Preventing Wrong Tooth Extraction

Barbara Worsley, DMA, Vice President, Patient Safety, and Pamela Willis, BSN, JD, Patient Safety Risk Manager II.

Extraction of the wrong tooth occurs with surprisingly high frequency and is, in most cases, preventable.

Always document why the extraction is warranted.

  • Include subjective patient complaints and your own 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 circumvent possible errors in tooth numbering by referring providers.

Double check the tooth number.

  • Check the referral form letter and the copy of the x-ray films in the presence of the patient; 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 that all referrals appear on the same form for consistency. Insist that both the name and number of the tooth or teeth be noted on a referral.
  • 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 use 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
  • Obtain a signed informed consent from the patient in advance of his or her appointment if possible.
  • 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 you can both see what the planned procedure will entail.

Remain cautious.

  • Use your written and radiographic records to verify (twice) the correct tooth or teeth to be extracted before picking up your forceps.
  • 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.

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.

J9890 10/14

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