Patient safety in dentistry: development of a candidate 'never event' list for primary care

Introduction The 'never event' concept is often used in secondary care and refers to an agreed list of patient safety incidents that 'should not happen if the necessary preventative measures are in place'. Such an intervention may raise awareness of patient safety issues and inform team learning and system improvements in primary care dentistry. Objective To identify and develop a candidate never event list for primary care dentistry. Methods A literature review, eight workshops with dental practitioners and a modified Delphi with 'expert' groups were used to identify and agree candidate never events. Results Two-hundred and fifty dental practitioners suggested 507 never events, reduced to 27 distinct possibilities grouped across seven themes. Most frequently occurring themes were: 'checking medical history and prescribing' (119, 23.5%) and 'infection control and decontamination' (71, 14%). 'Experts' endorsed nine candidate never event statements with one graded as 'extreme risk' (failure to check past medical history) and four as 'high risk' (for example, extracting wrong tooth). Conclusion Consensus on a preliminary list of never events was developed. This is the first known attempt to develop this approach and an important step in determining its value to patient safety. Further work is necessary to develop the utility of this method

Managing tooth surface loss

This chapter will emphasise the need to:Be aware that most patients diagnosed with tooth surface loss (TSL) do not need to be restored, at least in the short term, but need to be advised how best to control causative factors (e.g. extrinsic erosion, intrinsic erosion, and bruxism)Liaise with the patient's doctor to manage intrinsic erosion, e.g. gastro-oesophageal reflux disease (GORD) or bulimia. The patient must accept the risk of early failure if restorations are provided before the medical condition is controlledRecord baseline study models to monitor TSL longitudinallyImplement restorative treatment where there are major aesthetic concerns and uncontrolled dentine sensitivity or where further TSL would compromise restorabilityConsider restoring anterior teeth using composite. A large composite can later have its buccal surface covered with a ceramic veneer (sandwich technique)Be realistic about restoring posterior teeth and choose an appropriate material to cope with higher occlusal forces, particularly in bruxists. If teeth are to be crowned, patients need to be aware of the risk of pulp damage and its consequencesPlan reconstructions according to whether TSL is localised or generalised. Generalised wear is more difficult; space is created by increasing the occlusal vertical dimension