Avoiding wrong tooth or wrong-site allegations seems a relatively simple issue for dentists, yet claims continue to surface alleging negligence due to these misadventures.
The risk management solution to preventing these occurrences is straightforward.
Identify first the participants involved. Each individual shoulders some responsibility to help mitigate any possibility for a wrong-tooth mishap: you, your assisting staff, the specialist brought in for consult (as appropriate) and your patient. Each person has a stake in identifying correctly the tooth (or teeth) targeted for treatment to safeguard against an untoward outcome.
A wrong tooth event can be traced to problems involving a lack of informed consent with the patient (specifically: which tooth will receive treatment and what kind of treatment is planned for that tooth?), failure of office staff to mount films correctly or to invert placement of radiographs on the viewing box, misplacement of dental dams, failure to “time-out,” just prior to commencement of the treatment, or the failure to communicate effectively and efficiently when referrals are necessary. Contributing to the potential for mishap is the shifting of teeth, allowing for misidentification due to missing teeth that have allowed nearby teeth to move over time.
Dental work performed on a misidentified tooth results in permanent, irreversible mistakes (such as the extraction of the wrong tooth or a root canal done on the wrong tooth) and patient dissatisfaction.
These mishaps are compounded when the treatment or procedure causes damage to an adjacent tooth or crown, or excessive force is used causing physical injury.
Let’s look at the responsibility each member of the dental team has to safeguard the proper identification of the tooth to be treated before any work begins.
The Patient
Make the patient an active and engaged member of the dental care team. How? Include the patient in the development of a treatment plan. Research studies continue to substantiate that patients with a vested interest in their care (that is, being encouraged to speak up and ask questions) adhere to their treatment plan, and their outcomes are more closely associated with treatment expectations.
Informed consent is the discussion you have with your patient. This discussion encourages your patient to be actively engaged in the treatment process. Use this opportunity to educate your patient about the location of the tooth (or teeth) that will receive treatment. When the patient arrives for his/her next appointment, ask the patient to point to the general location of the tooth to be treated (such as the right or left side of face, the upper or lower jaw).