Narrative Review

Cover Story
Needlestick injuries in dentistry
Time to revisit
Anjali Ravi, BDS; Priyanka K. Shetty, BDS, MDS; Preetha Singh, BDS, PGDipPH;
Dipti Wakode, BDS, PGDipPH; Stephen F. Modica, MLS;
Priyanka Kodaganallur Pitchumani, BDS; Davis C. Thomas, BDS, DDS, MSD, MSc Med, MSc

ABSTRACT

Background. Blood-borne pathogens (BBPs) are infectious microorganisms that are found in
human blood and can cause diseases in humans. Health care workers such as physicians, surgeons,
nurses, dentists, dental students, dental assistants, laboratory technicians, personnel handling in-
fectious waste, and other health care employees are at increased risk of exposure to these pathogens.
Percutaneous injuries from needles or other sharp objects are the major sources of BBPs in the
workplace. Needlestick injuries (NSIs) have the most potential to transmit and have the easiest
mode of transmission of BBPs.
Types of Studies Reviewed. The authors searched electronic databases (PubMed, Web of
Science, Google Scholar, Scopus, Embase, MEDLINE-Ovid) for studies and articles focused on the
various aspects of NSIs, their possible causes, prevention, and management protocols.
Results. There is a lack of literature on the global prevalence of NSIs among dental practitioners and
underreporting of NSIs by clinicians. The authors also found that dental students and inexperienced
practitioners were the most vulnerable. They found apparent inconsistencies in guidelines and rec-
ommendations from various regulatory and statutory agencies in charge of limiting and managing NSIs.
Conclusion. The most significant occupational risks for health care workers globally are NSIs.
Dentists are recognized as one of the high-risk groups for exposure to NSIs. Although the reporting
rate was noticeably low, the frequency of NSIs among dental students was alarmingly high.
Practical Implications. Appropriate and succinct training of dental health care workers is crucial
for prevention and management of NSIs. It is recommended that dentists familiarize themselves
with recommendations from such agencies and organizations as the Center for Disease Control and
Prevention, Occupational Safety and Health Administration, and American Dental Association.
Key Words. CDC; OSHA; state dental board; ADA; needlestick injury; blood-borne pathogen.
JADA 2023:154(9):783-794
https://doi.org/10.1016/j.adaj.2023.06.004

H
ealth care workers (HCWs) in general, and dental health care workers (DHCWs) in
particular, are prone to experiencing needlestick injuries (NSIs), thereby increasing their
risk of exposure to more than 20 types of infections.1-4 Because specific data on
DHCWs are scant in the literature, for the purpose of our review they are included under
HCWs, unless otherwise specified. The incidence of NSIs among HCWs has been reported to
be 43% globally, which is a substantial percentage in terms of World Health Organization
(WHO) statistics.5 NSIs were brought to light in the early 1980s, after the discovery of the
HIV. Exposure to hepatitis B virus (HBV) and hepatitis C virus (HCV) via an NSI incident is
now more of a concern than exposure to HIV.1 Agencies such as the Centers for Disease
Control and Prevention (CDC), WHO, and Occupational Safety and Health Administration
(OSHA) have formulated guidelines to decrease the incidence of NSIs and protect HCWs.
Although these universal guidelines have reduced the risk of NSIs, these incidents still occur.1 Copyright ª 2023
American Dental
A 2020 investigation on the global prevalence of NSIs reported that dentists and nurses are Association. All rights
more likely than other HCWs to have an NSI.4 reserved.

