Dental

The HSE have issued specific Legionella guidance for the Dental sector. It is proven that dental surgeries can become a breeding ground for bacteria in water, patients are susceptible to infection as water is sprayed directly into the mouth, making inhalation almost inevitable. In recent years, advancement in dental chair technology has yet to find a 100% effective solution to Legionella.


At the very least every Surgery/Practice must have a written waterline management scheme and legionella risk assessment. Find out more about Legionella in the Dental Sector:

Risks :

Male patients who smoke have an increased risk.

Dental instruments form aerosols. These aerosols are spayed directly into the mouth, sometimes on open wounds, if the water is contaminated the patient will easily become infected.

The elderly and those with lowered immune systems, or existing chronic diseases like Diabetes have a substantially increased risk of contracting Legionnaires disease.

‘Plasticisers’ present in the plastic tubing of waterline systems encourage biofilm, which in turn becomes nutrients to the bacteria.

Water can stagnate within dental waterlines overnight & weekends allowing bacteria growth.

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Responsibilities :

Legislation that protect staff & the public must be complied with by all Dentists & Dental Practices. These being: Health and Safety at Work Act 1974 & Management of Health and Safety at Work Regulations 1999. Adherence to these are built in to the latest ACOP L8.

Dentists and Dental Practices must adhere to guidance supplied by the Health & Safety Executive (HSE) as laid out in the document now known as HSG274 Part 2. There is also further Dental sector specific information published by the HSE available here (HTM 01-05) and here (HTM 04-01 Part_A).

All Dentists and Dental Practices in England must be registered with the Care Quality Commission (CQC) which is the independent regulator of all health & social services in England. It is an executive non departmental public body of the Department of Health. Established in 2009, they employ over 2,000 staff. The CQC will randomly inspect all registered members, who also must pay a subscription.

Employers must report any case of Legionnaires’ that may have been caught at work to the Health and Safety Executive (HSE), under the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (RIDDOR). The duty to do this follows on from a doctor notifying the employer.

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Repercussions for Failures

Huge Fines by the CQC and/or HSE.

Special Measures’ enforcement.

Risk of death.

Expensive Court Cases.

Defamation and Bad Press.

Staff Flu-like symptom illnesses are far more common in Dentistry (possibly due to undiagnosed Legionella bacteria contamination).Defamation and Bad Press.

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Case Studies

Italian Woman dies after dentist visit

An 82 year-old otherwise healthy woman contracted and died from Legionnaires Disease in February 2012, in Rome, Italy. In a rare reported incident, a subsequent investigation found that other than being at home in the 10 days prior to her death, the only place she had visited was her dentist, twice. Tests showed identical bacteria in the water system of the dentist. Chlorination and Shock treatment techniques were performed at the surgery and the presence of Legionella removed.

British Dental Journal Study in West Scotland

Water from 40 Dental units in 39 practices were sampled and some interesting results were proven. For example, the microbiological quality of water from the dental units was poor compared to that of Drinking Water from the mains, also the age and make of Dental chairs and instruments made no bearing on the Bacteria count discovered.

Cross-Sectional Study in Hesse, Germany

This study of 90 dental sites confirms that in accordance with other European studies, Legionella bacteria was present in 33% of the sites analyzed. The report concludes that sites with good adherence to established prevention protocols is effective in reducing microbial contamination.

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