A Two-Pronged Approach to Understanding Quality and Safety Events at the Dental Office

Abstract

ABSTRACT

Objectives: Owing to the limited number and scope of studies in dentistry regarding quality and patient safety, the overarching goal of this thesis was to understand the nature and occurrence of quality and safety events in dentistry using a two-pronged approach – biomedical literature and patient-reported experiences.

Methods: I conducted two exploratory studies: the first was a detailed retrospective review of published case reports on dental patient safety events; the second was a cross-sectional study of 450 patients at a large dental teaching practice in South Africa about their quality and safety experiences using a self-adminstered questionnaire.

Results: 180 case reports (270 cases) were identified through the literature search. Most reports came from Europe and North America. The most commonly-reported safety event was wrong treatment or unnecessary treatment following misdiagnosis (23%). 11% of case reports ended in the death of the patient. On the other hand, the patient survey revealed that 45.5% had experienced one or more safety events during dental visits in South Africa (1.6 events per respondent). Intra-oral hard tissue injury, such as adjacent tooth damage during treatment, was the most commonly reported event by patients (30.4%). ‘Never events’ such as wrong tooth extractions or wrong-site procedures, occurred in 7% of patients. The combined quality rating was fair; about 41.4% of participants rated the quality of dental care they received as sub-optimal. Access to care was ranked the lowest among patient-defined quality dimensions.

Conclusions: Quality and safety events occur in dentistry, and are quite common.

Published case reports offer a window into the types and severity of quality and safety events in dentistry. Although the literature is very skewed to reports of significant events and is thus not representative of all AEs that happen, it is a valuable source of information especially in the absence of a centralized reporting system. Patient reports much better let us understand the effects and sequelae of AEs. More work is needed to move the profession forward in our understanding of these events so that we may prevent them.