JADA 154(9) n http://jada.ada.org n n 2023 783


ABBREVIATION KEY
BBP: Blood-borne
pathogen.
CDC: Centers for Disease
Control and
Prevention.
DHCW: Dental health care
worker.
HBV: Hepatitis B virus.
HCV: Hepatitis C virus.
HCW: Health care worker.
NSI: Needlestick injuries.
OSHA: Occupational Safety
and Health
Administration.
PEP: Postexposure
prophylaxis.
WHO: World Health
Organization.
784
Dentists are at a constant risk of exposure to blood-borne pathogens (BBPs) through direct
contact with contaminated blood during procedures.6,7 They are at a higher risk of experiencing
NSIs owing to the nature of oral health care settings.8-10 Negligence and risky practices by HCWs
are responsible for NSIs. These hazardous NSIs can be avoided by adhering to and practicing
standard cautionary protocols.1 Therefore, it is essential for the profession to understand and
mitigate the factors involved in the higher rate of NSIs.6 In this narrative review, we elaborate on
the epidemiology, etiology, and sequelae of and management and prevention protocols for NSIs.
METHODS
We searched electronic databases (PubMed, Web of Science, Google Scholar, Scopus, Embase,
MEDLINE-Ovid) for studies and articles focused on the various aspects of NSIs, their possible
causes, and prevention and management protocols. The time range was 40 years, from January 1980
through March 2023. The key words included in the search were but were not limited to needle,
needlestick, needlestick injury, dentist, dental practice, dentistry, public health dentistry, and
community dentistry. All articles selected were in the English language and with access to the full
article. All other articles were excluded.
DEFINITION
Various government agencies, such as the National Occupational Research Agenda and Great
Britain’s Health and Safety Executive, describe a sharps injury as a piercing or puncturing stab injury
resulting from medical instruments like a scalpel, needle, and other sharp objects. This percutaneous
injury in turn causes exposure to body fluids, especially blood.11,12 The CDC has estimated that, in a
hospital-based health care setting, more than 50% of these sharps injuries are caused by a
needlestick.11
NSIs are defined by the Canadian Centre for Occupational Health and Safety and the CDC
either as an injury from the piercing of needle equipment such as a hypodermic syringe or as an act
of puncturing intact skin, resulting in exposure to blood and body fluids.13-15
EPIDEMIOLOGY
Most of the literature on NSIs pertain to the medical field. The WHO estimates that 3 million of
the 35 million HCWs are exposed to NSIs annually.16 The probability of contracting infectious
diseases in the descending order of prevalence is HBV, HCV, and HIV after a single encounter with
virus-infected blood from an NSI.2,17,18 The occurrence of these infections after an NSI was esti-
mated to be higher in number in lower-income countries than in higher-income ones.2 NSIs are
more common in women than in men.5,19 It has been determined that factors such as less work
experience and being younger than 30 years are shown to be connected to HCWs’ being more
prone to NSIs.16 Lack of familiarity with the work environment, lack of training, and inadequate
risk awareness are a few possible explanations.16 The incorporation of NSI-prevention programs,
availability of training sessions and accurate information regarding the management of NSIs,
awareness programs for encouraging reporting of NSI cases in hospitals, classification of NSIs as a
priority, and introduction of the use of new equipment to reduce NSIs are among the factors that
contribute to the lower prevalence of NSIs in higher-income countries.2,4
Frequent BBP exposure in dentistry is attributed to factors such as close proximity of patients,
frequent patient movements, and constant use of various sharp instruments. This perpetual threat of
exposure to contaminated needles imperils dentists to contracting blood-borne infections and
experiencing emotional trauma.20 A Washington state study found that dental professionals
accounted for approximately 20% of percutaneous injuries sustained by HCWs. In addition, local
anesthetic syringe use and inappropriate recapping technique were responsible for NSIs in dentists
and dental hygienists. The most prevalent tasks that resulted in percutaneous injuries among dental
assistants were cleaning the equipment, changing the anesthetic carpule, and recapping.21 In a
survey conducted in Germany, approximately 60% of dentists had at least 1 NSI encounter in their
professional lifetime. The NSI incidents recorded in this study represent both lack of safe working
environment and strenuous working practices.22 According to a survey of Malaysian health care
professionals, dental care employees had the second highest frequency of NSI exposures country-
wide.23 A systematic review conducted among DHCWs in Pakistan reported that the frequency of
NSIs among DHCWs was found to be varied, ranging from approximately 30% through 70%.24
JADA 154(9) n http://jada.ada.org n n 2023
Another study found an approximately 50% prevalence of NSIs in DHCWs over a period of 11
months.25 To the best of our knowledge through the literature search, there seems to be a lack of
statistics on the global prevalence of NSIs among dentists. Owing to underreporting of events,
which is a serious concern in lower-income countries, it is difficult to quantify precisely the global
prevalence of NSIs among DHCWs.24 The lack of understanding that NSIs must be reported,
shortcomings in the knowledge about where to report, and the conviction that reporting incidents
is pointless as well as the reluctance to disclose the incidents are factors contributing to under-
reporting of NSIs.24,26

