Dental Water Lines Bacteria Led to Infections of Children, CDC Warns

Federal officials have become aware of multiple cases involving children infected with nontuberculous Mycobacteria (NTM) found in dental plumbing systems in recent years.

The U.S. Centers for Disease Control and Prevention (CDC) issued a dental water bacteria warning in a Health Alert Network (HAN) Health Advisory on October 31, highlighting the importance of pediatric dental facilities following existing safety recommendations and monitoring bacteria levels in dental waterlines.

Nontuberculous Mycobacteria are organisms commonly found in soil and water, which can cause serious side effects among vulnerable populations, such as children and the elderly. The bacteria often causes symptoms that include persistent cough, fatigue, weight loss, night sweats, and occasionally shortness of breath and even coughing up blood.

Oral mycobacterium infections within the mouth can pose more severe problems, as the infection can easily spread around teeth, potentially reaching the gums and jawbone. The CDC has warned that these types of infection within the mouth can often result in the removal of teeth and even part of the jawbone.

Dental Water Line Infection Outbreaks

While cases of nontuberculous Mycobacteria are rare, the CDC warns there have been an increasing number of outbreaks identified in recent years, many of which involve children being exposed to the bacteria from dental waterlines, with the most recent in March 2022.

The outbreak was identified after a cluster of suspected nontuberculous Mycobacteria infections were reported in children following dental procedures at a pediatric dental clinic. The CDC’s investigation into the outbreak revealed dental unit waterline testing showed microbial counts much higher than the level recommended by the CDC.

Health officials first learned of the dental water infection outbreak in September, after nearly two dozen children were diagnosed with Mycobacterium abscesses infections after receiving pulpotomies, or baby root canals, in which dentists remove infected pulp inside a baby tooth so the rest of the tooth can be spared.

A similar outbreak was recorded at a pediatric dental office in California in 2016, in which 37 children were hospitalized with Mycobacterium abscesses after receiving dental treatments at the Children’s Dental Group in Anaheim, California.

Pulpotomy Infection Risks

Children who receive pulpotomies, a procedure to restore infected baby teeth in kids, have been identified as a high risk group for several types of infections. The CDC warning indicates these types of water lines are at high-risk of containing bacteria due to the long, small-diameter tubing and low flow rates used in dentistry, as well as the frequent periods of stagnation.

The CDC warns that Legionella, Pseudomonas aeruginosa, and nontuberculous Mycobacteria (NTM) have all either been found in, or pose a risk of building up in, dental waterlines. To prevent exposing children to contaminated dental water, dental providers are being instructed to properly maintain and monitor their dental equipment and follow guidelines on infection control in dental settings which include a series of recommendations for treating dental unit waterlines.