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Part: 2

 Choose a Treatment Method

This one is easy and thankfully, there is ample information on this blog alone about the products we recommend, and why. Not to mention the gang of sales folks out there selling the latest and greatest waterline widgets that are not only effective, but they may save you time and money in the long run.

EPA Registration and Labeling

Always select products that have an EPA registration for dental waterline treatment. Unless the bleach you were using has an EPA registration for waterline treatment, ditch it and go with something validated for use in the dental unit. From there, you can evaluate products on an individual basis. Most companies pay good money for validation testing so they can advertise their level of disinfection. You can find that information on their EPA label and most likely their packaging. Can’t find your labels? You can search for them at the site at this link:

You will also find their instructions for use (IFU). Study these closely. These protocols can get complicated, will vary from product to product, and can end up costing you more money in man hours over the long term. What’s worse, the more complicated the protocols, the more likely folks will choose to cut corners and not follow the IFU. In our experience, staff protocol compliance is one of the top causes of water test failures despite it being one of the easiest factors to mitigate.

Shock Treatments and Compatibility

One final point about treatment products. Most manufacturers recommend using an EPA registered waterline cleaner (aka shock treatment) prior to starting the maintenance treatment. The problem is, they don’t always provide a shock treatment or tell you what is compatible with their maintenance products. When possible, look for products that have integrated shock and maintenance treatments to avoid unwanted chemical reactions in the waterline.

If you’ve never treated your dental units, you should plan on more than one shock treatment during the initial implementation and prior to your first water test. It may be beneficial to remove your handpieces as dead biofilms released from the shock treatment may be purged in the effluent water, and you don’t want that gunk clogging up your handpieces.

Formulate a System for Training Staff


Staff protocol compliance can make or break your treatment efforts.

Make it easy on yourself and others and create the necessary framework so people can fall back on their training in times of action.

Develop and maintain a waterline training binder and log book to track and maintain records of who has been trained and on what topics. As new individuals come on board, they too will need to be instructed on waterline safety efforts specific to your practice. It is also beneficial to have a protocol for what to do in the case of a protocol breach. Instill a culture of honor and responsibility around waterline cleanliness. The intent is to allow people to admit when they’ve breached protocol and to take responsibility to rectify the situation.

Many offices will have an Infection Control Officer who oversees all infection control efforts. If you don’t have one in your office, task someone with the job of becoming the resident expert on how waterline treatment should be executed and training others to do the same.

Establish a Water Quality Monitoring System

Your plan should include specific points covering water testing and its relevance to your practice.


According to OSAP…

…“dental procedural water monitoring is intended to identify failures in clinical water management practices and can also provide a positive-reinforcement feedback loop for the dental staff.”

Some things to think about and specify in your testing plan are:

  • Sampling and test methods to be used

  • Testing intervals

    • At least once a year. You can never test too much so do what your practice can afford. OSAP has some great recommendations in the Journal of Dental Infection Control and Safety, Vol. 1, Issue 1.

  • Action limits

    • 499 CFU/mL should always be your maximum allowable bacteria level.

  • What to do in the case of a failed water test

    • Consult with the waterline product manufacturer.


Step 2: Execute

Now you’ve got a plan. Everyone has been trained. It’s time to put it in place. This can be a little scary at first, but you’ve got this. Remember, the key to success is consistency. Stick to the plan.


Step 3: Evaluate and Repeat

As times goes by and you have some water test data to support whether your plan is working or not, you may see a need to alter your plan in some way. Awesome! You should be constantly evolving and improving your process with the introduction of new information.

Considerations for Sustaining Long Term Compliance

Sustainable waterline compliance is all about consistency. If you change some element of your plan, you should consider validating the change with a water test. Have fun with it. Water treatment is one big experiment that you get to run over and over. Some variables will affect the outcome in different ways, so keep track of how you direct your energy. As you build up your understanding of what works in your practice, quadruple down on that.

Thanks for Reading

Thank you for reading this installment of the Sterisil waterline blog. We are dedicated to putting out the most useful and well researched pieces possible. If you enjoyed this article, please share it with the world and subscribe at the bottom. Thanks for reading!