Objectives: As contemporary dentistry advances with newer technology that allows for the performance of more complex procedures, the hazard for patients receiving care has become elevated. It is incumbent upon the field of dentistry to investigate the adverse events (AE) that occur within dental, clinical practice so that the root causes can be identified and addressed.
Methods: 5,033 randomly selected charts from the electronic health records (EHRs) were reviewed by two independent reviewers at two dental schools and one multispecialty, large group practice. A 4-dentist, expert panel then further examined each record independently, and through a consensus process, evaluated these 4 outcomes: AE presence, AE type classification (12-category classification), AE severity and AE preventability status (5-category classification). We analyzed the contributing factors associated with increased AEs.
Results: Seventy-one AEs were identified (1.4% 95% CI; 1.1% to 1.8%). The most commonly seen AE types were related to pain (28.2%), hard tissue injuries (21.1%), infection (14.1%), and soft tissue injuries (14.1%). 69.0% of AEs were classified as mild, temporary harm while 22.5% were classified as moderate to severe, temporary harm. 7% of AEs were considered mild, permanent harm. Among the AEs found, most occurred following oral and maxillofacial surgery procedures. Lastly, according to the multivariate penalized logistic regression model, academic dental sites (OR=2.1:95% CI=1.1 to 3.5) and an increased number of total procedures (OR=1.13:95% CI=1.09 to 1.16) increased the odds of an observed AE.
Conclusions: The results demonstrate that dental AEs occur within clinical practice. These findings also yield insight into the factors associated with increased odds of AEs raising the need for more focused system wide training of dental providers. Reducing, preventing, and mitigating the harm as a result of dental care will require investigators to identify their root causes as a next step in the improvement of patient safety.