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| REVIEW ARTICLE |
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| Year : 2021 | Volume
: 13
| Issue : 3 | Page : 215-217 |
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Dental aberrations: A short review
Souparna Madhavan1, B Haifa2
1 Department of Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Prosthodontics and Crown and Bridge, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| Date of Submission | 09-Oct-2020 |
| Date of Decision | 19-Dec-2020 |
| Date of Acceptance | 06-Feb-2021 |
| Date of Web Publication | 12-Jul-2021 |
Correspondence Address:
B Haifa
Department of Prosthodontics and Crown and Bridge, Srinivas Institute of Dental Sciences, Mukka, Mangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJDS.IJDS_178_20
Oral health-care services provided by the dentist have to follow certain standards to avoid any kind of negligence during treatment. Patient safety is an important aspect of quality in health care system. In the present time, all dentists need to be cautious about the general perception and the high cost involved in the treatment and to avoid any serious injury to the patient. The best way to prevent being involved in a litigation is to follow a good clinical practice patterns. This article emphasizes on common clinical mishap and dental patient incidents in a clinical practice.
Keywords: Dental health care, dental negligence, patient safety
How to cite this article:
Madhavan S, Haifa B. Dental aberrations: A short review. Indian J Dent Sci 2021;13:215-7 |
| Introduction | |  |
Dentistry is an amalgamation of art and science and patient safety is an important aspect in terms of health-care treatment.[1] A dentist is a health-care professional providing care for the patient and needs to practice with certain standard of care. A breach in this standard of care can result in injury to the patient which is called dental negligence.[2]
Negligence is derived from the Latin word “neglego.” It is the absence of degree of care and skill in the treatment of patient.[3] Dentist might get involved in some kind of litigation process in their practice. It is thus important to provide healthcare minimizing the risk of unnecessary harm to the patient. The purpose this article is not to discuss the litigation process but the negligence or unintentional mistakes in the dentistry.
| Informed Consent | | |
Informed consent is a process of providing appropriate information to the patient; a process of understanding, assimilating the information and making a decision. It is also accepting of what is planned by somebody else. In India, 12 years and above can give consent.[4],[5]
Health professionals in India practices three types of consent.
- Implied consent: Refers to patient's passive cooperation in a process without a formal verbal or written consent, but it is legally effective
- Verbal consent: It is consent given verbally for routine diagnostic procedure
- Written consent: In this consent, the patient gives consent in a written form and it is required in extensive intervention cases involving certain risks.[6] Consent not required in cases of any emergency and any treatment or intervention can be carried out as a result of law.[6]
| Documentation | | |
Complete and accurate documentation is one of the key elements for successful dental practice. The dental record should provide all the details of treatment plan referrals and significant medical information for the dental treatment. It can be used as a legal document for alleged malpractice and professional misconduct.[5]
The basic elements for effective documentation are listed in [Table 1].[7]
| Diagnostic Errors | | |
In dentistry, it is important to upgrade the safety in patient's best interest, thus preventing harm to them.[8]
The Australian Health Foundation proposed diagnostic error framework as misdiagnosis (cracked tooth syndrome as Sinusitis), missed diagnosis (failure to detect dental caries due to radiographic errors), and delayed diagnosis (periodontal disease and oral cancer). Factors contributing for diagnostic errors can be enlisted as:
- Patient factor: Noncompliance, language barriers, poor awareness about oral health, anxiety and holding on the information
- Organizational factors: Inadequate diagnostic tools, excessive workload, completion to establish themselves, lack of time given for the diagnosing a condition[9]
- Communication failure and unnecessary procedures.
The communication skill is important factor for a successful dental practice. Dentist should be able to communicate with the patients the treatment plan, reasoning of the procedure and its possible complications. Dentists should avoid unnecessary treatment procedure to protect patient's oral health.[10]
| Referral | | |
A dental practitioner should have equal balance on diagnostic treatment procedure on one hand and thorough evaluation, follow-up and referral on the other hand. [Table 2][11]
Therefore, it is important that the interdisciplinary team should function toward the better treatment plan, procedure, and outcome for patient's good oral health.
| Cross Contamination | | |
Oral cavity provides a very good nutritive medium for bacterial growth.[12] The most common issue in every dental practice is infection control wherein blood and saliva contamination can easily occur. For instance, skin wounds to operator/staff with sharp instruments contaminated with blood or saliva, aerosols (50 μm) diameter is quite good enough to stay airborne for some period of time before settling on the surfaces/enter respiratory tract (if Personal Protection Equipment (PPE) not used).[13],[14]
Transmission of infectious diseases among patients and dental health-care personnel in dental set up is rare. However, patient to patient transmission have been documented.[15]
The other possible reason for cross contamination between uses could be due to hand pieces which are not sterilized appropriately according to the protocol.
All dental set up irrespective of level of care, most of the infection prevention protocol is followed especially CDC guidelines [Table 3]. | Table 3: CDC Guidelines for Infection control in dental health-care settings (2003)
Click here to view |
| Complication from Local Anesthesia | | |
Dental procedures often use local anesthesia. The usage of local anesthesia has great efficacy and safety in dental practice.
