Quantifying Dental Office–Originating Adverse Events: The Dental Practice Study Methods

Abstract

Background: Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm. Additionally, we do not know if patients of certain race, age, sex, or socioeconomic status disproportionately experience iatrogenic harm. Methods:We initiated the Dental Practice Study (DPS) with the aim of determining the frequency and types of adverse events (AEs) that occur in dentistry on the basis of retrospective chart audit. This article discusses the 6-month pilot phase of the DPS during which we explored the feasibility and efficiency of our multistaged review process to detect AEs.Results: At sites 1, 2, and 3, respectively, 2 reviewers abstracted 21, 11, and 23 probable AEs, respectively, from the 100 patient charts audited per site. At site 2, a third reviewer audited the same 100 charts and found only 1 additional probable AE. Of the total 56 probable AEs (from 300 charts), the expert panel confirmed 9 AE cases. This equals 3 AEs per 100 patients per year. Patients who experienced an AE tended to be male and older and to have undergone more procedures within the study year.Conclusions: This article presents an overview of the DPS. It describes the methods used and summarizes the results of its pilot phase. To minimize threats to dental patient safety, a starting point is to understand their basic epidemiology, both in terms of their frequency and the extent to which they affect different populations.

Why is there a lack of evidence regarding errors and complications in periodontal and implant therapy?

“…The quantification of adverse events may vary according to the disease or patient’s condition, the complexity of the procedures, and the professional’s knowledge and skills. A recent survey conducted in two US dental schools and one multispecialty large group practice listed the most common adverse events (and respective procedures) occurring in dentistry 6 : (a) an inability to swallow (dental anesthesia) 6 ; (b) severe tachycardia and light‐headedness and chronic trauma to tongue from margin of dental restoration (dental filling) 6 ; (c) persistent bleeding and involuntary trauma to soft tissue remote from the surgical site (dental extraction) 6 ; (d) persistent traumatic ulcer (use of a lower partial removable denture) 6 ; (e) development of wounds after a traumatic dental procedure and bone damage (dental implant surgery) 6 ; and (f) oral soft tissue laceration from loose wires (orthodontic procedure) 6 . However, the issue of whether the reporting of adverse effects or not is important, although straightforward and somehow obvious, deserves some additional insights.…”

“…The quantification of adverse events may vary according to the disease or patient's condition, the complexity of the procedures, and the professional's knowledge and skills. A recent survey conducted in two US dental schools and one multispecialty large group practice listed the most common adverse events (and respective procedures) occurring in dentistry 6 : (a) an inability to swallow (dental anesthesia) 6 ; (b) severe tachycardia and light-headedness and chronic trauma to tongue from margin of dental restoration (dental filling) 6 ;…”

“…(c) persistent bleeding and involuntary trauma to soft tissue remote from the surgical site (dental extraction) 6 ; (d) persistent traumatic ulcer (use of a lower partial removable denture) 6 ; (e) development of wounds after a traumatic dental procedure and bone damage (dental implant surgery) 6 ; and (f) oral soft tissue laceration from loose wires (orthodontic procedure). 6 However, the issue of whether the reporting of adverse effects or not is important, although straightforward and somehow obvious, deserves some additional insights.…”

Developing a Patient Safety Culture in Primary Dental Care

“…1 Previous attempts have been made to define or categorise patient safety incidents specific to primary care dentistry. 8,9 A recent study by Black & Bowie 10 found that the following events may be considered as adverse or never events related to dentistry (listed in order of risk to patient):…”

Segurança do paciente no cuidado odontológico: revisão integrativa

“…While the first studies in patient safety aimed to measure the incidence or prevalence of AE to know the problem's magnitude 6 , the initial studies in Dentistry, besides measuring their frequency, aimed to understand their causes, sparking reflection on the inherent challenges in the specificities of dental practice. From the perspective of measuring the incidence/prevalence of harms, the studies 12,21,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43 produced findings that ranges from the complications of local anesthesia/sedation; lesions to the tongue and lips; and loss of teeth from switched tooth extractions, ocular lesions and even death. Incidents involved allergies, infections, diagnostic delay or failure, and failure in the procedure, among others.…”