RM Matters

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In Doubt About How to Handle a Situation? Err on the Side of Caution.

August 2018

The Risk Management Advice Line is a complimentary service of The Dentists Insurance Company that has helped thousands of dentists seeking guidance on handling difficult situations in their offices. But not all callers are in the midst of a crisis. Sometimes, they simply need reassurance that they’ve done the right thing.

Senior Risk Management analyst Taiba Solaiman reports a situation in which a dentist called the Advice Line about a 36-year-old patient who presented for an exam and evaluation of her wisdom teeth. The dentist recommended extracting four third molars because their supereruption had created an anterior open bite following the use of an occlusal guard.

The patient noted on her medical history form that she was taking magnesium supplements. She also noted a history of benign ventricular contractions. As a precautionary measure, the dentist consulted with the patient’s physician prior to treatment. He had an informed-consent discussion with the patient and the patient signed the informed consent form prior to the extractions.

After checking the patient’s vitals, the dentist proceeded with treatment using five carpules of mepivacaine plain and nitrous oxide. The dentist performed the extractions using an elevator and extraction forceps, as they were considered simple extractions. The treatment was completed without incident and the patient was discharged with a prescription for pain medication.

The dentist called the patient later that evening for a postoperative check. The patient reported that the extraction sites were still oozing. The dentist called her again a few hours later and she reported that the bleeding had stopped.

The following day, the dentist was informed that the patient’s husband observed she was snoring that evening, but then later stopped breathing. Her husband immediately began performing CPR after calling 911. The dentist subsequently spoke with the patient’s cardiologist, who informed him that he did not believe the incident was related to the dental treatment.

Concerned over the incident, the dentist contacted the Advice Line. The analyst who answered advised him that he followed the proper protocol, but she also referred him to an attorney to determine whether he was obligated to report the incident to his state’s dental board, as some states require reporting of hospitalization following dental treatment. In this case, the attorney advised the dentist that he did not deem the incident reportable as the patient wasn’t transported directly to the hospital from the dental office.

Solaiman noted that this was a case of a dentist doing everything he was supposed to. He consulted with the patient’s medical doctor prior to treatment. He had an informed consent discussion with the patient and followed this with the written form. He checked her vitals prior to the procedure and used a local anesthetic that did not contain epinephrine (due to her reported heart condition).

“There were no issues with the dentist’s protocol and treatment,” she said. “But the likelihood of something happening is always possible. Even though the dentist took the right steps to avoid potential problems, an incident occurred.”

Solaiman said this scenario illustrates that in risk management, it’s better to be overly cautious than not cautious enough.

“No matter how careful you are, things can and do happen,” she said. “We are always on hand to confirm that you’ve followed the proper procedures.”

TDIC’s Risk Management Advice Line provides confidential, one-on-one guidance on a number of issues, including employer-employee relations, record keeping and documentation, commercial property, online security and scope of practice. Callers do not need to be TDIC policyholders — the service is offered at no cost to members of CDA, ADA or any sponsoring dental association. When calling the Advice Line, it is important to have the following information on hand:

  • Policy number or first and last name if you are a TDIC policyholder.
  • ADA number if you are not a TDIC policyholder.
  • Patient chart if calling about a patient issue.
  • Employee file if calling about an employment issue.
  • Details on prior calls to the Advice Line if the issue is ongoing or recurring.
  • Correspondence and other documentation (if applicable) should the analyst have further questions.

It is always prudent to err on the side of caution by calling the Advice Line. Not only can speaking to dedicated analysts set your mind at ease, it can ensure you’ve taken the necessary measures to protect your patients and your practice.

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