Orange County health officials allowed the on-site water system to be turned back on Tuesday at an Anaheim dental clinic where dozens of children were affected by a bacterial outbreak.
Dr. Eric Handler, the county's health officer, lifted the ban he issued Sept. 15 on use of the water system at the Children's Dental Group of Anaheim.
The prohibition stemmed from contamination of the water system with Mycobacterium abscessus, which officials believe was linked to about 50 children being infected during procedures at the dentist's office between March 1 and Aug. 11.
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The affected children, who range in age from 3 to 9, underwent a "pulpotomy procedure," which is done when infected pulp tissue of a tooth is treated or removed to prevent the loss of the tooth.
As of Friday, there have been 16 confirmed cases of infection and 35 considered probable cases of infection. All 51 patients have been hospitalized at some point, according to the OC Health Care Agency.
"Since the order was served, Children's Dental Group has been fully cooperative with the investigation, and in consultation with the Centers for Disease Control and Prevention, a plan for remediation was approved," Handler said.
"The on-site water system has been completely removed, replaced with new equipment, and the water from the new system has been tested to ensure it meets the standards established by the American Dental Association," he said.
County officials emphasized that "appropriate safeguards" have been established to prevent another outbreak, including a treatment that prevents bacteria from sticking to equipment and installation of "purification cartridges" in every dental chair that is connected to the water system.
Last month, Orange County supervisors agreed to spend $150,000 to help Children's Hospital of Orange County provide long-term treatments for dozens of children affected by the outbreak.
CHOC nurses and physicians need the money for multiple antibiotics and staff to administer the drugs and to follow up with the patients, according to a county staff report to the board.
"The severity of the infection requires a regiment of a variety of antibiotics to clear the infection, with clinicians working closely with each child to monitor adverse side effects and switching to alternative antibiotics as needed," according to the staff report.
One antibiotic -- Clofazimine -- "is being considered as one of the options for these children; however, the Food and Drug Administration has not yet approved it for this application," the report says.
That will require the hospital to go through a review process for each patient to justify its use for the dental infections.
"Both processes involve layers of review, volumes of paperwork and hours of time," according to the report.
The hospital wants to hire someone to manage the process.
"All of the affected children require surgery and approximately half of them will also require approximately two months of intravenous antibiotic treatment, followed by two to four months of oral antibiotics," according to the report.