NEEDLESTICK INJURIES AMONG DENTAL STUDENTS

Dental students are especially susceptible to NSIs.20,27,28 Among dental students, the undergraduate
class was found to account for the highest incidence of NSIs. This was followed by residents and
graduate students.20 With a potential for increased exposure to NSIs (secondary to an increased
number of clinical procedures) most likely during the final 1 through 2 years of their undergraduate
dental degree course, this cohort of students seems to be particularly vulnerable. This is true
compared with their medical counterparts.10 The delivery of local anesthetic, needle recapping,
passing syringe between the dentist and auxiliary staff members, and disposal of sharps wastes were
the procedures associated with NSIs.26,29-33 However, practices such as 2-handed needle recapping
and bending and disassembling needles were reported to be the most common causes of NSIs.26,27
The typical syringe system in surgical departments, nurses clearing the equipment, and dental
students administering local anesthetic pose the largest risks of experiencing NSIs to both student
nurses and dental students.10 It has been reported that oral surgical procedures are the most frequent
source of NSIs compared with other dental procedures.10 It is not clear whether this type of
literature had combined other instrumental exposures with NSIs. It also might be that, depending
on the course structure across various geographic locations and countries, there may be an increased
concentration and focus on more surgical procedures at the end of a 4- or 5-year dental under-
graduate program. Inexperienced students are thought to have a higher risk of exposure to NSIs. Yet
a few studies have reported higher NSI exposure in more experienced dental students, which is
probably related to their higher workload and clinical exposure.10,34,35 Dental students who lack
adequate knowledge of infection prevention may be more susceptible to workplace accidents.27,36
Practice of novel procedures and having insufficient clinical knowledge and experience could
enhance the incidence of NSIs further.20,27 Factors such as increased stress, fatigue, and anxiety
among dental students have been attributed to the high frequency of NSIs among them.34 In
addition, the fact that dental students usually work alone without an assistant, owing to a shortage
of auxiliary staff members, puts them at risk for NSIs.20,26,27,32,33 The NSI reporting rate among
dental students is low.27,36 Dental students either do not understand the reporting process or assume
that the exposure is minor or of low risk.37 Fear of being accused of causing the NSI was also
identified as a common reason for underreporting among dental students.30 A hefty workload and
reporting procedures necessitating additional time also may discourage NSI reporting. Owing to the
substantial underreporting rate, the affected students may receive insufficient postexposure pro-
phylaxis (PEP).27 In contrast to the low reporting rate of NSIs, there is an increased frequency of
occurrence of NSIs among dental students. Thus, dental schools can be instrumental in inculcating
in students the habit of abiding by and following the universal precautions to prevent NSIs.27
Dental students must be made aware of NSI preventive techniques and practice them frequently
throughout daily clinical training.19

SOURCES AND CAUSES OF NEEDLESTICK INJURIES

There are a number of factors responsible for NSIs, which include procedures and equipment
involved, HCWs’ lack of access to or availability of personal protective equipment, lack of
adherence to infection control protocols and occupational health training and education, inade-
quate needle management, negative organizational climate, heavy workload and fatigue, varied
work hours, high mental stress, and subjective risk perception.38-50 Numerous epidemiologic studies
have indicated that particular actions and medical equipment, such as recapping and sharp devices,
are associated with some NSIs.38,51 The practice of needle recapping is a major contributor to
NSIs.38,39,52 The circumstances under which NSIs occur among DHCWs may differ somewhat from
those conditions responsible for NSIs among other HCWs.19 Relatively limited accessibility and

