Patient Safety Challenges in General Dentistry

David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management.

The guidelines suggested in this article can help dentists address patient safety issues in general dentistry practices.

Infection Control

Following these infection control practices vigilantly can reduce the chance that you, your staff, or your patients will become infected:

  • Always wash your hands before donning gloves and again after removing them. Change gloves between patients.
  • When gloved, don’t touch noncritical patient care items that are not barrier protected or cleaned between patients.
  • Wear your personal protective equipment.
  • Use any single-use disposable instrument only once, and then dispose of it properly.
  • Follow the manufacturer’s directions for autoclaving dental instruments. Perform biological monitoring, and document the monitoring results. Store sterilized instruments in a clean, dry, and protected environment.
  • Establish a dirty area for processing and cleaning instruments in preparation for autoclaving to avoid cross-contamination of clean and sterilized items.
  • Select appropriate devices that reduce aerosol and droplet formation and the potential for sharps injuries.
  • Ensure that everyone follows universal precautions with every patient.
  • Manage occupational exposure to blood-borne pathogens, including post-exposure prophylaxis for work exposure to hepatitis B virus, hepatitis C virus, and HIV.
  • Check dental unit water lines, biofilms, and water quality regularly.

Dental Histories

Ask patients the right questions in the dental history. At a minimum, the questionnaire should include a patient’s appraisal of current health status, current medical treatment and medications, history of disease by system (with attention to congenital or valvular heart disease), and a history of high blood pressures, stroke, diabetes, thyroid function, bleeding disorders, malignancy, AIDS, chronic or acute infections, allergies, and venereal disease. The questionnaire should also include the status of pregnancy and the existence of pacemakers, valvular replacements, and prosthetic joints.

The dental history should also include information regarding previous dental work, radiographs, oral hygiene practice, oral habits, attitudes toward dentistry, and the reason for the patient’s visit.

Identify high-risk patients, and place an alert in their dental records in a conspicuous location. High-risk patients include those on anticoagulants, immunosuppressants, bisphosphonates, and other treatments or medications for chronic medical conditions.

Patient Selection

Selecting the right patient is imperative. This is especially true for elective aesthetic procedures, which are the most frequent cause of litigation in general dentistry. When interviewing a patient for an elective procedure, consider the individual’s chief complaint and concerns, expectations, aesthetic concerns, and needs. For more on this topic, read our article “Patient Selection for Elective Procedures.” Be especially cautious in planning treatments for patients who have unrealistic expectations and patients who demand an assurance or guarantee of results.


Follow state laws when purchasing, registering, and maintaining radiology equipment. For example, you must comply with manufacturers’ recommendations on maintenance schedules and record keeping. Employees who operate or work around radiological equipment must receive safety training. Additionally, dental offices generate medical waste, including sharps, pharmaceuticals, and biohazardous materials. Medical waste disposal is governed by state law through the Occupational Safety and Health Administration (OSHA).

Scope of Practice

When a general dentist ventures outside the scope of practice, complications may result in harm to the patient. For example, lingual nerve dysesthesia is a serious complication that can occur when a dentist practices beyond his or her experience and expertise. This type of patient injury can be prevented through referral, treatment selection, choice of technique, and common sense. If, however, a complication occurs, the dentist should refer the patient to a reputable oral surgeon in the area. Every general dentist should establish a good working relationship with a local oral surgeon.

Patient Mishaps

Handle patient mishaps carefully. For example, if a patient inadvertently swallows part or all of a tooth, crown, or dental instrument, inform the patient immediately, and refer him or her for a chest or gastrointestinal x-ray. Any abnormal results should be reviewed by the patient’s physician, and a follow-up appointment with the physician should be scheduled. Document the dental record with any treatments provided and all discussions of the event, treatment options, and referrals for medical care. Coordinate arrangements with the patient and the treating medical practitioner for medical care and x-rays. Communicate with the patient’s physician and maintain a dialogue with the patient. Notify your patient safety risk manager.

Contact the Department of Patient Safety and Risk Management for guidance and assistance in addressing any patient safety or risk management concerns.

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 healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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