Sterile solutions (eg, sterile saline and sterile water) should be used as coolant irrigation in the performance of oral surgical procedures where a greater opportunity exists for entry of microorganisms, exogenous and endogenous, into the vascular system and other normally sterile areas that support the oral cavity. (eg, bone and subcutaneous tissue) and increased potential exists for localized or systemic infection (see Oral Surgical Procedures). Conventional dental units can not reliably deliver sterile water even when equipped with independent water reservoirs because the water-bearing pathway can not be reliably sterilized. Delivery devices (eg, bulb syringe or sterile, single use disposable products) should be used to deliver sterile water. Oral surgery and implant handpieces, as well as ultrasonic scalers, are commercially available that bypass the dental unit to deliver sterile water or other solutions by using single use disposable or sterilizable tubing.
Recommendations
Dental Unit Waterline, Biofilm and Water Quality
1. Use water that meet EPA regulatory standards for drinking water (ie, < 500 CFU/mL of heterotrophic water bacteria) for routine dental treatment water.
2. Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the recommended quality of dental water.
3. Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product.
4. Discharge water and air for a minimum 20 to 30 seconds after each patient from any device connected to the dental water system that enters the patient's mouth (eg, handpieces, ultrasonic scalers and air/water syringes).
5. Consult with the dental unit manufacturer on the need for periodic maintenance of anti-retraction mechanisms.