Daublander and Muller studied that overall incidence of complications related to LA is 3.5% in dental set up for nonrisk patients, 5.7% for high risk factor patients.[16]
The most common complications include pain on injection, needle fracture, lack of effect, trismus, hematoma and other complications such as allergy (anaphylaxis hypersensitive reaction) and systemic toxicity are documented. Therefore, certain necessary precautions such as recording appropriate medical history, anxiety management, and differentiated anesthesia (based on type of the treatment) should be done to reduce the complications.[17],[18]
| Medication Errors | | |
Medication errors are an avoidable error leading to inappropriate medication use/patient harm which is in control of health-care professionals.
Prescription writing is a fundamental task by professionals. Errors could be due to:
- Improper format
- Illegibility
- Incorrect dosage
- Informal use of abbreviations
- Unsigned prescription
- Mistakes through phone call prescribing medications
- Prescribed drug should be safe without allergy and intolerance.
Juliana et al. found that among 297 dental prescriptions analyzed, 100% were prescribed by generic name, 98.3% used abbreviations, 26% were illegible prescriptions.[19]
In a study by Naveen Jacob found that 50%of the prescriptions written did not have name of the patient, 65% of the prescriptions were without the date, 90% of the respondents failed to write patient identification. The prescription writing should be therefore should be error free and appropriate in the best interest of patients.[20]
A comprehensive patient incidents are listed in [Table 4].
| Conclusion | | |
Patient safety is very important and pillar of any health-care system. Mistakes occur in every profession, but its individual dentist's duty to avoid errors. In the present time, all dentists need to be cautious about the general perception and the high cost involved in the treatment and avoid any serious injury to the patient and be aware of negligence and its consequences.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Campbell S, Tickle M. What is quality primary dental care. Br Dent J 2013;215:135-9.  |
| 2. | Dhawan R, Dhawan S. Legal aspects in dentistry. J Indian Soc Periodontol 2010;14:81-4. [Full text] |
| 3. | Kumari M, Kumar G, Reddy LVK, Sinha P. Negligence in medical and dental profession – A review. Int J Oral Health Med Res 2017;4:86-90. |
| 4. | Finkbuner BL. Legal and Ethical Issues in Dental Business Office. Mosby: Elsevier; 2011. p. 59-77. |
| 5. | Murkey PN, Khandekar IL, Tirpude BH, Ninave SV. Consent-Medico Legal Aspects. Medico legal update: 2006:6:4. |
| 6. | Miza AM. Importance of Informed consent in dentistry. Int Dent J Stud Res 2012;1:13-6. |
| 7. | Oldenburg AM, Hay LJ. Dental malpractice learning rules of the road. Contin Educ Dentaltown.com 2010:84-91. |
| 8. | Roumainn RB. From good to better towards patient safety initiative in dentistry. JADA 2012; 43:956-60. |
| 9. | Nikdel C, Nikdel K, Ibarra Noriega. A. Clinical dental faculty members: Perceptions of diagnostic errors and How to avoid them : J Dent Educ 2018:82:340-8. |
| 10. | |
| 11. | Balan G, Balan A. Dental malpractice. Rom J Oral Rehabil 2014;6:37-43. |
| 12. | Buddeberg C. Doctor patient relationship in dentistry. SSO Schweiz Monatsschr Zahnhelikd 1980;90:406-18. |
| 13. | Abhichandani SJ, Nadiger R. Cross contamination and dentistry: A comprehensive overview. Chron Young Sci 2013;4:51-8. |
| 14. | Hind WC. Aerosol Technology: Properties Behaviour and Measurement of Airborne Particles. 2 nd ed. New York: Wiley; 1982. p. 6-8. |
| 15. | Redd JT, Bacumbach J, Kohn W, Nainan O, Khristova M, Williams I. Patient to patient transmission of hepatitis B virus associated with oral surgery. J Infec Dis 2009;195:1311-4. |
| 16. | Daublander M, Muller R. Incidence of complication associated with local anesthesia in dentistry. Anesth Prog 1997;44:132-41. |
| 17. | Yalcin BK. Complications associated with local anesthesia in oral maxillofacial surgery. 2019:1-4. [doi: 10.5772/Intechopen. 87172]. |
| 18. | Sakkinen J, Huppunen M, Suurone R. Complications following local anaesthesia. Norwegian Dent J 2005;115:48-52. |
| 19. | Juliana MD, Lyra DP Jr., Rabelo JS, Siqueira JS, Balisa-Rocha BJ, Gimenes FR, et al. Analysis and detection of dental prescribing errors in primary health centre unit in Brazil. Pharm World Sci 2010;32:30-5. |
| 20. | Panchbhai AS. Rationality of prescription writing. Indian J Pharm Educ Res 2013;47:7-15. |
[Table 1], [Table 2], [Table 3], [Table 4]
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