Dental water system linked to severe oral infections in California children

Nearly two dozen cases of children suspected or confirmed to have life-threatening Mycobacterium abscessus infections have been linked to an Anaheim, California dental office.

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Update, October 10, 2016: On October 7, the County of Orange Health Care Agency announced that the number of cases involved has increased to 30. The agency has also approved the Children's Dental Group's selection of a new water system.

Nearly two dozen cases of children suspected or confirmed to have life-threatening Mycobacterium abscessus infections have been linked to an Anaheim, California dental office.

On September 15, the County of Orange Health Care Agency ordered the Children’s Dental Group of Anaheim to “cease the use of that facility’s on-site water system for any patient dental procedures.” (1) The agency’s laboratory has confirmed that multiple samples from the practice’s water system have tested positive for mycobacterium similar to the kind believed to have sickened the children.

Dental Water System

The children involved all received pulpotomies over the last several months; the practice’s website states that they are contacting the parents of all patients who have received this treatment since April 2. (2)

READ MORE | What's in the water? Concerns over dental unit water lines challenge compliance efforts for patient safety

According to the Orange County Register, Sam Gruenbaum, the CEO of the group practice, “has previously said the clinic practiced industry-standard sanitation practices.” (3)

The Health Care Agency has stipulated that the following requirements are to be met before the order to cease use of the water system will be lifted:

  • The facility must provide a written plan for replacement of the current on-site water system for review and approval by HCA.
  • Upon HCA-approval of the plan, the facility must fully implement the plan to replace all equipment that could potentially be a source of Mycobacterium as indicated by laboratory testing.
  • All on-site water system renovation and replacement must be reviewed by HCA, including laboratory testing as appropriate, to assure patient safety. (1)

The consequences of these M. abscessus infections have been severe. The Health Care Agency reports that the children involved in all 22 cases have been hospitalized at some point. The Orange County Register states that many of these children are on long-term IV antibiotics, and some have even required the removal of sections of jaw and permanent teeth. (4, 5)

READ MORE | H2O so simple: Simplicity should be the key in ensuring dental water is as safe as drinking water

This is not the first time pediatric patients have been sickened by contaminated water lines. In September 2015, several children in Atlanta, Georgia were diagnosed with cervical and/or submandibular lymphadenitis and/or osteomyelitis of the mandible. The Georgia Public Health Department traced the infections to contaminated water in a pediatric dental practice.

DentistryIQ will be following the development of this outbreak.

Editor's note: For a broader discussion of the risks of contamination of dental water lines, please see the NPR article "Infection Outbreak Shines Light On Water Risks At Dentists' Offices," published September 30.

References
1. County Health Officer Issues Order Mandating Children’s Dental Group of Anaheim Cease Use of Facility Water for Dental Procedures. County of Orange Health Care Agency website. http://ochealthinfo.com/civicax/filebank/blobdload.aspx?BlobID=57884. Published September 15, 2016. Accessed September 29, 2016.
2. Anaheim Developments. Children’s Dental Group website. http://www.childrensdentalgroup.com/locations/anaheim-developements/. Accessed September 29, 2016.
3. Anaheim dental clinic ordered to stop using water after 10 kids hospitalized. The Orange County Register website.http://www.ocregister.com/articles/children-729073-tooth-hospitalized.html. Published September 15, 2016. Updated September 16, 2016. Accessed September 29, 2016.
4. 7-year-old girl loses some teeth, part of jaw bone, after dental infection outbreak. The Orange County Register website. http://www.ocregister.com/articles/mimi-730242-morales-children.html. Published September 26, 2016. Accessed September 29, 2016.
5. More children infected at dental clinic losing permanent teeth. The Orange County Register website. http://www.ocregister.com/articles/children-729995-clinic-dental.html. Published September 23, 2016. Accessed September 29, 2016.

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