Suspected Mycobacterial Infections Follow Pulpotomies

Dentistry Today


The Orange County (OC) Health Care Agency and other public health organizations are investigating mycobacterial dental infections among pediatric patients who had been treated with pulpotomies at the Anaheim location of the Children’s Dental Group. So far, one case has been confirmed with 13 additional probable cases.

“Mycobacteria are commonly occurring bacteria in the environment that generally pose minimal risk,” said Jessica Good, public information officer with the agency. “In rare instances, water sources within a facility can become contaminated with higher levels of bacteria, increasing risk to patients receiving pulpotomies or other invasive procedures.”

According to Good, the confirmed case involves illness consistent with mycobacterium abscessus infection, a history including a visit to the Children’s Dental Group Anaheim practice, and a culture that has tested positive for mycobacterium abscessus. The affected children range in age from 3 to 9 years old.

“The infection causes localized dental abscess, but may infect nearby bone,” said Good. “Treatment generally involves IV antibiotics and treatment of the site.”

Symptoms have appeared anywhere from 15 to 85 days after these pulpotomy procedures, often coming on slowly over days to weeks. These symptoms may include swelling, redness, and pain around the infected tooth. Quick identification of the infection is key to effective treatment.

Children’s Dental Group is now reaching out to patients at risk, which includes about 500 children who received pulpotomies in Anaheim between April 6 and August 28 of this year. The Centers for Disease Control and Prevention (CDC) reports that, during a 2014 and 2015 outbreak following pulpotomies in Georgia, the infection rate was about 1% to 2% of those who had the procedure.

“We are asking all of these patients, even in the absence of any symptoms, to come in for x-rays, an examination, and a health history so that we can evaluate whether any signs of infection exist and prescribe appropriate care if necessary,” the company said in an official statement.

The OC Health Care Agency has also ordered the clinic to stop using water for its procedures since 5 on-site water samples have tested positive for mycobacteria. A plan to replace the water system is underway and will be submitted to the OC Health Care Agency for approval. Until then, the practice will be limited to x-rays and exams.

To prevent infections associated with waterlines, the CDC urges dental practices to follow manufacturer guidelines for disinfection, monitor water quality to ensure recommended bacterial counts, use point-of-use water filters, and eliminate dead ends in plumbing where stagnant water can enable biofilm formation.

Healthcare providers who identify patients with symptoms consistent with oral mycobacterial infection following treatment at the Children’s Dental Group Anaheim office are asked to call 714-221-1112 for further assessment and treatment. Information on possible cases or questions about the investigation should be referred to the OC Health Care Agency Epidemiology Program at 714-834-8180.

Meanwhile, parents who have concerns about the care that their children received at the facility are encouraged to file a written report with the Dental Board of California at

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