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Safety Needles and Intraoral Injections


Question: Is it mandatory to use safety needles for intraoral dental injections?
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Answer:  Presently, it is not mandatory to use safety needles when giving
intraoral injections, however the Occupational Safety and Health Administration’s
(OSHA) Bloodborne Pathogen Standard (29 CFR 1910.1030) requires the use of
engineering and work practice controls (in addition to standard precautions and
use of personal protective  equipment) to reduce the employee’s exposure to
bloodborne pathogens. OSHA also requires evaluation of the effectiveness of
existing controls and consideration of more advanced engineering controls such as
safer needle devices as they become available. Employees directly responsible for
patient care (e.g., dentists, hygienists, and dental assistants) should be
involved in identifying and choosing these devices.1 This is important because
when presented with a device that has a significantly different design than a
traditional device, decisions regarding preference and future use can be dependent
upon the individual practitioner’s style and technique.

Aspirating anesthetic syringes that incorporate safety features have been
developed for dental procedures, but the low injury rates in dentistry limit
assessment of their effect on reducing injuries among dental health-care
personnel (DHCP).2 The USAF Dental Evaluation and Consultation Service
(DECS) has performed limited clinical evaluations of two currently
available dental safety anesthetic syringes. Neither was universally
accepted by the evaluators, and it is acceptable to continue to use the
conventional dental anesthetic syringe with appropriate work practices
such as one-handed recapping (e.g., the scoop technique, using a needle
recapping device) and not passing needles unsheathed.

Safer versions of sharp devices used in hospital settings have become available
(e.g., blunt suture needles, phlebotomy devices, and butterfly needles), and
their impact on reducing injuries has been documented.3-6 Therefore, if you're
doing IV sedations in the dental clinic, you are required to use IV safety
equipment. Also, safety scalpels are becoming more widely available and have
the potential to decrease percutaneous injuries. DECS has evaluated several
safety scalpels.
Additional information on identifying and evaluating safer dental devices in USAF dental facilities is available in the USAF Guidelines for Infection Control in Dentistry. and the March 2005 InControl Fact Sheet: Evaluating Safety Devices in USAF Dental Clinics. References 1. US Department of Labor Occupational Safety and Health Administration 29 CFR Part 1910.1030 Occupational Exposure to Bloodborne Pathogens, Needlestick and Other Sharps Injuries; Final Rule. Federal Register 2001; 66 (12); 5317–5325. As amended from and includes Federal Register 1991 29 CFR Part 1910.1030 Occupational Exposure to Bloodborne Pathogens; Final Rule. 56(235);64174–64182. 2. CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. 3. CDC. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993–1995. MMWR 1997;46:21–25. 4. CDC. Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures—New York City, March 1993–June 1994. MMWR 1997;46:25–29. 5. Mendelson MH, Lin-Chen BY, Solomon R, Bailey E, Kogan G, Goldbold J. Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. Infect Control Hosp Epidemiol 2003;24:105–112. 6. CDC. Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. Available at: www.cdc.gov/sharpssafety/toc.html Accessed September 2005. (Lt Col Harte)
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