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Mann B. National Public Radio. 2020;July 17.
Despite efforts to reduce opioid prescribing for pain management, physicians and dentists still overprescribe these medications. This news story shares concerns regarding how engrained the reliance on medications for pain management is to the culture of care and its role in opiate dependence and abuse.
Sarasin DS, Brady JW, Stevens RL. Anesth Prog. 2020;67(1):48-59. 
This two-part series discusses anesthesia- and sedation-related medication errors and adverse events in healthcare and dentistry (part 1) and how these errors impact dentistry and approaches to address these issues within a dental anesthesia medication safety paradigm - the Dental Anesthesia Medication Safety Paradigm (DAMSP) - which offers four general guidelines for reducing anesthesia medication errors and adverse drug events in dentistry (part 2).
Farooqi OA, Bruhn WE, Lecholop MK, et al. Int J Oral Maxillofac Surg. 2020;49:397-402.
The over-prescribing of opioids is a recognized contributor to patient harm. This multidisciplinary panel developed six recommendations to manage pain after dental procedures while reducing harm to patients: (1) Offer alternatives to opioids after dental surgery to interested patients when clinically appropriate. (2) Avoid prescribing opioids after dental surgery if pain is comfortably management with over-the-counter medication. (3) Advise patients about non-pharmacological therapies (e.g., cold, heat, distraction). (4) Teach patients to maximize non-narcotic (over the counter) pain medication with scheduled dosing unless contraindicated. (5) Engage in shared decision-making with patients. (6) Consider factors such as medical contraindications, risk for addiction, and risk aversion when prescribing opioids.
Clough S, Handley P. Br Dent J. 2019;227:311-315.
Assumptions, communication barriers, and implicit biases can compromise the care of patients with disabilities. This commentary discusses the presence of diagnostic overshadowing when providing dental services to patients with learning disabilities. The authors provide indications of pain and other behaviors clinicians should recognize to help with diagnosing conditions in this vulnerable population.
Stahl JM, Mack K, Cebula S, et al. Mil Med. 2019.
This retrospective study of dental patient safety reports in the military health system demonstrated an increase in reported events, which may reflect improvements in safety culture. Wrong-site surgery was the most common adverse event, suggesting the need to enhance safety practices in dentistry.
Plessas A, Nasser M, Hanoch Y, et al. J Dent. 2019;82:38-44.
This randomized simulation study examined the performance of dentists on a clinical diagnostic task—interpretation of dental radiographs with and without time pressure. Dentists identified abnormal findings more frequently when they did not feel time pressure, suggesting that time pressure adversely impacted their diagnostic acumen.
Harbaugh CM, Lee JS, Chua K-P, et al. JAMA Surg. 2019;154:e185838.
This retrospective cohort study found that adolescent patients who received opioids for surgical and dental procedures were more likely to develop persistent opioid use if they had family members with long-term opioid use. The study team recommends preoperative screening for long-term opioid use in family members as part of prescribing decision-making for adolescent patients.
Schroeder AR, Dehghan M, Newman TB, et al. JAMA Intern Med. 2019;179:145-152.
This retrospective cohort study found that opioid-naive adolescents who received an opioid prescription from a dentist were more likely to receive a subsequent opioid prescription or be diagnosed with an opioid use disorder compared to opioid-naive adolescents who did not receive an opioid prescription from a dentist. This finding is consistent with prior studies in adults, demonstrating increased risk of subsequent opioid use following short-term prescriptions. The authors urge caution in prescribing opioids to adolescents.
Nainar SMH. Pediatr Dent. 2018;40:323-326.
Patient safety concepts that have been embraced by hospital and ambulatory medical care are increasingly being applied to dental practice. This review discusses adverse events in pediatric dental patients and suggests that when they occur, such incidents affect the ability of dental practitioners to provide care. The author highlights peer support as an important tactic to assist these second victims.
Neily J, Soncrant C, Mills PD, et al. JAMA Netw Open. 2018;1:e185147.
The Joint Commission and National Quality Forum both consider wrong-site, wrong-procedure, and wrong-patient surgeries to be never events. Despite improvement approaches ranging from the Universal Protocol to nonpayment for the procedures themselves and any consequent care, these serious surgical errors continue to occur. This study measured the incidence of incorrect surgeries in Veterans Health Administration medical centers from 2010 to 2017. Surgical patient safety events resulting in harm were rare and declined by more than two-thirds from 2000 to 2017. Dentistry, ophthalmology, and neurosurgery had the highest incidence of in–operating room adverse events. Root cause analysis revealed that 29% of events could have been prevented with a correctly performed time-out. A WebM&M commentary examined an incident involving a wrong-side surgery.
Stocks SJ, Donnelly A, Esmail A, et al. BMJ Open. 2018;8:e020952.
Adverse events reported by patients are often different and more expansive than safety hazards identified by health care providers. Researchers elicited adverse events from a nationally representative sample of British outpatients. About 8% of patients reported an adverse event, which were frequently problems with medications, accessing care in a timely way, and diagnostic errors.
Ensaldo-Carrasco E, Carson-Stevens A, Cresswell K, et al. Br Dent J. 2018;224:733-740.
This Delphi study aimed to identify expert consensus on never events in dentistry. The resulting list of 23 events includes medication errors, retained objects, and wrong patient and wrong procedure events across diagnostic and treatment activities and is consistent with existing never events in medicine.
J Am Dent Assoc. 2018;149:237-272.
The use of opioids in various care environments to address acute pain contributes to the opioid crisis. This special collection explores opioid use in dentistry as a patient safety issue. The articles explore prescribing behaviors, disparities present in opioid prescribing, prescription monitoring mechanisms, and general benefits and harms associated with opioids and managing acute dental pain.
Dental Patient Safety Foundation; 16011 S. 108th Ave., Orland Park, IL 60467.
Dentistry, like other areas of health care, is intrinsically risky. This patient safety organization collects, analyzes, and shares insights drawn from reports of errors, near misses, and systems problems experienced in dental practice to support improvement.
Kalenderian E, Obadan-Udoh E, Maramaldi P, et al. J Patient Saf. 2021;17:e540-e356.
In this study, researchers developed and tested classification schemes for types and severity of adverse events in dentistry using medical record review and expert consensus. Pain and infection were the most common types of adverse events in the cases reviewed.
Black I, Bowie P. Br Dent J. 2017;222:782-788.
This study describes a Delphi consensus process for identifying never events for dentistry. Recurring themes included infection control, safe prescribing, and documentation of medical history, consistent with medical never events. A previous PSNet perspective examined patient safety issues unique to dental care and strategies to reduce risks.
Baker JA, Avorn J, Levin R, et al. JAMA. 2016;315:1653-4.
Given increasing rates of overdose related to opioids, providers' prescribing behavior has come under greater scrutiny. Researchers examined opioid prescribing by dentists after surgical tooth extraction for a cohort of Medicaid patients and found significant variation in the amount of medication prescribed. They suggest that dental care should be one of the areas that is considered when implementing programs to decrease opioid use.
Ensaldo-Carrasco E, Suarez-Ortegon MF, Carson-Stevens A, et al. J Patient Saf. 2021;17:381-391.
Although research has worked to better understand safety issues associated with ambulatory medical care, little is known about safety in dentistry. Investigators analyzed 40 articles describing near misses or adverse events in ambulatory dental care and found a wide variation in the frequency of patient safety incidents across studies. They suggest that more rigorous epidemiological studies are needed to accurately quantify safety events and contributing factors in outpatient dental practice.