New institute to fill gap on dental health guidance after CDC cuts

This past July, the Association for Dental Safety (ADS) — an organization for oral health care providers and researchers — announced the launch of the ADS Institute for Dental Safety and Science. This new nonprofit entity aims to strengthen and expand on the work previously performed by the CDC’s Division of Oral Health before the Department of Government Efficiency eliminated it in April.

Among ADS’s responsibilities is providing guidance in managing oral infection outbreaks. For example, when Georgia and California children experienced serious systemic infections as a result of bacterial contamination of untreated dental unit waterlines in 2015 and 2016, the ADS issued a white paper in 2018 with protocols for treating and testing dental waterlines to prevent future outbreaks. 

When a similar outbreak occurred in Georgia in 2022, the CDC’s response relied on the ADS’s document, according to the ADS. The CDC also updated its Healthcare Infection Control Practices Advisory Committee (HICPAC) waterline guidance in 2025 just before the unit was eliminated by DOGE.

I spoke with Eve Cuny, an ADS board member who will serve as Chair of the new institute and work alongside Michelle Lee, current executive director of both the ADS and the Institute for Dental Safety. The institute could be a helpful evidence-based resource for journalists covering oral infections.

Can you tell me a bit about the ADS and the new institute, including the role it will fill?

The Association for Dental Safety is a long-time organization dedicated to infection prevention and patient safety in all oral health care settings. We worked really closely with the CDC’s Division of Oral Health for many years to help get information out to oral health practitioners and to create resources to assist the CDC with some of their educational materials, but the elimination of the division leaves a gap for the profession. In any health care setting, there are infectious risks and other safety risks, whether it be professionals getting a needle stick and a potential exposure to a blood-borne disease or a patient adverse event or a medical emergency during care.

We would like to keep providing those resources and information to the public and to the profession, and we’re well-positioned to do that because of our long-term collaboration with the Division of Oral Health. The ADS Institute will be a separate entity from the organization set up to provide guidance, resources, tools and education around infection prevention and patient safety in oral health care settings.

We’ll be putting together an advisory committee with a broad range of expertise, and once that’s in place and we’ve set our priorities and strategies, we’ll develop working groups to work on very specific topics. We anticipate one of the first ones will be looking at updating guidance on dental unit waterlines.

Can you explain what dental unit waterlines are and how they might pose infection risks?

The way dental units are constructed, water is used for irrigation during dental treatment and as a coolant for devices, such as dental handpieces. But because of the way the water flows through a small tubing in the units, biofilm tends to form inside dental unit waterlines that are not treated — and even sometimes in ones that are being treated with antimicrobials. Those biofilms can contain pathogenic organisms. 

In fact, over the past eight to 10 years, there have been several really serious outbreaks among children receiving dental care that resulted in infections. We’re talking hundreds of children that have serious infections that resulted in surgeries and hospitalizations, some of them life-changing illnesses. In response to that, ADS came out with a white paper discussing why treatment on dental unit waterlines should be done and how they should be monitored, but that also needs updating.

And those guidelines are for dentists, hygienists, orthodontists, anybody who uses that equipment, correct?

Yes, anyone who uses dental equipment in a practice setting. That’s really important work because, without that surveillance in outpatient settings, like dental offices, it’s really hard sometimes to make the argument for infection prevention practices. People don’t see the connection between exposure and disease. But once you have clusters, you can convince people that they actually do need to take action.

Who is the primary audience for the resources developed at the Institute?

We will continue to primarily try to reach dental offices and practitioners — assistants, hygienists and dentists. But we have also worked over the years with regulatory bodies, such as state dental boards, some state health departments, Indian Health Services, and other health organizations, providing education and materials for them. For instance, during COVID 19, in the very beginning, we did a series of webinars on behalf of the American Dental Association that were viewed over 150,000 times by the profession.

In what ways might this institute be helpful to journalists?

We are strongly evidence-based in anything that we do. We will require that what we produce be rigorously reviewed and that peer-reviewed publications back up anything we say. We do not make recommendations based on opinion, and I think that that’s where we can help journalists. If it’s in our wheelhouse, we will give reliable answers, or we will say we don’t have the answer.

Often when people think of infectious disease risk, oral health may not often come to mind right away in the general public. What kinds o›f issues might journalists want to make people aware or look into?

I think the profession is much more aware than they were many years ago, when I first got into the profession, because of what’s going on in our world with the emergence of HIV and hepatitis C and other infectious diseases. I think the general population maybe makes a lot of assumptions about safety not just in oral health care, but in outpatient health care in general. 

But we have to remember, almost any procedure done in dentistry, with a very few exceptions, is going to generate sprays and spatters that contain body fluids. The mouth is very close to the eyes, and if there is a splash from the mouth of an organism that can infect the eyes, we know that that can happen when there’s no eye protection for the patient, along with injuries to the eyes.

Almost every dental procedure uses double-sided sharp instruments that will come into contact with body fluids and blood and tissue, and we know that those are vectors for transmitting infectious diseases. Being aware of proper disinfection and sterilization protocols and use of personal protective equipment for the patient and for the providers are things we tend to take for granted, but there has to be somebody letting you know what amount of protection is enough and what is really not necessary. 

Those are the ways that we try to help the profession and the public. Our focus is not as broad as what the Division of Oral Health did, but our goal here is to fill a gap and keep dental patients and dental providers safe in the dental clinic setting.

Possible story ideas on oral health for journalists to explore

• Are local dentists in your area following the ADS guidelines to reduce risk of infection from dental unit waterlines?
• What other risks exist in dental offices, and what are local dentists doing to mitigate them?
• How many people in your area lack access to dental and oral care?  
• What services are available for people without dental insurance or the resources to pay for out-of-pocket care?
• What questions about practice safety might someone want to ask when looking for a new dentist?
• What are the most common oral infections and what are their symptoms?
• How common is transmission of blood-borne infections in dental offices and what can mitigate them?
• What can people do to reduce their risk of oral human papillomavirus (HPV) infections, which can lead to oropharyngeal cancer? Should they undergo screening, and how effective are screening tests?