Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

modified retraction technique
Delivery of mandibular block injection using modified retraction technique.
What is it?

A modified method for retracting tissue while performing injections in patients' mouths, in order to avoid needlestick injuries to the healthcare provider.

What problem does it aim to solve?

Needlestick injuries are a common problem — when it comes to the causes of occupational exposure to bodily fluids in dentistry, accidental pokes with anesthetic needles are number one. Over a ten-year period at the Dugoni School, 37% of all exposure incidents were from needles. Needle injections usually require two hands, one of which is used to retract tissue around the injection site, and thus is the most likely hand to be injured.

How does it work?

Starting in 2011, the Dugoni School began teaching a modified retraction technique during the hands-on portion of the anesthesia curriculum. In this technique, students first identify oral landmarks and the injection site in their patients using their eyes and hands. They then remove their hands and use a mouth mirror to retract tissues before giving the injection. This study tracked the number of needlestick injuries before and after the introduction of this technique, as well as faculty ratings and patient reports.

What are the real-world implications?

The modified technique appears to reduce the number of intraoral needlestick incidents while injecting anesthetic in patients.

What are the next steps?

Even though needlestick incidents are the most common source of occupational exposure to bodily fluids, they (thankfully) don't occur with great frequency, and therefore, the sample size of this study is too small to validate with statistical analysis. The technique shows preliminary good results, and follow-up studies on larger numbers of patients and providers would be useful.


Bernadette Alvear Fa and Eve Cuny (2016) "Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries." Anesthesia Progress: Winter 2016, Vol. 63, No. 4, pp. 192-196. 


Bernadette Alvear Fa, DDS, Director of Local Anesthesia Curriculum and Assistant Professor for the Department of Preventive and Restorative Dentistry (previously the Integrated Reconstructive Dental Sciences), University of the Pacific, Arthur A. Dugoni School of Dentistry

Eve Cuny, MS, Director for Environmental Health and Safety and Associate, Professor in the Department of Diagnostic Sciences (previously the Department of Dental Practice), University of the Pacific, Arthur A. Dugoni School of Dentistry