Safety in the Dental Practice

Typical Hazards 

Anaesthetics 

Even local anaesthetics can present complications in routine use. To be sure, serious complications from local anaesthetics used in general dental practice are uncommon. Nevertheless, toxicities may occur, and dental professionals and their staff must be prepared to handle emergencies. 

Sharps 

In dental practice, a wide variety of instruments—most notably needles—are arranged, used, passed between colleagues, and disposed of in a relatively confined space. Patients move through those spaces, so they are also at risk of inadvertent sharps injury.¹ Because sharps injuries most commonly occur with needles, they are often referred to as needlestick injuries. 

A 2014 survey of over 1200 dental nurses found that 51% had had a needlestick injury, and 60% of these had had more than one.^1,2 A 2023 report by the American Dental Association (ADA) pointed out that data for needlestick injuries in dental practice are lacking, but that dentists are an especially high-risk group.³ 

Sharps should be disposed of immediately and should never be recapped by hand.⁴ Using a mechanical device that allows for one-handed safe control and recapping of needles, such as the Prestoject® Safety Stand, allows for optimal sharps safety. Prestoject® Safety Stand is designed for safe needle recapping and syringe holding during treatment, ensuring safety and comfort for dental professionals 

For more suggestions, see the American Dental Association’s (ADA) Do’s and Don’ts for the Safe Handling of Instruments and Sharps guideline.⁵ 

The Centers for Disease Control and Prevention (CDC) “Stop Sticks Campaign” provides a 4-step “what to do” protocol that the CDC recommends every facility includes in its “Exposure Control Plan” and employee training curriculum.⁶ 

Radiation 

Diagnostic X-ray imaging uses ionizing radiation to visualize structures—primarily bone—in the body. Ionizing radiation has enough energy to damage DNA, resulting in a small increase in the risk of developing cancer later in life.⁷ Tissue burns, hair loss, cataract formation, and other effects of X-ray exposure are highly unlikely at the doses used in dental practice. Children and fetuses are much more radiosensitive than adults and may be at higher cancer risk due to their longer remaining lifetime.^8,9 

X-ray safety in the dental office includes protecting staff. This is dictated and mandated by most local guidelines and regulations. In general, operators should wear a personal dosimeter and should be shielded by a wall or shield at least 6 feet (1.8 meters) from the X-ray source. Patients should be provided with a protective apron and thyroid shield. Radiation doses should be adjusted to be "As Low as Reasonably Achievable" (ALARA).⁷ Pediatric protocols should be used for children.⁸ X-ray equipment should be well-maintained and inspected regularly. 

Infection 

Lapses in infection prevention and standard precaution procedures can result in bloodborne pathogen transmission. Such lapses may warrant immediate notification of health department officials to contain the lapse and notify and test potentially affected patients. 

The Centers for Disease Control and Prevention’s (CDC) Guidelines for Infection Control in Dental Health-Care Settings - 2003 is considered to be the standard of practice for clinical dentistry.¹⁰ The CDC’s Infection Prevention Checklist for Dental Settings is a useful resource for self-auditing infection control measures.¹¹ Of course, practitioners should also consult local regulations and guidelines. 

Wearing personal protective equipment (PPE) has always been of great importance among dental professionals, even pre-COVID-19. Double-gloving is a common practice among dental professionals, and this has been shown to be an effective technique for preventing infection transmission without affecting the dexterity or comfort of the wearer.¹² 

Dental masks are another type of PPE that is of great value for infection control in the dental office. A 2024 study found that potentially pathogenic microorganisms from patients’ oral cavities can be found on the outside of masks, suggesting that the masks serve a valuable purpose.¹³ 

Take-Home Message 

As with any safety issue, potential hazards in the dental office can be best attenuated through good prevention and preparation. This may include: 

• Ensuring all staff who are involved in instrument sterilization, handling needles and other equipment, or who are employed around X-ray equipment are properly trained and using proper procedures. 

