C.E. Credit. Elevating the Conversation: Safety and Risk Management in Dental Practice

Figures & data

Table 1. Components of “the Plan for Health Care Risk Prevention in Dentistry.”^4(p807)

Item	Comment
“…promote a culture of patient safety in dental care.”^4(p807)	“Culture of safety is the product of individual and group values, attitudes, perceptions, skills, and patterns of behavior which lead to commitment, style and ability in the management of the health and safety ….” “… organizations with a positive safety culture are characterized by communication based on mutual trust, by shared perceptions of the importance of safety and by trust in the effectiveness of measures for prevention.”^4(p807)
Promote an “increased awareness amongst dentists about the general aspects and basic measures involved in patient safety”^4(p807 and related research.	The authors propose an emphasis on dentists’ awareness of safety culture, but also among patients and others involved in the management/business of dental care, stating this “is absolutely fundamental.”^4(p807)
Create “an organizational structure for the management of dental care risks.”^4(p807)	The authors propose a structure consistent with the system in place in Spain.^4 In the U.S., this structure may involve local/state public health and/or professional organizations.
Develop “tools for the identification, analysis and assessment of risks related with dental care.”^4(p807)	Includes “a system for notification and recording of adverse events which take place in professional practice”^4(p807); classification of adverse events (AEs) “on the basis of a specific taxonomy”^4(p807; use of tools to study reported AEs (e.g., root cause analysis-RCA) and prevent future AEs (e.g., failure mode and effects analysis-FMEA).^4
Establish “lines of information on adverse events.”^4(p808)	Communication/information pathways will facilitate the sharing and consolidation of AE data. Information sources may include professional literature, PSOs and other practitioner/patient reporting sources, health departments, malpractice claims (insurers, courts).^4
Establish “measures to prevent health care risks by elimination or reduction.”^4(p808)	Measures may derive from and be used by an individual practice or be more general, based upon known risks. Examples include infection prevention and control recommendations or evidence-based clinical guidelines.^4
Implement “ongoing training of professionals on patient safety.”^4(p808)	Should include an urgent alert system and periodic update communications.^4 (Addition in the U.S.—Continuing Dental Education on patient safety and risk management.)
“Research in the field of Dental Patient Safety.”^4(p808)	Academic research and “any other applicable instrument of education or research.”^4(p808) (Such resources in the U.S. may include commercial product safety research, computer or other device hardware/software, electronic dental records systems, etc.)

Table 2. Standard of care in dentistry.*

Characteristic	Comment
What a reasonable and prudent practitioner would do under the same or similar circumstances.	Although the concept is widely understood, there are no definitions of what is, or is not reasonable and prudent for each dental procedure.
A reasonable and prudent dentist should act with skill and due care when treating patients.	Examples of exercising due care: informing the patient of the diagnosis; referring when indicated; obtaining informed consent before treatment; completing treatment that has been started; and following up on the patient’s care and status.
The standard of care is a dynamic concept, changing over time with new technology, research, and advancements in clinical methods.	Remaining current on evidence-based clinical guidelines, new methods, materials, and treatments (applying principles of evidence-based practice) is essential to meeting the standard of care.
In a malpractice action, the standard of care is articulated through the opinion testimony of expert witnesses.	Expert witnesses are professionals with background and training similar to the dentist defendant, typically from the same practice community.
The specialty standard of care typically applies to treatment ordinarily performed by a dental specialist.	The patient (plaintiff) customarily retains a dental specialist as an expert witness in such cases involving treatment that a dental specialist would ordinarily provide. Although there may be exceptions, the specialty standard of care would apply to a general practitioner defendant.

*Adapted from CNA Risk Control Resources (2023).

Figure 1. Dental malpractice payments ≤ $99,999.

Figure 2. Dental malpractice payments ≥ $100,000.

Figure 3. Paid indemnity range comparison: 2016 claim dataset vs 2020 claim dataset.

Figure 4. Average total incurred of top dental procedures associated with all professional liability claims.

Table 3. Informed consent^.

All healthcare providers have a duty to obtain a patient’s informed consent before commencing treatment. The consent must be given without coercion or fraud, based upon the patient’s reasonable understanding of what will take place, including: the nature of the proposed treatment, reasonable treatment alternatives, and the foreseeable material risks and potential complications. Unauthorized treatment of a patient may constitute the crime of battery. Most patients have a reasonable idea of what will occur during a routine examination or treatment and give implied permission for work performed when they visit an office for such care. Implied consent, however, has serious limits as a legal defense, especially when more complex or risky treatment is involved. Dentistry is a highly technical profession, and patients often have a limited understanding of the procedures to be performed. Relying on implied consent minimally risks misunderstanding, and may lead to serious adverse events. Informed consent can be regarded as an educational process involving two main components: Discussion, including disclosure and patient education. Informed consent requires a verbal communication component, whether or not a written consent form is used. The informed consent discussion also helps to manage patient expectations with respect to treatment outcomes. Documentation in the patient record. Documentation often includes the use of a written informed consent form. (In certain states, a written form may be required for some procedures.) Documentation elements should include verification that the discussion occurred and evidence that the patient understood and agreed to proceed through an acknowledgment as signed by the patient or the patient’s authorized representative. In today’s healthcare environment, the informed consent process assumes ever-greater significance in terms of patient education, dentist-patient communication, risk management and patient safety.

^Adapted from CNA Risk Control Resources (2023).