JADA 154(9) n http://jada.ada.org n n 2023 785

 visibility of the operating field, frequent usage of sharp instruments, increased workload, and stress-
induced potential loss of focus make dental care professionals more susceptible to NSIs.6,27,53,54
Factors such as fewer auxiliary staff members, frequency of injections, failure to secure and
dispose of sharps immediately after injection, inadequate awareness, and lack of optimum training
are largely responsible for NSIs.53,55 In addition, a dental care professional’s experience, patients
treated per day, awareness of infectious diseases, and adherence to infection control guidelines
influence the incidence.8 The WHO reports that practices such as 2-handed recapping of needles
and lack of proper disposal of sharps waste increase the chances of NSIs.55 It also has been reported
that the most common causes of NSIs among dentists and dental hygienists are anesthetic syringe
use and improper needle-recapping techniques.7,56

COMMON INFECTIONS AS A SEQUELAE OF NEEDLESTICK INJURIES

HCWs are prone to contract an occupational infection after coming into contact with blood or
body fluids. Any organism in the operating field can be transmitted through an NSI.57-59 Multiple
articles refer to approximately 20 types of infections that are transmitted most commonly through
NSIs in HCWs.2,3,16,60 A summary of the possible pathogens transmitted by NSIs is given in
Box 1.1,9,57,58
Although many pathogens can spread through NSIs, only a small number of them seem to be
clinically significant. The 3 most serious pathogens that can be contracted as a result of NSIs are
HIV, HBV, and HCV.1,20,60 The transmissibility of HIV has been reported as widely varied,
dependent on various factors including, but not limited to, amount of exposure, viral load, and
gauge of the needle.1,66 There is no effective HIV vaccine, and making use of antiviral medications
is the only PEP option available.64 Considering the seriousness of an HCV infection, it is still a
major risk through NSIs but with a lower rate of transmission.81 Of these viruses, HBV is the most
transmissible, with the highest risk of contracting the infection after exposure.1,9
HBV is a widespread health issue and a recognized occupational concern for those who work in
the medical and dental fields. The frequency of HBV infection among HCWs is significantly higher
than that among the general population.61,81 The mainstay of HBV prevention has been the
availability of HBV vaccines since their introduction in 1981.82 OSHA’s Bloodborne Pathogens
Standards require that this vaccination is available to all employees who may be exposed to BBPs at
work, in addition to other safety precautions.61,83,84

COVID-19 AND NEEDLESTICK INJURIES

There was a significantly heightened risk of HCWs contracting infections through NSIs in their
hectic work environments at the height of the COVID-19 pandemic. This was also true in the case
of mass vaccination sites.85-88 Although the risk of experiencing a COVID-19 infection through an
NSI is low and there is a lack of substantial evidence, the fear of contracting HIV, HBV, and HCV
is something that cannot be overlooked.89 It has been reported that cancellation of elective pro-
cedures led to a slight decrease in NSIs in hospitals.90,91

OTHER EXPOSURES
Hypodermic syringes are known to be the most prevalent cause of NSIs among HCWs.85 There is a
reported higher occurrence of NSIs among oral maxillofacial surgeons during intermaxillary fixation
procedures.92

PREVENTION
The WHO underlines the need for HCWs to have appropriate training to reduce the occurrence of
NSIs in a hospital context and the adoption of universal infection prevention measures.8 There is
an emphasis on following infection control standards and various prevention protocols in an
attempt to eliminate or minimize percutaneous exposure incidences.93-95 However, NSIs are a major
concern in the dental workplace, particularly among less experienced dentists and dental stu-
dents.16,27,93 The preventive measures as per recommendations from the various agencies are
summarized below.

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 Box 1. Possible pathogens transmitted by a needlestick injury.

