Treatment injuries in dentistry--cases from one year in the Swedish Patient Insurance Scheme

Occurrence and risk factors of dental root perforations: a systematic review

BACKGROUND

Iatrogenic root perforations are an unfortunate accident that can occur during dental treatment and can lead to peri-radicular damage, poor treatment outcome and extraction of the tooth. The aim of this review was to analyse the occurrence and risk factors for root perforation.

METHODS

A systematic search of the literature was conducted in CINAHL, Cochrane, EMBASE, Medline and SCOPUS in May 2019. Additional literature was identified through a hand search. Clinical studies enrolling adults with permanent dentition were included. Single case studies and case reports were excluded. Duplicate articles were removed, titles and abstracts were screened and studies were selected according to the inclusion criteria. Data were collected and reported in accordance with PRISMA guidelines. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

A total of 916 articles were screened, from which 47 full-text articles were analysed and 22 articles were finally included in the study. The data were analysed qualitatively because meta-analysis could not be conducted owing to lack of heterogeneity among the studies. Most of the articles were retrospective cross-sectional studies on root canal treatments performed by undergraduate students. The occurrence of perforation ranged from 0.6% to 17.6%. Risk factors for perforation included experience of the practitioner, tooth type, and tooth morphology. The risk of bias in most of the studies included was assessed as low.

CONCLUSIONS

This systematic review suggests a need for additional studies on the risk factors associated with iatrogenic root perforation as the current literature is insufficient. Educational efforts in dental schools should address the issue of perforations and provide more clinical experience prior to graduation in order to improve the clinical skills of graduates.

Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients

PURPOSE

Injuries of the inferior alveolar nerve (IAN) related to endodontic treatment are being increasingly reported. However, consensus on the preferred intervention and the timing of and indications for surgical treatment is lacking. Here, we describe our experience with painful IAN injuries arising from endodontic treatment and requiring prompt microsurgical treatment.

METHODS

Seven consecutive patients with painful IAN injuries were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had undergone root canals endodontic treatment in the mandibular molar or premolar between 2007 and 2014. The time elapsed between injury and referral for surgical treatment ranged from 10 days to 20 months. Each patient was treated by one of several different microsurgical procedures, described herein.

RESULTS

Overall, neurosensory status and IAN-related pain improved in all seven patients. The best results were obtained by IAN replacement with a sural nerve graft. However, complete sensory recovery was not achieved in any of the patients.

CONCLUSIONS

Although our sample includes only seven patients, early surgical treatment with an interpositional sural nerve graft seems to allow neurosensory recovery. Less satisfactory results are achieved in patients with IAN injuries of > 12 months duration.

Dental treatment injuries in the Finnish Patient Insurance Centre in 2000-2011

Objective The Patient Insurance Centre in Finland reimburses patients who sustained injuries associated with medical and dental care without having to demonstrate malpractice. The aim was to analyse all dental injuries claimed through the Patient Insurance Centre over a 12-year period in order to identify factors affecting reimbursement of claims. Methods This study investigated all dental patient insurance claims in Finland during 2000-2011. The injury cases were grouped as (K00-K08) according to the International Classification of Diseases (ICD-10). Calendar year, claimant's age and gender, dental disease group and health service sector were the explanatory factors and the outcome was the decision of a claim. Multiple logistic regression modelling was used in the statistical analyses. Results The total number of decisions related to dental claims at the PIC in 2000-2011 was 7662, of which women claimed a clear majority (72%). Diseases of the pulp and periapical tissues (K04) and dental caries (K02) were the major disease groups (both 29%). Of the claims 40% were eligible for reimbursement, 27% were classified as insignificant or unavoidable injuries and 32% were rejected for other reasons. The proportion of reimbursed claims declined during the period. Patients from the private sector were more likely to be eligible for compensation than were those from the public sector (OR = 1.89, 95% CI = 1.71-2.10). Conclusions The number of dental patient insurance claims in Finland clearly rose, while the proportion of reimbursed claims declined. More claims received compensation in the private sector than in the public sector.

An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland

OBJECTIVE

Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland.

MATERIALS AND METHODS

The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases.

RESULTS

Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications.

CONCLUSIONS

Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.

Patient claims and complaints data for improving patient safety

PURPOSE

The purpose of this paper is to describe patient complaints and claims data from Swedish databases and assess their value for scientific research and practical health care improvement.

DESIGN/METHODOLOGY/APPROACH

The article first describes previous research into patient claims and similar schemes. It then presents three types of data on patient claims and complaints in Sweden: data generated by the Patient Insurance Fund, the Medical Responsibility Board and the Patients' Advisory Committees and considers methodological issues in using the data.

FINDINGS

The databases' value is problems related to spontaneous reporting, which makes it difficult to know how much the data correspond to general injury rates and health care patterns. Another issue is the balance between the size of study materials and the timeliness, e.g. when diagnosis-specific analysis requires data pooling over several years in order to reach adequate case numbers. Adjustment for confounders not present in the databases, e.g. data on hospital case-mix, may add to difficulties using the data in comparative analyses of safety performance.

RESEARCH LIMITATIONS/IMPLICATIONS

The databases' safety analysis and quality improvement value depends on understanding their function, data collection method and their limitations as a source of data about the true incidence and prevalence of injuries and safety problems.

ORIGINALITY/VALUE

This is the first thorough review of the possibilities and limitations associated with the use of claims and complaints data in health care research and improvement.

Prevalence of ocular injuries, conjunctivitis and use of eye protection among dental personnel in Riyadh, Saudi Arabia

AIMS

To find out the prevalence of ocular injury and infection among dental personnel in Riyadh, Saudi Arabia.

PARTICIPANTS

Two hundred and four dental personnel.

METHOD

A questionnaire completed by researchers and observation during practice.

RESULTS

The response rate was 81%. Dentists and dental technicians had a similar prevalence (42.3%) of foreign bodies in their eyes during the period of one month. Almost 50.5% of dentists rarely had foreign bodies in their eyes, while only 22.2% of dental technicians claimed the same. The majority of dental surgery assistants (73.6%) never experienced foreign bodies in their eyes. Only 27.0% of female personnel had foreign bodies in their eyes as compared to 73.0% of male personnel, while only 28.5% of females had conjunctivitis as compared to 71.4% among male personnel. 75% of regular eye protector wearers (EPW) never had foreign bodies while 67.2% EPW never had conjunctivitis. Dental technicians were more prone to ocular injury, 13.8% as compared to 4.4% of dentists. Only 30% of the regular eye protector wearers suffered ocular injury.

CONCLUSIONS

Protection of the eyes should be emphasised and practised at undergraduate level. The awareness of eye protection should be highlighted at all clinical and research symposia. Further studies should be conducted to assess the financial implications of ocular injuries and infections in dental institutions and practices. Recommendations are made for universal precautions and the observation of safety at work guidelines by all dental team members.