It’s said that the wheels of justice turn slowly.
A recent decision (Oct. 4, 2022) by the Georgia Supreme Court caught my eye over the weekend. A chain of Georgia dental clinics had requested the court examine a lower court’s decision to block it from defending itself against a sanction; the court declined the request. The sanction was placed for willfully ignoring document requests from families of children who allegedly became sick after treatment.
According to the filed suit, back in 2014, at least 23 children, including those of the plaintiffs, became ill with Mycobacterium abscessus infections after undergoing a pulpotomy at one of the defendants’ clinics. The CDC’s “Morbidity and Mortality Weekly Report” (MMWR) dated April 8, 2016, lays out the case in detail.
In September 2015, the Georgia Department of Public Health (DPH) was notified by a hospital of a cluster of pediatric Mycobacterium abscessus odontogenic infections. The reporting hospital had provided care for nine children who developed presumptive or confirmed M. abscessus infection after having a pulpotomy at a pediatric dentistry practice.
DPH staff visited the clinic on September 22, 2015, to evaluate infection control and prevention practices, and to view a mock pulpotomy demonstration. Their report indicated that the clinic used tap water for pulpotomies without water quality monitoring or bleaching of waterlines at the end of each day, as recommended in the manufacturer guidelines.
The DPH’s investigation found all patients were severely ill, requiring hospitalization at least once for a median of 7 days; 17 patients required surgical excision and 10 received outpatient intravenous antibiotics. Fortunately, as of April 5, 2016, no deaths resulted from infection. The water samples collected from the seven dental stations had averaged bacterial counts 182 times above both the ADA and the CDC’s recommended maximum level for use in non-surgical dental procedures. The samples also exceeded the EPA regulatory standards for drinking water of ≤500 colony-forming units (CFU). M. abscessus was isolated from all water samples. All water and patient isolates were indistinguishable by PFGE, indicating a common source.
The CDC notes that M. abscessus causes skin and soft tissue infection, can cause disease in multiple organs, and that it displays tolerance to commonly used disinfectants.
Key Takeaway: Test Your Water!
Without regular treatment and monitoring of the water in the dental unit and waterline tubing as well as shocking of waterlines, a biofilm can form and replicate rapidly. Improperly maintained dental unit water lines can permit growth and amplification of microorganisms, including Mycobacterium abscessus.
Testing your water regularly—just as with spore testing—is an easy but absolutely necessary infection control practice.