Virus
Viral hemorrhagic fever viruses57,61
Dengue57,58
Hepatitis B9
Hepatitis C9
Hepatitis D57,62
Hepatitis G57,63
Herpes simplex 13,57,64,65
HIV1,66
Cytomegalovirus9
Epstein-Barr virus9
Kyasanur virus57,67
Varicella-zoster virus57,68
Bacteria
Corynebacterium diphteriae57,64
Leptospira icterohaemorrhagiae57,69
Mycobacterium leprae57,70
Mycobacterium tuberculosis57,64
Mycoplasma caviae71
Rickettsia rickettsii (Rocky Mountain spotted fever)57,72
Rickettsia typhi (typhus)57
Staphylococcus aureus57,73
Treponema pallidum9,57,64
Clostridium tetani1
Parasite
Leishmania species57,74
Plasmodium cynomolgi57,75
Plasmodium malariae3,57,76,77
Plasmodium vivax57,75
Plasmodium falciparum78
Trypanosoma brucei57,74
Yeast
Cryptococcus neoformans57,79
Sporotrichum schenkii57,80

OSHA
In the United States, OSHA decides the standards related to prevention and postexposure man-
agement of NSIs in employees.61,96 Percutaneous injuries accounted for most of the BBP trans-
mission in employees covered under OSHA. Thus in 2000, the OSHA BBP standard was revised to
include the Needlestick Safety and Prevention Act (HR 5178).61,97 A summary of the components
of the OSHA 2000 NSI prevention act is given in Figure 1. Although OSHA has mandated
abstinence from needle recapping, it has an apparent exemption for the special setting of dentistry.
The corresponding OSHA regulation published in 2001 indicates this exemption for dentistry and
recommends the use of a 1-handed technique or a mechanical device.98 One of the techniques
recommended for recapping needles in dentistry is shown in Figure 2.

European Agency for Safety and Health at Work

According to the European Agency for Safety and Health at Work, approximately 1.2 million NSIs
occur each year in Europe.100 A summary of the risk-management measures recommended by the

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 • Sharps with engineered sharps • Review and update exposure
injury safeguards control plans
• Needleless system • Use of relevant technologically
• Other similar medical devices updated safer medical devices

Needlestick Safety
and Prevention Act
Occupational Safety and
Health Administration
2000

• Obtain input from the affected

• Maintenance of sharps injury log
health care worker

Figure 1. Main components of the Needlestick Injury Prevention Act by the Occupational Safety and Health
Administration.99

Figure 2. Technique using a disposable recapper.

European Agency for Safety and Health at Work is given in Figure 3, and the hierarchy of controls
recommended by the same organization is given in Figure 4. The recommendations from various
regulatory agencies for prevention of NSIs for HCWs in general, and dentists in particular, are
summarized in Box 2.101-107

788 JADA 154(9) n http://jada.ada.org n n 2023

 Avoiding the
use of sharps
when not
required
Defining and Equipping
carrying out safety-
safe procedures engineered
(including safe medical
disposal) devices
Risk
management
measures

Consistent The
overall restriction
prevention against
policies Adequate recapping
training; use
of personal
protective
equipment;
providing
vaccination

Figure 3. Risk management measures recommended by the European Agency for Safety and Health at Work.101,102

Gloves

LAST PRIORITY AND

LEAST EFFECTIVE
Individual control measures
(for example, personal protective
equipment)
WORK PRACTICE CONTROLS
(for example, ban 1-handed recapping and use
universal precautions)
ADMINISTRATIVE CONTROLS
(for example, training and policies)

THE SECOND LEVEL

Isolate the hazard by using engineering controls such as
safer needle devices and sharps containers

FIRST PRIORITY AND MOST EFFECTIVE LEVEL

Elimination or substitution of needles and other sharps, where possible

Figure 4. Hierarchy of control.

