Updated July 2021
The Centers for Disease Control (CDC) have maintained virtually the same guidelines for dental infection control since 2003 on dental unit water quality. To help ensure the best dental practices rise to the top, most state dental boards have adopted specific language requiring practices to follow these CDC guidelines.
And while there are dental boards that do not require it, it is important to note this does not mean a dental practice would not be subject to dental board discipline, patient complaint, staff whistle-blowing, or civil litigation, should they not follow and document compliance with these guidelines – as seen this in cases like the Anaheim outbreak. Additionally, OSHA and local health departments can be very active in some states and often requires CDC compliance.
Following CDC guidelines is not for some practices – it's best practice, is often considered the standard of care, and it's simply the right thing to do.
To help practices understand exactly what their dental board says on the matter, use the map and state by state dental board rules below to see where your dental board stands.
Learn what the CDC recommends specifically for dental unit water quality
***This does not constitute legal advice. All practices should consult their dental board and legal counsel to determine all current necessary requirements for their practice.
“All dental offices must conform to and comply with the current recommendations and guidelines of the Centers for Disease Control and Prevention (C.D.C.) relating to infection control practices for dentistry and/or dental offices.”
"Comply with current recommended infection control practices for dentistry as published by the national centers for disease control and prevention and as adopted by the Board."
Arkansas: MOBILE Required
"(q) A mobile dental facility shall comply with the current recommendations for infection control practices for dentistry promulgated by the Centers for Disease Control, as it existed on January 1, 2009, and any rule of the board relating to infection control or reporting in a dental office.... All mobile dental facilities must comply with all applicable federal, state and local laws, regulations and ordinances including but not limited to those concerning radiographic equipment, flammability, construction, sanitation, zoning, infectious waste management, universal precautions, OSHA guidelines and federal Centers for Disease Control guidelines, all rules and regulations of the Board. The operator must possess all applicable county, state and city licenses or permits to operate the unit at the location where services are being provided. Further, each mobile dental facility must have the following functional equipment: 1. Ready access to a ramp or lift. 2. Sterilization system. 3. Potable water including hot water."
“In addition to meeting applicable standards of care, dentists and dental hygienists must follow the Centers for Disease Control and Prevention (CDC) 2003 “Guidelines for Infection Control in Dental Health-Care Settings”, including the CDC’s March 2016 “Summary of Infection Prevention Practices in Dental Settings”, and the Occupational Safety and Health Administration’s (OSHA) “Bloodborne Pathogens Standard”. A licensee is also responsible for the compliance of unlicensed dental personnel.” 3 CCR 709-1 Rules and Regulations. 12-35-129. Grounds for disciplinary action. (1) The board may take disciplinary action against an applicant or licensee in accordance with section 12-35-129.1 for any of the following causes: (kk) Committing an act or omission that fails to meet generally accepted standards for infection control;"
“(15) failure to adhere to the most recent version of the National Centers for Disease Control and Prevention's guidelines for infection control in dental care settings. A violation of any of the provisions of this chapter by any unlicensed employee in the practice of dentistry or dental hygiene, with the knowledge of the employer, shall be deemed a violation by the employer. The Commissioner of Public Health may order a license holder to submit to a reasonable physical or mental examination if his or her physical or mental capacity to practice safely is the subject of an investigation. Said commissioner may petition the superior court for the judicial district of Hartford to enforce such order or any action taken pursuant to section 19a-17.”
"Conversely, all dentists are required by law to adhere to CDC infection control standards and have received extensive training in this area to prevent the transmission of infectious diseases such as HIV and Hepatitis B during dental procedures."
"Approved infection control practices. Licensed dentists and licensed dental hygienists shall practice levels of infection control consistent with the guidelines and recommendations of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) and the ADA. [Eff and comp 2/9/01; comp 2/9/02; am and comp 1/27/14; comp 8/22/16] (Auth: HRS §448-6) (Imp: HRS §§447-1, 448-6) The board requires the supervising licensed dentist to appropriately train or provide training to dental assistants which shall include, but not be limited to: (1) Proper sterilization and disinfection procedures which meet the guidelines of: (A) The U.S. Department of Labor Occupational Safety and Health Administration bloodborne pathogen standards; (B) The State of Hawaii Department of Labor and Industrial Relations Occupational Health and Safety bloodborne pathogen standards; (C) The CDC prevention guidelines; and (D) The ADA Clinical Practice Guidelines;"
"031. INFECTION CONTROL. In determining what constitutes unacceptable patient care with respect to infection control, the Board may consider current infection control guidelines such as those of the CDC."
