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Nontuberculosis Mycobacterial Infection Linked to Pulpotomy Procedures and Possible Dental Waterline Contamination Reported in California and Georgia

September 21, 2016 Recent news items1, 2 have reported on one confirmed case of Mycobacterium abscessus oral infection in a pediatric dental patient in Anaheim, California.  As reported, 7 patients treated at the Children’s Dental Group since May 3, 2016 have been hospitalized with serious oral cellulitis; all of the patients had undergone pulpotomy procedures at the clinic.2  It is estimated that up to 500 children could be affected.1  M. abscessus is a rapidly growing, nontuberculous mycobacterium (NTM) found commonly in water, soil, and dust and can be a contaminant of medical devices; infection with M. abscessus can result in dental abscesses and other skin and soft tissue infections.2, 3  The Los Angeles Times reported2 that the California Department of Public Health, the Centers for Disease Control and Prevention (CDC), and the Dental Board of California are working with the Orange County Health Care Agency to investigate the source of the infections.

A related 2016 report3 from the CDC and the Georgia Department of Public Health described the first incidence of transmission of M. abscessus to patients via dental waterline in a pediatric dentistry practice. It was determined that the practice was using tap water for pulpotomy procedures without water quality monitoring or bleaching of waterlines at the end of each day (as recommended by the manufacturer). Of 1,386 pulpotomies performed since January 2014, a total of 20 patients with confirmed (n=11) or probable (n=9) M. abscessus infections were identified (as of January 2016). All patients were severely ill and required at least one hospitalization (median hospital stay 7 days; range: 1–17 days); 17 patients required surgical excision and 10 received outpatient IV antibiotics. As of April 5, 2016, no deaths had resulted from infection.

The ADA Oral Health Topics include professional resources on dental unit waterlines and infection control.

References

  1. Perkes C. 7 children hospitalized after treatment at Anaheim dental clinic, 500 more could be affected. The Orange County Register. September 13, 2016 (Updated September 14, 2016). Accessed September 16, 2016.
  2. Rocha V. Oral infection outbreak appears linked to an Anaheim dental office, officials say. Los Angeles Times. September 14, 2016. Accessed September 16, 2016.
  3. Peralta G, Tobin-D'Angelo M, Parham A, et al. Notes from the Field: Mycobacterium abscessus Infections Among Patients of a Pediatric Dentistry Practice--Georgia, 2015. Accessed September 15, 2016.

Prepared by: Center for Scientific Information, ADA Science Institute

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