Dental Infection Control Update:
Pulpotomy Procedures and Mycobacterial Infection in Children
Dental infection control and prevention practices are coming under increased scrutiny as a result of a growing number of infection outbreaks over the past few years.
In 2015, a pediatric Mycobacterium abscessus odontogenic infection outbreak was reported in Georgia. The outbreak was tied back to patients undergoing a pulpotomy, or "child root canal," at a pediatric dentistry practice. Twenty children were hospitalized.
In just the past few weeks, reports of a similar outbreak came out of Southern California. There is an outbreak of Mycobacterium abscessus infections in children ages 3-7 that had undergone a pulpotomy at a dental office. The water in the dental lines appeared to be the cause of infection. Several children have been hospitalized thus far. These infections may result in long-term illness as well as ongoing dental issues.
Mycobacterium abscessus is one of several slow-growing bacteria that are ubiquitous in water and soil. The group of bacteria known as non-tuberculous mycobacteria are very difficult to eradicate once they adhere to foreign objects. The organism tends to adhere to and grow in devices that collect water and create stagnation.
In the case of these children, the water that was used during the pulpotomy treatment allowed bacteria growing in the water to be trapped in the tooth when it was capped after the procedure was completed. In patients whose teeth are not being capped, the bacteria would ordinarily be flushed away during daily life.
Dental waterlines are generally plastic in nature, and carry water to the hoses that rinse a patient's mouth. Dental waterlines are a challenge as bacteria grow biofilm which adheres to the plastic tubes and is very difficult to eradicate. Mycobacteria are not the only organisms that grow in dental water lines, and several studies have revealed issues with microbes and stagnant water.
The team of infection prevention experts at Infection Control Consulting Services (ICCS) provide guidance and policies for professionals in the dental and oral surgery arena to improve "best practices" with respect to all aspects of dental care, including maintenance of water lines. The team follows the Centers for Disease Control and Prevention (CDC) guidelines and checklists while conducting onsite observations, paying particular attention to flushing and purging of lines, monitoring of water quality, and choice of chemicals, sterilization practices and more.
Phenelle Segal, President of ICCS, notes that following manufacturers' instructions is very important, as is preventing short cuts in practice. "Infection prevention professionals are well aware of the dangers surrounding water-loving organisms such as the nontuberculous mycobacteria," she says. "Every effort to mitigate the risk of infection should be entertained and implemented."
To coincide with International Infection Prevention Week, which takes place October 16-22, Phenelle and the ICCS team urge everyone to follow this year's international theme of "break the chain of infection" as we all strive toward providing safer, compliance care to patients.