Patient Safety/Risk Management Tips
Preventing Wrong Tooth Extraction
As the first medical professional liability insurer to establish a patient safety department, The Doctors Company sets the industry standard with innovative tools that can help you reduce risk and keep your patients safe.
Extraction of the wrong tooth occurs with surprisingly high frequency and, in most cases, is preventable.
Always document why the extraction is warranted.
- Include subjective patient complaints and objective clinical findings (e.g., results of periodontal probing and radiographic findings).
- Place any fax transmissions of updated treatment requests, updated e-mails, or non-electronic records in the medical record.
- Document a description of the tooth or teeth to be extracted (e.g., “upper right first premolar”) to avoid possible confusion between different tooth numbering systems.
Double check the tooth number.
- Check the referral form letter and the copy of the x-ray films; confirm the correct tooth with your patient.
- Examine any appliance sent with the patient to be sure it matches up with the tooth to be removed.
- Develop a standardized referral form to improve communication between the referring dentist and the surgeon.
- Insist on the name and number of the tooth/teeth.
- Remember that missing teeth may cause other teeth to shift and be misnumbered.
- Don’t assume—contact the referring dentist if you have any questions about the extraction request, and document the discussion.
Promote safety systems.
- Develop and utilize an extraction check-off list incorporating the Joint Commission’s Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery.
- Use the Joint Commission’s Speak Up program to enhance your safety systems. (Its brochure, “Help Avoid Mistakes in Your Surgery” is available at www.jointcommission.org/PatientSafety/SpeakUp.)
Confirm that you have the patient’s informed consent to remove the specific tooth or teeth.
- Ensure the consent is specific and does not simply state that “extractions will be performed.”
- Extract only the specific tooth or teeth for which you have received consent.
- Provide the patient with a mirror so that you can both see what the planned procedure will entail.
- Obtain a signed informed consent from the patient in advance of his or her appointment if possible.
Slow down and be careful.
- Before you pick up your forceps, use your written and radiographic records to verify (twice) the correct tooth or teeth to be extracted.
- Encourage your staff to speak up if they notice any confusion or potential problems with tooth selection.
Be proactive if something goes wrong.
- Identify any wrong site tooth extraction as soon as possible to improve the patient’s clinical outcome and reduce your legal liability.
- Disclose the event to the patient. The ideal disclosure should also include a simultaneous offer of a well-reasoned solution (e.g., implant, orthodontic movement, or bridge) and a discussion regarding cost deferral.
- Don’t leave it up to the patient to try to find a solution.
- Contact your patient safety/risk manager for assistance with our disclosure guidelines.
J7327 4/09
By Barbara Worsley, Regional Assistant Vice President, Patient Safety.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.