Common mistakes, negligence and legal offences in paediatric dentistry: A self-report

Department of Paediatric Dentistry, Tel Aviv University, Tel Aviv, Israel.
European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry. 08/2011; 12(4):188-94. DOI: 10.1007/BF03262805
Source: PubMed


To identify the type and relative prevalence of mistakes, negligence and legal offences (MNLOs) performed or nearly performed by paediatric dentists during their entire career.
The population consisted of 25 (29.4%) certified and 48 (56.5%) non-certified paediatric dentists, and 12 (14.1%) residents in paediatric dentistry. A structured anonymous questionnaire accessed occupational characteristics and frequencies of MNLOs (0, 1-4, 5-10, >10).
The most prevalent MNLOs related to the performance of radiographs: bite-wings with overlapping teeth (90%), overturned film (30%), film over-exposure (48%), faulty film development (84%) and exposure of the same side of film twice (32%). Other MNLOs were drilling an intact tooth (37%), misdiagnosing existing radiographic caries (63%), anaesthetising the wrong tooth (49%), accidental incision of the cheek/lips during treatment (73%), administering an incorrect dose of antibiotic (49%) or analgesics (24%), extracting the wrong tooth (15%), documenting the wrong tooth in the patient's file (63%), and a child swallowing an instrument (33%) or clasp (15%). Prevalent MNLOs included administering sedation to a child who had not fasted (32%), sedating without monitoring (9%), treating children without receiving signed parental consent (15%) and losing a radiograph (64%).
MNLOs occur commonly during various operative dental treatments. Means to raise awareness and to implement regulations should be addressed to limit these mistakes.

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Available from: Malka Ashkenazi
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    • "Patient safety (PS) is a current global health issue, as adverse events (AEs) occur in all healthcare settings, resulting in many harmed patients. Quite recently the World Health Organization (WHO) [1], in collaboration with the World Dental Federation (FDI), the Council of European Dentists (CED) [2], the American Academy of Pediatric Dentistry (AAPD) [3] and several researchers [4] [5] [6] [7] [8] [9] have addressed the need for a safety culture in dentistry, where professionals can learn from each other. Both negative and positive PS data and experiences should be shared [9]. "
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    ABSTRACT: Objective: Assessing current patient safety incident (PSI) prevention measures and risk management practices among Finnish dentists. Materials and methods: A total of 1041 dentists practicing in the private or public sectors in southern Finland completed an online questionnaire concerning PSI prevention, PSI-reporting systems, feedback and knowledge gained from device incidents and patient-generated safety information and the knowledge of national PS-guidance. The answers were handled anonymously. Statistical evaluations were performed using chi-square analysis. Results: Dentists suggested multiple methods for preventing PSIs related to dental diagnostics, various treatments, equipment and devices, medications, communication, infection control and general practice safety. Preventive methods reported most frequently included working with caution and forethought, keeping accurate patient records and the availability of correct patient information. A special PSI-reporting system was used by less than one third of respondents. Feedback received on PS-related data and the utilization of guidebooks varied significantly between the studied dentist groups. Conclusions: Several PSI prevention techniques are already used in Finland. However, wide variation exists in PSI prevention and risk management practices among Finnish dentists. Systematic implementation of available safety methods would probably prevent several PSIs. The results indicate that the more dentists know about PS risks, the easier it is for them to recognize situations possibly leading to patient harm. Anonymous PSI reports, patient complaints and claims data should, therefore, be actively used for mutual learning. Increased PS education in dentistry is also needed.
    Full-text · Article · May 2013 · Acta odontologica Scandinavica
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    • "According to self-reports of dentists, the most prevalent errors in paediatric dentistry relate to performance of intraoral radiographs (Ashkenazi et al. 2011). This is despite the fact that bitewing radiographs are considered the most efficient, accurate and common tool for diagnosis of proximal caries (McDonald 1983; Nysther and Hansen 1983; Harrison and Richardson 1989). "
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    ABSTRACT: Aim: To assess the frequency of use with young uncooperative children of the bitewing radiograph film holders: KWIK-BITE, Snap-a-ray, and a Sticky tape, and to compare the quality of bitewing radiographs achieved with these types of film holders. Study design: This retrospective study assessed 298 pairs of bitewing radiographs of children aged 3-14 years. The radiographs were evaluated according to age, type of behavioural management approach used, extent and degree of overlapping surfaces, visibility of the alveolar bone, and the presence of folds, cone-cut and elongated teeth. Results: Snap-a-ray was used more frequently in younger children (p < 0.001), less cooperative children (p < 0.001), and in those who were treated under sedation (p < 0.001). The KWIK-BITE holder was used more frequently in older children (p < 0.001), cooperative children (p = 0.001), and in those under general anaesthesia (p < 0.001). About 76.5 % of the radiographs contained technical errors. The degree of overlapping surfaces in radiographs was not correlated with the type of film holder used, but rather with the degree of children's cooperation. Conclusions: The Snap-a-ray film holder was used more frequently in young uncooperative children; nevertheless, its use was not associated with an increased frequency or degree of overlapping surfaces.
    Full-text · Article · Apr 2013 · European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry.
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    • "Current dentistry is a complex activity and several factors make a dental operatory a potentially highrisk environment. Even though many patient safety (PS)-ensuring methods have been implemented in dental procedures, researchers have reported several hazards related to various dental treatments [1] [2] [3] [4] [5] [6] [7] [8] [9] [10], dental equipment and devices [1], dental materials [11] [12] and medications [13]. Furthermore, medical emergencies occur in dental care, although most of them are not life-threatening [14]. "
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    ABSTRACT: Abstract Background. Few data are available on dental patient safety (PS), as most PS studies have focused on other activities in health care. Objective. To detect types and causes of dental PS incidents (PSIs), including adverse events (AEs) and near misses (NMs), in Finnish dental care. Material and methods. Altogether 1041 privately or publicly employed dentists in southern Finland completed a structured questionnaire using an internet-based system (Webropol) in 2010. Results. Nearly one third of the dentists reported some PSI in the previous 12 months. Of the 872 reported events, 53% were classified as AEs, 45% as NMs and 2% remained unclassified. Nearly half of the PSIs had occurred during some form of dental treatment. One third of the AEs were related to dental equipment, devices and supplies. Most of the reported AEs resulted in little or no permanent harm to patients. However, 13% of AEs were considered as serious enough to potentially cause severe harm or did in fact cause permanent harm. Conclusions. Reported dental PSIs in Finland are in many respects similar to those reported in other countries. Compared to all annual dental visits in Finland, severe dental AEs seem to be relatively rare. Less severe AEs and NMs are not uncommon, especially in dental surgery, endodontic and restorative treatment. The results of this retrospective study, however, reveal more about incident types than their true prevalence and that further studies on dental PS are needed.
    Full-text · Article · Jan 2013 · Acta odontologica Scandinavica
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