1. Need for retreatment of the same tooth or need to redo the same procedure performed less than twelve months before. |
When there is no complication that is inherent to the patient (poor habits or other comorbidities), dental procedures generally last more than twelve months. |
Premature contact between opposing teeth leading to: fractures of teeth or restorations; pericementitis or temporomandibular joint disorders (TMD); loss of dental implants or factures to prostheses over implant. Need for endodontic retreatment due to: insufficient disinfection of root canals; breakage of endodontic instruments and root perforations during canal treatment; unsatisfactory sterilization of instruments. Need to redo restorations due to: residual caries; dentin hypersensitivity due to mechanical exposure of dentin following inadvertent removal of dental tissue; removal of excess restoration material invading gingival sulcus and interproximal spaces. |
2. Lesions occurring in the treatment setting (dental clinic or office) not caused by the dental treatment itself (e.g., falls from height or patient’s body colliding with equipment/instruments) |
Patient should be protected from incidents with or without harm or injuries, even those not resulting directly from the dental treatment. |
Injuries produced by falls from height or colliding with equipment; ocular lesions due to lack of patient’s protective goggles. |
3. Procedure-related complications during dental treatment (e.g., paresthesia; extraction of wrong tooth; soft tissue lacerations; lesion from leakage of chemical substances; ocular lesion; aspiration and/or swallowing of foreign body). |
Failures in manipulation of tissues, instruments, disinfectant substances, inadequate storage of substances using recipients from other products, or failure in planning may cause harm/lesions during dental treatment. |
Paresthesia caused by nerve injury during tooth extraction; lesions to other teeth, whether or not leading to unplanned extraction (luxation/fracture/avulsion of other teeth; aspiration and/or swallowing of foreign body; ocular lesion due to lack of protective goggles during treatment; lesions caused by chemical substances. |
4. Systemic complications during or after dental treatment. |
Systemic disorder may be triggered by incomplete patient history or inadequate planning or follow-up. |
Allergies/anaphylactic shock related to: latex (rubber dam, procedure gloves); local anesthetic; disinfectant substances; uncontrolled hemophilia or diabetes can present prolonged bleeding; severe anorexia nervosa induced by orthodontic treatment |
5. Infections resulting from dental treatment. |
Failure in the asepsis chain or in antimicrobial prophylaxis can lead to infection. |
Alveolitis; infections can lead to serious complications such as Ludwig’s angina; dissemination of infectious and contagious diseases. |
6. Return for urgent care due to pain, edema, or other reason. |
When patients feel pain or discomfort to the point of returning for urgent care or require a new unscheduled visit, they may not have been properly oriented as to what to expect while waiting for their next appointment, or something unexpected may have happened. |
Painful manifestation caused by infection or excessive manipulation of the treatment site; fractured tooth wall between endodontic/prosthetic treatment sessions; soft tissue injury caused by remaining tooth fragment after temporary filling falls out; post-anesthesia traumatic ulcers in pediatric dentistry. |
7. Complications related to drug prescription |
Lapses/errors can lead to switched medication, and faulty patient history can lead to unexpected drug reaction. |
Harmful drug-drug interaction |
8. Dissatisfaction expressed or documented by patient or family (includes documents, documented complaints, conflicts between patient or family and health professionals). |
Difficult patient/provider relations or communication can lead to an adverse event. |
Law suits against dentists at the civil, criminal, or administrative level are not harm or adverse events per se, but the motive should be investigated. |
9. Unforeseen change in treatment plan |
Unforeseen facts that lead to a change in the course of treatment may signal the occurrence of adverse events. |
Extraction of tooth that was undergoing root canal treatment; unforeseen need for endodontic treatment. |
10. Death |
Any death during or immediately after outpatient dental treatment is unexpected and must be investigated. |
Deaths associated mainly with infection and anaphylactic shock. |
11. Failure or breakage of instrument during treatment |
Instrument breakage during treatment may be a contributing factor to incident. |
File broken inside root canal may compromise adequate cleaning of the canal; broken drill bit may injure patient’s mucosa; pieces of broken instruments can be swallowed or aspirated. |
12. Caldwell-Luc surgery/access to maxillary sinus |
Caldwell-Luc technique can be used to remove material inadvertently shifted into the maxillary sinus during dental treatment. |
For example, filling material for root canal and drill bit can migrate into maxillary sinus during procedures. |
13. Graft or use of mineral trioxide aggregate (MTA) |
Mineral trioxide aggregate is used in the treatment of root perforation; grafts may be necessary to correct bone or gingival loss that may be due to complications of prior dental treatment. |
Root tear or perforation during cleaning of root canal system; endodontic and periodontal infection leading to loss of buttress tissues (gingiva and bone). |
14. Any other complications not included in the previous items |
There are situations that totally escape expectations and that can lead to adverse events. Any other circumstances that do not fit the previous items. |
Interruption of procedures in progress due to power or water shortage, e.g.: interruption of a photopolymerizable restoration or a surgical intervention. |