is widely believed that wrong-site tooth extractions are underreported, along with other dental errors (Canale, 2005; Brennan et al., 2004; Brennan et al., 2005). Reasons for wrong- site tooth extractions are varied and may include: ● Cognitive failure of the office staff and/or the patient. ● Miscommunication between the dental staff and patient. ● Miscommunication between the general practitioner and the oral surgeon. ● Numerous/adjacent carious teeth (instead of one easily identifiable diseased tooth). ● Partially erupted teeth mistaken as third molars. ● Extensively carious teeth that are part of the Comprehensive Treatment Plan. ● Improperly labeled or mounted radiographs. ● Alternate (unfamiliar) tooth-numbering systems. The Oral and Maxillofacial Surgeons National Insurance Company (OMSNIC) Risk Retention Group has released data on its 4,300 members (Lee, Curley, & Smith, 2007) showing the prevalence and circumstances of wrong-tooth or wrong- site surgery. Claims were most commonly filed for paresthesia resulting from the placement of implants and third molar extractions, infection, and wrong-site tooth extraction. Although 14% of all claims resulted from wrong-site tooth extractions, these errors accounted for 30% of claims actually paid. The company identified communication problems within the surgeon’s office and with the referring dentists as the primary causes for many wrong-site surgeries. Neither a surgeon’s age nor experience was predictive of errors. Furthermore, there was no pattern of particular sites or teeth being implicated in these claims. Providing risk management seminars and courses has not lessened the number of claims and no clearly identified trends have reduced the incidence of wrong-site surgeries (Lee et al., 2007). To avoid dental errors, particularly wrong-site tooth extractions, and improve the overall quality of care provided in dental offices, Lee and colleagues (2007) have suggested the following guidelines: ● Develop and present a wrong-site extraction prevention educational program for the entire staff. Equipment-based errors Medical/dental errors resulting in patient injuries can occur not only from operator errors, but also from equipment malfunction. In 2007, the U.S. Food and Drug Administration (FDA) Safety Information and Adverse Event Reporting Program, known as MedWatch, reported serious injuries – including third-degree burns to patients – during dental procedures using poorly maintained and designed electric dental handpieces. Injuries occurred while cutting tooth and bone, extracting teeth, and performing other dental procedures. Tissue damage was not immediately apparent to the operators because the handpiece’s housing insulated the operator from the overheated handpiece. Patients were unaware that they were being burned because the anesthesia prevented them from feeling the heat. Some of the patients with serious burns needed plastic surgery. Poorly maintained electric handpieces used by physicians have also caused burns to patients and operators during medical procedures, including orthopedic surgery (FDA, 2007). Diagnostic errors Diagnostic errors are defined as diagnoses that are missed, wrong, or delayed. Such errors are common in dental offices and may involve a range of situations, such as the improper diagnosis of periodontal disease or gingivitis, errors in Enhancing diagnostic accuracy Diagnostic errors were once thought to stem from individual healthcare professionals’ lack of training and skill (Newman- Toker & Pronovost, 2009). Current belief is that misdiagnosis is the result of larger system failures that affect practice in general, such as miscommunication between healthcare providers
The most frequent form of active failure in wrong-site tooth extractions is cognitive failure. Latent factors such as lack of communication and training also play a role. A carefully designed staff education program, which includes case studies, information feedback, and clinical guidelines, can lessen the risk of cognitive failure. ● Design a clearer, more informative referral slip. If there is any question or confusion about the correct tooth or teeth to extract, the oral surgeon should immediately seek clarification from the referring dentist. Such confusion may arise when a patient’s teeth have drifted into areas left by missing teeth – especially if the dentist and oral surgeon are using different numbering systems to designate teeth. Because there are two different ADA-recognized tooth-numbering systems – the Universal Numbering System (1 through 32) and the Palmer Notation System (utilizing a simple symbol for each quadrant and the numbers 1 through 8), the dental practitioner should minimize potential confusion by describing in detail the tooth to be extracted (e.g., right maxillary first premolar) on both the consent form and the referral slip. ● Show the patient the tooth/teeth to be extracted at the consultation appointment. At the initial consultation appointment, the practitioner should verbally inform the patient (or his or her parent or guardian) about the extraction. Using a handheld patient mirror, the practitioner should visually indicate the tooth or teeth to be extracted. ● Reconfirm with the patient the tooth/teeth to be extracted on the day of surgery. Evaluate clinically and confirm that the patient, chart, and properly oriented X-ray are correct and confirm which teeth are to be extracted on the day of the surgery. Unfortunately, there is no reliable or practical way to mark teeth prior to the extraction. Conduct a “time-out” prior to treatment to confirm the tooth or teeth to be extracted using the two-person rule. Consult the referral form prior to starting any procedure. If a prosthesis is to replace the extracted teeth, the surgeon should confirm that the design of the prosthesis is compatible with the extraction plan prior to initiating treatment. The high-speed dental handpiece rotating a diamond or carbide bur at speeds up to 400,000 rpm is routinely used in close proximity to the patient’s tongue, lips, and throat. Understandably, the literature contains numerous reports of serious lacerations and other injuries associated with high-speed handpieces that range from minimal to severe patient injury (Obadan et al., 2015). Another material concern is the solution most often used to irrigate root canals during nonsurgical endodontic treatment. Sodium hypochlorite is bleach and highly cytotoxic. There are multiple reports in the dental literature describing the extrusion of sodium hypochlorite past the apex of the tooth into the surrounding tissues, or the inadvertent injection into the mucosa (Waknis, Deshpande, & Sabhlok, 2011). Dental healthcare providers must maintain the standard of care in their “hands-on” clinical treatment, as well as their equipment and office maintenance.
diagnosing disorders that involve cavities or the hard tissues around the teeth, or even errors in diagnosing malignant neoplasms (Newman-Toker & Pronovost, 2009).
during transitions in care, miscommunication of test results, or mislabeled specimens. Human issues such as sleep deprivation and anxiety can also contribute to cognitive errors. Additionally, the noise and distractions of the healthcare environment do not promote clear thinking. It is evident that when clinicians have
EliteLearning.com/Dental
Book Code: DHFL2624
Page 21
Powered by FlippingBook