MANAGEMENT OF NEEDLESTICK INJURIES

As we mentioned above, prevention of NSIs is better than finding a cure after an exposure. When
occupational exposures do occur, however, PEP remains a crucial component of exposure man-
agement. The HCW should be evaluated immediately after the exposure and first aid administered.
The skin that has been exposed should be washed with soap and water. The use of antiseptics at the
exposure site has not been shown to reduce BBP transmission. The same goes for squeezing of the

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 Box 2. Salient features of guidelines and recommendations from
various regulatory agencies.

Centers for Disease Control and Prevention101,103

2003 updated guidelines for infection control: dental health care

Do not recap needles using 2 hands

Do not use any technique that requires directing the needle tip to any part of the
body

Do not manipulate the needle before disposal

Use 1-handed scoop technique or mechanical devices for recapping

Recap needles before removal from nondisposable aspirating syringes

Recap needles between injections using recommended techniques

Do not pass an uncapped syringe
World Health Organization

Eradicate needle recapping104

Safety-engineered syringes in reducing the issue of reuse and preventing
needlestick injuries105
Occupation Safety and Health Administration and European Agency for
Safety and Health at Work102,106

Before beginning any procedure, contemplate safe handling and disposal

As per availability, use safe and effective needle substitutes

Use engineered sharps injury protection

Ensure that the device’s safety features are activated

Sharps should not be passed between health care workers

Contaminated needles should not be broken, sheared, or recapped

Ensure that contaminated needles are disposed of instantly in appropriately
secured, puncture-resistant, leak-proof, labeled sharps containers. These sharps
containers must be in close vicinity

In case of an uncooperative or confused patient, inform the employers about the
risk situation

Mandatory completion of blood-borne pathogen training
American Dental Association107

Follows Occupational Safety and Health Administration and Centers for Disease
Control and Prevention
Department of Health (New Jersey)108

Do not recap, break, or bend by hand any contaminated needles

Other regulations: same as Centers for Disease Control and Prevention

exposed area to express blood out. Application of harsh chemical agents including disinfectants at
the exposure site is not recommended.81 Prompt reporting to the appropriate chain of command of
any exposure to BBPs is crucial. A thorough examination of the exposure and exposure source is
required. The exposure routes and how the exposure occurred should be documented. Employees
must be evaluated medically as soon as possible owing to the imminent nature of succinct
chemoprophylaxis within a short time. Depending on the type and source of the exposure, follow-up
evaluations at an occupational clinic should take place at recommended regular intervals. Usually,
the interval sequence is 1 week, 12 weeks, 6 months, and 12 months. During these visits, the
HCW’s health is evaluated, and repeat testing may be required depending on the infection. Ac-
curate recording of the incident description and postexposure management should be part of the
employee’s confidential medical record.61 The following are the PEP measures for the 3 most
common infections contracted after an NSI.

790 JADA 154(9) n http://jada.ada.org n n 2023

HIV
The following recommendations are applicable to circumstances in which an HCW has been
exposed to a source person who is either HIV-positive or has a reasonable suspicion of being HIV-
positive.109
1. HIV testing of source patients: Because the timing of PEP is crucial, a rapid test for HIV is
recommended as well as not waiting for test results to begin PEP.110,111 If the source patient is
found to be HIV-negative, PEP should be stopped, and no further HIV testing for the exposed
provider is recommended.
2. PEP timing and duration: PEP should be started within 72 hours after exposure.112
3. Drug selection recommendations for HIV PEP: The severity of exposure no longer determines
the number of drugs to be administered in a PEP regimen for HIV. A regimen should be pre-
scribed only after consulting with an antiretroviral expert.
4. Follow-up of exposed HCW: Irrespective of whether exposed HCWs receive PEP, they should be
provided with testing after exposure, follow-up examination (within 72 hours), counseling, and
medical attention. During the initial 6 through 12 weeks after exposure, the HCW is expected to
follow precautionary methods such as barrier contraception and avoid pregnancy, breastfeeding,
and donation of blood to avert secondary transmission.
5. Testing after exposure: The HCW should be monitored for seroconversion after occupational
HIV exposure using HIV testing. After baseline testing, follow-up testing should be performed at
1.5, 3, and 6 months. Several studies suggest that PEP be imposed for 4 weeks.110,112,113