• Ensuring personal protective equipment (PPE) is available to staff and patients when necessary. 

• Ensuring dental professionals and staff are prepared for medical emergencies and emergency equipment is stocked and ready. 

• Self-auditing procedures and protocols, such as instrument sterilization, radiation safety, and handling of contaminated materials. 

Resources: 

ADA’s Do’s and Don’ts for the Safe Handling of Instruments and Sharps. 

CDC’s Dental infection prevention and control: Best practices for safe injections. 

CDC’s Guidelines for Infection Control in Dental Health-Care Settings - 2003 

CDC’s Infection Prevention Checklist for Dental Settings 

 References: 

1. Imran A, Imran,  Ashley M. Straight to the point: Considering sharp safety in dentistry. Br Dent J. 2018;18171. doi:10.1038/bdjteam.2018.171
2. Over half of dental nurses have had a needlestick injury. Br Dent J. 2014;217:490. doi:10.1038/sj.bdj.2014.965
3. Ravi A, Shetty PK, Singh P, et al. Needlestick injuries in dentistry: Time to revisit. J Am Dent Assoc. 2023;154(9):783-794. doi:10.1016/j.adaj.2023.06.004
4. Dental infection prevention and control: Best practices for safe injections. Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed February 3, 2025. https://www.cdc.gov/dental-infection-control/hcp/dental-ipc-faqs/safe-injections.html
5. 5. Sharps safety, disposal, and safe injection practices. American Dental Association (ADA) website. Published Accessed February 3, 2025. https://www.ada.org/resources/practice/legal-and-regulatory/09_sharpsdisposal#:~:text=Exposure%20to%20used%20sharps%20in,scalpels%2C%20and%20needleless%20IV%20ports.
6. 6. Stop sticks campaign. Centers for Disease Control and Prevention (CDC) website. Published February 26, 2019. Accessed February 3, 2025. https://www.cdc.gov/nora/councils/hcsa/stopsticks/whattodo.html
7. 7. Medical X-ray imaging. U.S. Food and Drug Administration (FDA) website. Published February 21, 2023. Accessed February 3, 2025. https://www.fda.gov/radiation-emitting-products/medical-imaging/medical-x-ray-imaging#:~:text=As%20in%20many%20aspects%20of,exposure%20to%20ionizing%20radiation%20include:
8. 8. X-rays. U.S. National Institute of Biomedical Imaging and Bioengineering (NIBIB) website. Published June, Accessed February 3, 2025.  https://www.nibib.nih.gov/science-education/science-topics/x-rays#:~:text=However%2C%20x%2Drays%20produce%20ionizing,radiation%20exposure%20is%20generally%20small.
9. 9. Pediatric X-ray imaging. U.S. Food and Drug Administration (FDA) website. Published March 20, 2023. Accessed February 3, 2025. https://www.fda.gov/radiation-emitting-products/medical-imaging/pediatric-x-ray-imaging#:~:text=The%20individual%20risk%20from%20X,question%20or%20to%20guide%20treatment.
10. 10. Dental infection prevention and control: Summary of infection prevention practices in dental settings: Basic expectations for safe Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed February 3, 2025. https://www.cdc.gov/dental-infection-control/hcp/summary/index.html
11. 11. Dental infection prevention and control: Appendix: Infection prevention checklist for dental settings. Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed February 3, 2025. https://www.cdc.gov/dental-infection-control/hcp/summary/appendix.html
12. 12. Padhye MN, Girotra C, Khosla AR, et al.. Efficacy of double gloving technique in major and minor oral surgical procedures: A prospective study. Ann Maxillofac Surg. 2011;1(2):112-119. doi:10.4103/2231-0746.92771
13. 13. Gund MP, Naim J, Lang J, et al. Detection of viable oral bacteria of the patient on the surgical mask of dentists. BDJ Open. 2024;10:4. doi:10.1038/s41405-023-00182-4