increasingly more standardized. Protocols and SOPs are seen as a requirement by OSHA and many State Dental Boards to maintain licensure and operations. Some states have taken additional precautionary regulations to reinforce CDC recommendations and best practices.

While the idea of an organization-wide waterline maintenance program can seem daunting, ProEdge Dental Water Labs has partnered with the world’s largest DSOs to build a simple, effective, repeatable protocol – specifically designed for you. ProEdge partners with each office to ensure they are achieving DUWL compliance.

If you are just getting started in understanding waterline compliance and mitigating risk, The Complete Guide to Dental Unit Waterline Compliance and State-by-State Waterline Maintenance Standards are excellent resources to dive into. The Dental Unit Water Quality: Organization for Safety, Asepsis and Prevention whitepaper is also a fantastic resource to dig deeper into the science behind effective waterline maintenance practices.

ProEdge Dental Water Labs is the go-to partner that specializes in dental waterline compliance. ProEdge is the leading voice in DUWL maintenance and the largest dental water testing lab in the world.

Connect with ProEdge’s DSO waterline compliance
team for a consultation to jump start your process.
Call 888.843.3343 or email


1 “Treating and Monitoring Dental Water” by Nancy Dewhirst, RDH, BS and John A. Molinari, PhD



4 Jasjit Singh, Kathleen O’Donnell, Negar Ashouri, Felice C Adler-Shohet, Delma Nieves, M Tuan Tran, Antonio Arrieta, Lisa Tran, Michele Cheung, Matthew Zahn, 926. Outbreak of Invasive Nontuberculous Mycobacterium (NTM) Infections Associated With a Pediatric Dental Practice, Open Forum Infectious Diseases, Volume 5, Issue suppl_1, November 2018, Page S29

5 Peralta G, Tobin-D’Angelo M, Parham A, et al. Notes from the Field. Mycobacterium abscessus Infections Among Patients of a Pediatric Dentistry Practice — Georgia, 2015. MMWR Morb Mortal Wkly Rep 2016;65:355–356.

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