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 www.jointcommission.org/topics/speakup_brochures.aspx.)
- 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.
- 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.