Adverse incidents—including erroneous extractions, like the case we describe below—are unfortunate for patients and dental professionals alike. But depending on the circumstances, it may be that they can still be managed well by the dental team, so that a subsequent complaint or claim is avoided.
An Example Case
A Dental Defence Union dental therapist member recently requested our assistance with a complaint following an extraction they had carried out on a 10-year-old patient. The patient had been referred to the member for the extraction of their upper left deciduous canine.
Unfortunately, the dental therapist mistakenly extracted the partially erupted permanent canine. Once they realized what happened, they told the patient’s parents and apologized, as they knew they had an ethical and professional duty of candor that required them to be open and honest when the mistake had been identified.
The patient’s parents subsequently made a complaint to the practice, and the member responded with our assistance. The member explained what happened and apologized again, while also setting out the steps they planned to take to avoid a similar situation arising in the future.
This included discussing the wording of referrals with the referring dentist, to try and ensure they were as clear as possible. The response to the complaint also explained that if the member ever had any doubts or questions about a referral, they would ask for clarification from the referring dentist before starting any treatment.
As the extraction of permanent teeth is outside the scope of practice for a dental therapist, there was a risk that our member might face additional criticism. We therefore advised them to incorporate some relevant continuing professional development into their personal development plan.
Making a Plan
It’s important to know what to do when something goes wrong, and that means having the right plans, procedures, and practice policies in place.
Make sure that any adverse incident is thoroughly investigated, and, when necessary, appropriately reported. An investigation of any adverse incident should look at what happened, why it happened, and what can be done to help prevent a similar situation arising in the future.
This should be carried out in a no-blame way and the findings should be shared with the whole team, as it might mean a similar situation doesn’t happen to someone else. It can also be worthwhile to go through a similar investigation when there has been a ‘near miss,’ which might help prevent a difficult situation arising in the future that could result in someone suffering harm.
When considering what happened and why, take into consideration all relevant factors, which includes asking questions such as:
- Were the correct records available?
- Were the records up to date and accurate?
- Were there any factors that might have led to a lapse in concentration?
This is not an exhaustive list—but instead, are good examples of some of the factors you might need to consider.
Avoiding a Complaint
Although the extraction in this case did result in a complaint, there are steps you can take to help prevent a patient from being dissatisfied with their treatment. If a patient is undergoing orthodontic treatment, as in this example, it’s sensible to meet with an orthodontist at the earliest opportunity to see if the treatment plan can be amended so that the patient gets a good result with the minimum of disruption.
If erroneous extraction was not part of the orthodontic treatment plan, arrange for the patient to have a further assessment so that all appropriate treatment options can be explored. Think carefully about involving other clinicians in this assessment, as the patient might now lack confidence in your abilities.
Make sure you tell the patient—and their parents—of any developments, so that they’re kept up to date with your progress at arranging their ongoing care. Keep good records of all your discussions with the patient, their parents, and with anyone else who might be involved in resolving the situation and helping you arrange care for the patient.
As with so much of dental practice, rectifying an inadvertent error and achieving a good result for the patient involves good communication and having reliable practice procedures in place. When the dental team works well together, it is often possible to achieve an outcome that the patient is happy with.