Compliance With Waterline Management Guidelines Amongst Dentists In London And Northern Ireland

Objectives: Microbial contamination of dental waterlines significantly reduces water quality. The aim of this study was to examine the factors that affect dentist's compliance with national recommendations for dental waterline management. Methods: 266 Principal Dentists (100 rural Northern Ireland, 166 London) were randomly selected from Health Authorities' registers and recruited into a cross-sectional prevalence survey. An environmental risk assessment was conducted through a structured interview and questionnaire, taken in the dental office. Results: 84% of dentists were male and 16% female. A water decontamination system was fitted or a biocide used in only 32% of the dental units. 26% had installed an independent water reservoir system and of these 17% used sterile water; 36% filled the reservoir with mains water. Multivariable analysis revealed that dentists were more likely to have fitted a water decontamination system if they practiced in London (p<0.0001) and if the dental unit was newer (median age 3.25 years vs. 9.5 years if no decontamination system, p<0.0001). Men were less likely to have employed a decontamination system than women (p=0.037). 67% had a written cross infection control policy. In multivariable analysis, Northern Ireland dentists were more likely to have a written policy (p=0.032) as were offices with more than two dentists (p=0.02). However, only 48% of policies included a statement on flushing of waterlines; only 6% complied with national guidelines and flushed beginning of the session and between patients. Dentists were more likely to flush their waterlines on a daily basis if they practiced in Northern Ireland (p=0.018), if they worked in larger offices with more than two dentists (p=0.015) and if they treated more patients (median 23 patients/day, p=0.006). Conclusions: Low levels of compliance with published guidelines were found amongst dentists located in rural and metropolitan areas of the UK. Infection control advice needs to be targeted at smaller practices and male dentists.