Indiana: MOBILE Required
"(3) The mobile dental facility conforms to all applicable federal, state, and local laws, regulations, and ordinances dealing with radiographic equipment, flammability, construction, sanitation, zoning, infectious waste management, universal precautions, OSHAguidelines, and federal Centersfor DiseaseControl Guidelines, and the applicant possesses all applicable county and city licenses or permits to operate the unit"
"650—30.4(147,153,272C) Grounds for discipline.: The following shall constitute grounds for the imposition by the board of one or more of the disciplinary sanctions set forth in rule 650—30.2(153) specifically including the imposition of civil penalties not to exceed $10,000. This rule is not subject to waiver pursuant to 650—Chapter 7 or any other provision of law. 35. Failure to comply with standard precautions for preventing and controlling infectious diseases and managing personnel health and safety concerns related to infection control, as required or recommended for dentistry by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services."
"Section 5. Infection Control Compliance. (1) Each licensed dentist in the Commonwealth of Kentucky shall: (a) Adhere to the standard precautions outlined in the Guidelines for Infection Control in Dental Health-Care Settings published by the Centers for Disease Control and Prevention; and (b) Ensure that any person under the direction, control, supervision, or employment of a licensee whose activities involve contact with patients, teeth, blood, body fluids, saliva, instruments, equipment, appliances, or intra-oral devices adheres with those same standard precautions. (2) The board or its designee shall perform an infection control inspection of a dental practice or office utilizing the Infection Control Inspection Checklist, if the board and its staff become aware of a violation, or a reliable allegation of a violation, of the Guidelines for Infection Control in Dental Health-Care Settings which may pose imminent public risk."
"All dental health care providers shall strictly observe recognized standard precautions as currently recommended by the Federal Centers for Disease Control (CDC). The board conducts inspections of all dental offices within Louisiana to ensure compliance with this requirement. The current CDC guidelines may be found at the first link below."
"02 313 Board of Dental Practice
Ch. 9 Complaints / Investigations / Unprofessional Conduct
L. Violation of sanitary and safe office conditions as set forth below://
Failure to utilize Center for Disease Control and Prevention ("CDC") Guidelines for Infection Control in Dental Health-Care Settings, 2003 at the time of treatment."
"Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care"
“(1) Infection Control Practices. All persons licensed by the Board and all practices providing dental services are required to operate in compliance with the current Recommended Infection Control in Dental Health-Care Settings - 2003, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta.”
"Subp. 11. Infection control. Dental health care personnel shall comply with the most current infection control recommendations, guidelines, precautions, procedures, practices, strategies, and techniques specified by the United States Department of Health and Human Services, Public Health Service, and the Centers for Disease Control and Prevention. Infection control standards are subject to frequent change."
"All professionals licensed by the Mississippi State Board of Dental Examiners must meet or exceed the current Recommended Infection-Control Practices for Dentistry as published by the federal Centers for Disease Control and Prevention. It is the responsibility of all licensed dentists to ensure that their auxiliary staff who may be exposed to blood and other body fluids are familiar with and adhere to the aforementioned recommendations."
"24.138.418 INFECTION CONTROL (1) Each person who is licensed pursuant to the provisions of Title 37, chapter 4, MCA, shall comply with the provisions of the Guidelines for Infection Control in Dental Health-Care Settings, 2003. The board adopts and incorporates by reference the guidelines which set forth the Centers for Disease Control and Prevention (CDC) recommendations for infection prevention and control in a dental-care setting."
"NAC 631.178 Adoption by reference of certain guidelines; compliance with guidelines required.
1. Each person who is licensed pursuant to the provisions of chapter 631 of NRS shall comply with: (a) The provisions of the Guidelines for Infection Control in Dental Health-Care Settings-2003 adopted by the Centers for Disease Control and Prevention which is hereby adopted by reference."
