Catastrophic Risk Due to Water Contamination – A Black Swan of Dentistry

What’s a “Black Swan?”

It was once believed that “all swans are white.”  That belief was dispelled when Black Swans eventually were discovered.  Today, risk managers use the term “Black Swan” to refer to a seemingly unlikely but high impact event that actually may come to pass.  Recent examples of Black Swans include the 9/11 terrorist attacks, the 2008 financial crisis and the COVID-19 pandemic.  While some people believe such events are unpredictable, that’s simply not true.  Take, for example, COVID-19.  That particular virus and its exact timing may not have been predictable but a global pandemic certainly was (especially considering that it was preceded by the bird flu, swine flu, SARS and MERS).  We let our guard down because – fortunately – these viruses were contained and limited in both health and economic impact.  However, we should have been better prepared.

Catastrophic Risk Due to Water Contamination

            In dentistry, catastrophic risk due to water contamination is like a Black Swan because it’s rare and most dentists do not think it will happen to them.  But failure to regularly test the quality of dental water can increase the probability of such catastrophic risk.  Why?

  • Bacteria love to grow in stagnant water found in water lines:  Dentists use water only sporadically so water lines (i.e., the flexible plastic tubes that carry water to the hoses that rinse patients’ mouths) often contain stagnant water.  Water lines that do not meet cleanliness standards are the perfect breeding ground for microorganisms such as Pseudomonas aeruginosa, Legionella, Nontuberculous Mycobacterium and Staphylococcus aureus.
  • High Concentrations of Antibiotic Resistant Bacteria Can Sicken People – Consider the following real-life cases:

o   2015 – Multiple children were hospitalized with severe infections due to contaminated  water at an Atlanta, GA practice.

o   2016 – More than 70 children contracted mycobacterium abscessus infections due to contaminated water at an Anaheim, CA practice.

In both cases, numerous patients lost teeth and/or ended up losing portions of their jaw bones because antibiotics were not effective and the dental practices were hit with costly and reputationally damaging lawsuits.  

How to Mitigate this Risk

You should take the following steps to protect` your patients and your practice:

  1. At the beginning of each day, flush all water lines for two full minutes
  2. Between patients, flush all water lines for at least 20 seconds (don’t confuse this with your suction lines; those are different and should be maintained properly also)
  3. At the end of each week, purge the lines so water does not become stagnant
  4. On a periodic basis, test and shock your water lines to ensure your water treatment solutions are effective:  The latest recommendations are to test and shock monthly until you get three months of passing tests, then test and shock quarterly.  If you are not getting good test results, research why.  Perhaps your lines are old and need to be replaced.  Also, be sure to maintain proper logs of such testing

If you have questions or need assistance with water testing, please feel to contact us at www.doc4ne.com.  We’re here to help you reduce risk and maintain your patients’ trust.

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