HCV
The CDC has updated the recommendations for treating acute HCV infections. These recom-
mendations stipulate that baseline testing of the source patient and HCW should be performed
within 48 hours after exposure. There are 2 recommendations when testing the source patient.
The source patient can first be tested for HCV RNA using a nucleic acid test. This method is
favored, especially if the source patient has engaged in behaviors that raise the risk of contracting
HCV (such as using an injectable drug within the past 4 months) or if risk cannot be estimated
accurately. The second option is to first check the source patient for HCV antibodies and, if the
results are positive, to check for HCV RNA. A detailed procedural protocol with specifics can be
found in Moorman and colleagues.114

HBV
The risk of developing occupationally acquired HBV infection among HCWs remains high, owing
primarily to exposure to patients with chronic HBV infection. HBV vaccination is recommended
for at-risk HCWs. Postvaccination serologic testing is also highly recommended for the same group.
The importance of timely vaccinations and prompt postexposure protocols can be found in Schille
and colleagues.115

CLINICAL PEARLS
HCWs in general, and dentists in particular, are vulnerable to NSIs. Considering even higher
susceptibility of dental students, specifically in their third and final years, to NSIs, they may need
to be retrained in prevention, reporting, and management of NSIs. Emphasis should be given on
prevention using succinct education and training of the entire dental team. Prompt reporting is
crucial in an attempt to update the available statistics on NSIs. The dental team should be
educated and in compliance with immunization and prompt postexposure protocols. The dental
team should be well versed in proper instrument handling and sharps disposal protocols. The
dental team needs to understand the importance of avoiding prolonged and hectic procedures
toward the end of their daily work schedule, in an attempt to minimize NSIs secondary to fatigue.
The apparent incongruence of guidelines and recommendations may need to be addressed at the
level of the regulatory agencies. With a view that further pandemics such as COVID-19 are only
a question of when and not if, HCWs should be aware of and prepare for the high possibility of
NSIs during such events. HBV, HCV, and HIV reportedly carry a single exposure risk of 6%
through 30%, 0% through 7%, and 0.2% through 0.5%, respectively, when a person is exposed
to virus-infected blood.17

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 CONCLUSIONS
Dentists, dental students, and auxiliary staff members are prone to experiencing NSIs. There is a
specific increased susceptibility for dental students, untrained staff members, and newer practi-
tioners. Preventing NSIs is much easier than following the protocols after an NSI happens. A global
standardization for guidelines, recommendations, and postexposure management should be
explored. Dental schools and other health professions’ educational institutions should have training,
retraining, and enforcement protocols in place to prevent and succinctly manage NSIs. n

Dr. Ravi is a clinical preceptor, General Dentistry and Comprehensive Care,
Rutgers School of Dental Medicine, Newark, NJ.
Dr. Shetty is an assistant professor, Department of Oral Pathology and
Microbiology, A. J. Institute of Dental Sciences, Mangalore, India.
Dr. Singh is a clinical preceptor, General Dentistry and Comprehensive
Care, Rutgers School of Dental Medicine, Newark, NJ.
Dr. Wakode is a clinical preceptor, General Dentistry and Comprehensive
Care, Rutgers School of Dental Medicine, Newark, NJ.
Mr. Modica is a librarian, Information and Education Services, George F.
Smith Library of the Health Sciences, Rutgers Biomedical and Health
Sciences, Newark, NJ.
Dr. Kodaganallur Pitchumani is a postgraduate resident, Department of
Periodontology, The Ohio State University College of Dentistry, Columbus,
OH.
Dr. Thomas is an associate clinical professor, Center for
Temporomandibular Disorders and Orofacial Pain, Department of
Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ.
Address correspondence to Dr. Thomas, Center for Temporomandibular
Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers
School of Dental Medicine, 110 Bergen St, Newark, NJ 07103, email
davisct1@gmail.com.
Disclosures. None of the authors reported any disclosures.

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