New Hampshire: REQUIRED
"CHAPTER Den 500 ETHICAL AND PROFESSIONAL DUTIES
PART Den 501 ETHICAL DUTIES
(p) Pursuant to RSA 317-A:17, II (g), licensees shall adhere to the American Dental Association’s current guidelines for infection control and radiographic practices, as published 2016 and available as noted in Appendix II."
new jersey: Required
"3:30-8.5 OSHA AND CDC REQUIREMENTS
a) When providing dental services, all licensees and registrants shall comply with:
2) Centers for Disease Control and Prevention (CDC) Recommended Infection Control Practices for Dentistry, incorporated herein by reference, as amended and supplemented, and available at the CDC website."
New mexico: Required
"18.104.22.168 CONTROL AND PREVENTION OF BLOODBORNE INFECTIONS: The following rules are enacted to prevent transmission of the human immunodeficiency virus (HIV), hepatitis B infectious state (i.e. acute infection and chronic carriers only) (HBV), the hepatitis C virus (HCV), and other blood borne infections.
A. Requirements for providers. Any provider licensed or certified by the New Mexico board of dental health care must comply with the guidelines established in this rule. A provider who fails to use appropriate infection control techniques and sterilization procedures to protect patients may be subject to disciplinary action by the board."
New york: required
"§ 29.2 General provisions for health professions. 13.failing to use scientifically accepted infection prevention techniques appropriate to each profession for the cleaning and sterilization or disinfection of instruments, devices, materials and work surfaces, utilization of protective garb, use of covers for contamination- prone equipment and the handling of sharp instruments. Such techniques shall include but not be limited to: v. sterilizing equipment and devices that touch intact mucous membranes but do not penetrate the patient's body or using high-level disinfection for equipment and devices which cannot be sterilized prior to use for a patient; vi. using appropriate agents, including but not limited to detergents for cleaning all equipment and devices prior a sterilization or disinfection; ix.adequately monitoring the performance of all personnel, licensed or unlicensed, for whom the licensee is responsible regarding infection control techniques;"
North carolina: required
"§ 90-233. Practice of dental hygiene. (a5) Clinical dental hygiene services shall be provided in compliance with both CDC and OSHA standards for infection control and patient treatment."
north dakota: Required
"43-28-18. Grounds for denial of or disciplinary action against license and certificate.
The board may deny an application or take disciplinary action against the license and the
certificate of registration of any applicant or dentist who has:
19. Failed to comply with commonly accepted national infection control guidelines and standards."
"Section 328.32 - Grounds for Penalties
Version 1 (as amended by Laws 2019, SB 848, c. 428, § 3, emerg. eff. May 21, 2019) A. The following acts or occurrences by a dentist shall constitute grounds for which the penalties specified in Section 328.44a of this title may be imposed by order of the Board of Dentistry or be the basis for denying a new applicant any license or permit issued by the Board: 13. Practicing dentistry in an unsafe or unsanitary manner or place, including but not limited to repeated failures to follow Centers for Disease Control (CDC) or Occupational Health Safety Administration (OSHA) guidelines;"
"818-012-0040 Infection Control Guidelines
In determining what constitutes unacceptable patient care with respect to infection control, the Board may consider current infection control guidelines such as those of the Centers for Disease Control and Prevention and the American Dental Association."
"(a) Dentists. Unprofessional conduct, as defined in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)), includes the following conduct by a dentist:
(7) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control or to ensure that auxiliary personnel and other supervisees follow these Federal guidelines."
rhode Island: required
"CHAPTER 40 – PROFESSIONAL LICENSING AND FACILITY REGULATION PART 2 – Dentists, Dental Hygienists, and Dental Assistants
2.2 Incorporated Materials
A. These regulations hereby adopt and incorporate by reference the Center for Disease Control and Prevention’s “Summary of Infection Prevention Practices in Dental Health Care Settings” (2016), not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these regulations.
