September 17 is World Patient Safety Day, established by the World Health Organization in 2019. To mark it, Dr. Cortés Torres presented the lecture Patient safety in dentistry: a critical analysis, which reviews ten recent scientific papers. This is a summary of its main ideas; the full document, in Spanish, can be downloaded below.
In short: most adverse events in dentistry can be prevented with planning, standardized procedures, checklists and sound informed consent.
The WHO defines patient safety as "the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum". In dentistry, information on the subject is still limited.
Not a "medical error": a chain
An accident rarely has a single cause. The lecture therefore proposes replacing "medical error" with a more precise term: chain of error in healthcare. Errors can be grouped as:
- Clinician errors (surgical and non-surgical).
- Clinical support staff errors.
- Administrative errors (facilities, equipment).
- Other links in the chain.
The problem is large. In Colombia, between 2010 and 2019 there were 364,113 deaths the health system could have prevented: 17 of every 100 deaths in that period (National Institute of Health).
What we can learn from aviation
Commercial aviation is among the safest systems in the world, and many of its tools transfer to the dental office:
- Sterile cockpit: at critical moments, talk only about the task. Phones, calls and unrelated conversations increase distraction.
- Cross-checking: a colleague confirms the data before acting.
- Read-back: whoever receives an instruction repeats it in full, rather than just saying "ok".
- Human factors: lack of sleep, fatigue, hunger, dehydration and stress all raise risk. The acronyms HALT (hungry, angry, late, tired) and IMSAFE help identify when we are not fit to treat safely.
One dental example: accidentally injecting sodium hypochlorite instead of local anaesthetic. Labelling, checking and not relying on memory prevent it.
The most frequent adverse events
An analysis of dental adverse events in the US Veterans Health Administration (Lo et al., JADA, 2025) found these to be the most common:
| Event | Frequency |
|---|---|
| Wrong-site surgery (for example, extracting the wrong tooth) | 40.5% |
| Ingestion of an object | 19.0% |
| Improperly sterilized instruments | 7.1% |
The most common cause was the absence of policies and protocols.
Checklists: one for every visit
Each visit should have a checklist attached to the clinical record. The lecture proposes four short lists:
- Before: informed consent.
- Procedure: equipment, biomaterials, technique and the most likely contingencies.
- On finishing: prescription, post-operative instructions, clinical record notes and self-assessment.
- Follow-up.
Behind the lists are four barriers against error: plan, standardize, simplify and rely less on memory. The WHO surgical safety checklist, for example, has been associated with fewer surgical complications.
In endodontics
- Instrument fracture: a retained fragment does not mean failure. Inform the patient and refer to a specialist if needed: that reflects professionalism, not incompetence. When it happens, pause, reassess and proceed with care.
- Single-use instruments: cutting instruments should not be reused, because they contact blood and fluids, retain infected debris, lose sharpness and suffer metal fatigue.
- Sodium hypochlorite accidents: more likely when the root apex communicates with nearby tissues, as with fenestrations or perforations. Proper canal preparation before irrigating helps prevent them.
Informed consent: think like the patient
The Montgomery case (UK, 2015) replaced the "prudent doctor" test with the "reasonable patient" test: every material risk for that particular patient must be disclosed, along with reasonable alternatives, including no treatment. In endodontics it is worth recording, among others, the risk of fracture (especially in cracked teeth), the need for prompt restoration, the importance of follow-up and how to manage post-operative pain without self-medicating.
What is missing
Patient safety should be a compulsory subject in dental programmes, and graduates should keep up to date on it. As the lecture puts it: dentistry is health care, and patient safety is a matter of ethics, diagnosis, management and prevention.
If you are a patient
- Read and ask whatever you need before signing informed consent.
- Confirm with your dentist which tooth will be treated.
- Ask for post-operative instructions in writing and avoid self-medicating.
To cite: Cortés-Torres JO. Patient safety in dentistry: A critical analysis. Colombian Institute of Endodontics, Bogotá D.C., September 17, 2026.