Study Says Patient Safety Needs More Research

Dentistry Today
Image courtesy of nenetus at


Image courtesy of nenetus at

Effective safety protocols require more investigation, according to the University of Manchester in the United Kingdom. Its researchers note that the concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve it or minimize the occurrence of adverse events.

“There have not been many studies in this field due to the concept being poorly defined specifically in relation to dentistry: ie, what is an ‘adverse event’ in dentistry?” said Edmund Bailey, locum consultant in oral surgery at the Eastman Dental Hospital, honorary lecturer in oral surgery at the university’s school of dentistry, and author of the study.

“All will accept that erroneous tooth extraction is an adverse event. But other issues, such as misdiagnosis of periodontal conditions or poor restorations, are a little harder to define. This also brings in the concept of quality to dentistry,” Bailey said.

The researchers initially identified 3,240 published studies potentially related to patient safety, defined by the World Health Organization as “The reduction of the risk of unnecessary harm associated with healthcare to an acceptable minimum.” Yet only 9 of them included different outcome measures and, therefore, different measures of success.

Four studies detailed the use of checklists to ensure safety. Three papers examined reporting systems for adverse reactions to dental materials. One described an intervention that alerted practitioners via electronic notes to Web-based guidelines regarding patients’ medical conditions. The last study detailed trigger tools, or easily detectable and focused items in a patient’s case notes that can help identify adverse events.

“I would suggest that practitioners introduce correct site surgery policies and checklists into their clinics, especially when carrying out extractions,” said Bailey. “The review demonstrated that these could reduce errors in dentistry. It is important that all staff involved in this process are engaged. Otherwise, the checklist is just a piece of paper.”

Overall, the researchers said that the number of publications on patient safety is increasing, and it is an active area of research. Yet there is a lack of literature specifically showing patient safety interventions leading to improvements, as tools are identified but not verified from the literature searches. Interventions are suggested, but they are not trialed.

Also, the study found that there were no independently verified, well-validated tools in use that can lead to improvements in patient safety specific to dentistry. The researchers cited a lack of understanding of basic epidemiology of patient safety in dentistry as well, along with little understanding of the views of patients when it comes to safety.

As a result, the study recommends a collaborative approach as dental researchers work with other areas of primary care to develop concepts for improving patient safety using common methods and an agreed taxonomy. Priority areas for patient safety also should be identified, with clinical care guidelines produced as a result.

“National Health Services England has been interested in this work, as well as the dental faculty of the Royal College of Surgeons of England. The indemnity providers have also taken an interest, but were unable to provide much information to us due to their commercial interests and confidentiality,” said Bailey.

“Dr. Elisabeth Kalenderian at Harvard has a research interest in patient safety in dentistry. One of her studies was included in the review,” Bailey said. “Also, in Scotland, there is a Patient Safety Program that is looking at including dentistry in its remit.”

The study, “Systematic Review of Patient Safety Interventions in Dentistry,” was written by Edmund Bailey, Martin Tickle, Stephen Campbell, and Lucy O’Malley and published by BMC Oral Health. Additional information on learning tools for practitioners is available in a previous study, “Patient Safety in Primary Care Dentistry: Where Are We Now?” published by the British Dental Journal.

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