2.15.1 Denial, Revocation or Suspension of License/Violations and Sanctions
30. Failure to follow current minimum infection control recommendations developed by the Centers for Disease Control and Prevention (CDC) published in the document entitled Guidelines for Infection Control in Dental Health-Care Settings and weekly spore testing."
south carolinA: required
"(1) All dental practices shall conform to and comply with the current recommendations and guidelines of the Centers for Disease Control and Prevention (CDC) relating to infection control practices for dentistry and/or dental offices."
south dakota: required
20:43:04:03. Inspections for safety and sanitation.
The board may suspend or revoke any license issued, after opportunity for hearing as provided in SDCL 1-26, for failure of a dentist to maintain the dentist's entire dental office in a clean and sanitary condition without any accumulation of trash, debris, or filth. The dental office must be maintained in full compliance with all health requirements of the city or county, or both, in which it is located. The dentist must maintain the office in compliance with the Guidelines for Infection Control in Dental Health Care Settings, 2003, of the Center for Disease Control and Prevention. The dentist must permit inspection of the dental office at any time by anyone authorized by the board."
"Compliance with industry standards is of the utmost importance in all settings and having the ability to access credible resources in a timely manner is critical. Oral Health Services would like to direct you to the CDC’s “Summary of Infection Prevention Practices for Dental Settings: Basic Expectations for Safe Care” here on our website. CDC’s evidence-based recommendations guide infection control practices in dental offices nationally and globally; provide direction for the public, dental health care personnel and policymakers; and affect technology development in the dental industry.  Additional infection control resources are available at the Centers for Disease Control and Prevention’s Infection Prevention & Control Guidelines & Recommendations website by clicking CDC's Infection Control Guidelines."
“The purpose of rules contained in this subchapter is to establish proper sterilization, disinfection, and other infection control procedures in the practice of dentistry. Failure of a dental health care worker to practice and maintain these procedures constitutes a significant danger to public health and safety. Any violation of these rules regarding infection control in this subchapter and other applicable statutes, rules, or regulations that may be incorporated by reference herein or that may apply otherwise through federal or state mandate or regulation shall be considered a failure to safeguard the public interest and thus shall constitute, at a minimum, negligence in the performance of dental services and failure to use proper diligence in the conduct of a dental practice, pursuant to Section 263.002, Dental Practice Act.
"(a) All dental health care workers shall comply with the universal precautions, as recommended for dentistry by the Centers for Disease Control and required by THSC, §§85.202, et seq, 1991, as amended, in the care, handling, and treatment of patients in the dental office or other setting where dental procedures of any type may be performed."
"§ 584. Unprofessional conduct
The Board may refuse to give an examination or issue a license to practice dentistry, to practice as a dental therapist, or to practice dental hygiene or to register an applicant to be a dental assistant and may suspend or revoke any such license or registration or otherwise discipline an applicant, licensee, or registrant for unprofessional conduct. Unprofessional conduct means the following conduct and the conduct set forth in 3 V.S.A. § 129a by an applicant or person licensed or registered under this chapter:
(9) practicing dentistry or maintaining a dental office in a manner so as to endanger the health or safety of the public; or..."
"Standards for Professional Conduct In The Practice of Dentistry
Follow the applicable CDC infection control guidelines and recommendations. See https://www.cdc.gov/oralhealth/infectioncontrol/index.html"
Washington: Required (Pending)
Effective December 1, 2021, all water lines must be tested.
WAC 246-817-660 Dental unit water quality. (1) A licensed dentist shall use water that meets United States Environmental Protection
Agency regulatory standards for drinking water of five hundred or less colony-forming units or CFUs. (2) A licensed dentist shall follow manufacturer's instructions when testing the water delivery system for acceptable water quality. If manufacturer's instructions are unavailable, a licensed dentist shall test the water delivery system for acceptable water quality quarterly. A licensed dentist shall test the water delivery system five to ten days after repair or changes in the plumbing system and again at twenty-one to twenty-eight days later.
west virginia: indeterminate
"Section 6.Compliance with Code of Ethics. Dentists shall comply with the provisions of this Chapter, the ADA's Principles of Ethics and Code of Professional Conduct, the ADHA's Bylaws and Code of Ethics, and the Centers for Disease Control's Summary of Infection Prevention Practices in Dental Settings as referenced in Chapter 1."