The U.S. Centers for Disease Control and Prevention have issued a warning following confirmation of a recent outbreak of a nontuberculous mycobacteria infection. This appears to have been caused by contaminated water lines in some dental clinics. Now, medical professionals are urging parents to look out for symptoms in their children and themselves. Fortunately, treatment is available for those who have caught the infection.
The U.S. Centers for Disease Control and Prevention (CDC) have issued a warning that some American children have caught a serious infection from contaminated water lines in some dental clinics [1].
The infection, caused by a bacteria type called Nontuberculous Mycobacteria (NTM) is rare. But small clusters of cases in recent years have taken place, with the CDC now becoming aware of another recent cluster [1].
The harmful bacteria lodge in the narrow water lines of dental equipment. This equipment is used for everything – from routine cavity fillings to more complex procedures like root canal treatments.
What is Nontuberculous Mycobacteria?
NTM is a type of bacteria. It is found in water, marshland and soil. However, it shouldn’t be confused with mycobacteria tuberculous – which causes Tuberculosis.
While children are predominantly at risk, adults can also be affected. Infections typically occur after either wisdom teeth extractions or root canal treatments [1].
One of the most notorious past outbreaks of NTM came in California in 2016 [1]. 71 patients were treated for NTM infection [1].
NTM is not the only infection or disease linked to dental water lines. For example, Legionella Disease is another type of bacteria that has contaminated water supplies in dental clinics in the past [3].
The new outbreak
This most recent outbreak was in March 2022, which the CDC was alerted to [2]. An investigation into this new outbreak is being carried out by the CDC [2].
Initial visits to the dental clinic under investigation found that the tested water line resulted in microbial counts far higher than the level recommended by the CDC [2].
Symptoms and treatment of an NTM infection
The symptoms of an NTM infection usually involve swelling in the jaw or neck. Moreover, an abscess, pain, weight loss, night sweats and general fever are other symptoms to look out for [4]. Symptoms do not always appear immediately. Instead, they can slowly appear.
If left alone, hearing loss, permanent tooth loss and facial nerve palsy are potential consequences [1]. This underlines the importance of getting help if you believe you have an NTM infection.
NTM infections usually get worse over time [1]. Treatment usually requires surgical removal of the diseased tissue. This can result in loss of the jawbone, and potentially even teeth [1]. Antibiotics are commonly prescribed as part of a multi-drug regimen [1].
In every case in the past that has involved NTM infection following dental treatment, a surgical procedure has been required to resolve the issue [1]. Therefore, this shows the possible damage of an NTM infection.
The CDC’s comments
Dr. Michele Neuburger is a dental officer within the CDC’s Division of Oral Health. She commented on this development. She says that “NTM infections following dental procedures are very serious” [1].
Neuburger continued by warning that “these infections can be resistant to antibiotic treatment”, before calling them “difficult to treat” [1].
Continuing, Neuburger says that “if dental water lines are not maintained properly and regularly treated with germicides, these bacteria, along with other microorganisms in the water, will attach to the interior surfaces of the water-line tubing and form a biofilm, which serves as a reservoir where microorganisms can grow and increase in numbers” [1].
Neuburger continued to explain by saying that “pieces of biofilm can break off into the water system and then be released into the patient’s mouth” [1].
Furthermore, Neuburger has urged parents to contact their dentist immediately if they suspect themselves or a child of theirs has developed an NTM infection [1].
The CDC have made some recommendations to dental clinics. These include the regular use of chemical germicides in the water lines – which can help in lessening the threat of bacteria.
It is important for dental clincis to follow these guidelines. Moreover, this involves maintaining equipment and following safety procedures for water to ensure that it is safe for use.
These infections are rare, but do happen. Remaining vigilant both before and after dental treatment is important. Our oral health is crucial, and should always be a priority for us all.
Thinking points…
1) While this is concerning, do not let this put you off attending the dentist. Please remember that NTM infections are very rare. Visiting the dentist is very important for both yourself and your children. Regular check-ups can help to ensure your oral health is strong, and identify any potential problems. Remember to book an appointment when needed!
2) If this news makes you anxious, you’ll be pleased to hear that at our Calgary dental clinic Savanna Dental, safety is of the utmost importance to us. We follow the designated guidelines to ensure our water supply is safe for patients. Furthermore, our dental staff are always happy to talk you through treatments, and reassure you about the water supply. We would love to see you soon – see our website for more information!
What we offer at Savanna Dental
Savanna Dental is a Calgary dental clinic that provide its patients with a range of treatment options and advice aimed at improving oral health.
It is crucial to brush your teeth at least twice a day and to floss regularly. Moreover, eating healthily and trying to avoid sugary foods and drink is important.
We advise our patients to attend our Calgary-based dental clinic twice a year for a regular dental check-up. When problems are detected, we have many treatments available. For instance, these include cavity fillings and root canals.
Here at Savanna Dental, we also have some cosmetic treatments available! These include dental implants, tooth whitening and Invisalign™! Many people find that these treatments have a positive impact on their appearance, confidence and self-esteem.
In addition, all of our services at our Calgary dental clinic Savanna Dental are in line with the Alberta Dental Fee Guide.
We would love you to visit our Savanna Dental clinic in Calgary! You can find out more about us by visiting our website https://savannadentalclinic.ca.
References
[1] Reinberg, S. (2022). CDC warns of rare bacterial infections from dentists’ water lines. Available: https://medicalxpress.com/news/2022-11-cdc-rare-bacterial-infections-dentists.html. Last accessed: 12th November 2022.
[2] CDC Health Alert Network. (2022). Outbreaks of Nontuberculous Mycobacteria Infections Highlight Importance of Maintaining and Monitoring Dental Waterlines. Available: https://emergency.cdc.gov/han/2022/han00478.asp. Last accessed: 12th November 2022.
[3] Atlas, R. M., Williams, J. F., & Huntington, M. K. (1995). Legionella contamination of dental-unit waters. Applied and Environmental Microbiology. 61 (4): p1208-1213. DOI: https://doi.org/10.1128/aem.61.4.1208-1213.1995.
[4] Asthma + Lung UK. (2022). Non-tuberculous mycobacterial infection (NTM). Available: Last accessed: 12th November 2022.
