Areas of risk within dental practice

Clinical risk is associated with carrying out dental examinations, treatment and care of patients.

Examples of clinical risk include:

• allergies or intolerances to materials (e.g. latex, adrenaline)
• sharps injury (e.g. needlestick)
• inhalation or ingestion of foreign objects
• broken instruments
• misjudging patient expectations
• crown or bridge failure
• burns or trauma related to instrumentation
• extraction of the wrong tooth
• poor lab work
• failures in diagnosis (e.g. undiagnosed periodontitis).

Although dental teams can insure against some of these risks through professional indemnity, indemnity organisations would advise that avoidance of these risks is desirable and risk-reduction measures should be in place.

Examples of risk-reduction measures include:

• routine use of rubber dams and clamp chains
• disposing of sharps as recommended in standard infection control precautions
• discarding of instruments as per manufacturers instructions e.g. single use items
• maintaining good communication (both verbal and written) with patients (see Communication)
• keeping diagnostic and clinical skills up to date
• working with due care and attention.

Many GDC cases against dentists and dental care professionals are indefensible as a result of poor administrative procedures. Examples of administrative risk include: 

• illegible records
• inappropriate alterations made to records
• inadequate security of records
• incomplete information recorded
• treatment without obtaining valid consent
• breach of confidentiality
• failure to comply with the Data Protection Act 2018 [1]
• inadequate handling of complaints.

The major contributory factor to administrative risk is communication, whether it is written or verbal. Misunderstandings can arise between staff, clinicians and patients, other staff and patients. However, good documentation can frequently defuse any potentially difficult situation.

Examples of risk-reduction measures include:

• maintaining accurate and contemporaneous records (see Record-keeping)
• using computer systems (see Record-keeping)
• having written policies and procedures, and ensuring staff read, understand and follow them
• reviewing policies and procedures regularly and updating when necessary
• recording, documenting and analysing incidents or significant events (see Significant Event Analysis and Incident Reporting)
• maintaining good verbal and written communication with staff and patients (see Communication)
• training staff in all aspects of practice activity, including legal and ethical practice (see Ethical Practice)

Examples of systems risk include:

• power or equipment failure;
• IT systems failure.

Examples of risk-reduction measures include:

• maintaining and testing equipment (e.g. dental unit, sterilizer, radiographic equipment) in accordance with manufacturers’ instructions
• installing appropriate software protection (e.g. anti-virus and firewalls), and keeping these up to date
• taking physical security measures to minimise the likelihood of theft or deliberate tampering, or damage as a result of water, fire, electrical faults, magnetic risks or other environmental factors (e.g. excess heat, cold, humidity or dust)
• ensuring that the operation and recovery of systems are not dependent on single individuals who might be absent (see Continuity Planning)
• putting in place back-up and emergency repair arrangements for IT systems to ensure there is no loss of data (see Record-keeping).

Examples of personnel risk include:

• difficulties with recruitment and retention
• staff shortages as a result of turnover, sickness or leave
• ill health
• working patterns.

Examples of risk-reduction measures include:

• offering staff good terms and conditions
• putting in place employment contracts
• ensuring staff are multi-skilled (to avoid single points of failure)
• maintaining good staff communication systems (e.g. staff meetings and appraisal)
• establishing contacts with providers of agency staff
• agreeing succession planning and deputising arrangements.

Examples of financial risk include:

• poor profitability
• bad debts.

Examples of risk-reduction measures include:

• seeking advice from a good business adviser
• putting in place a business plan
• making debt-collection arrangements
• taking out permanent health insurance
• pre-payment or deposits for appointments.

Environmental risks can involve accidents or incidents resulting from deficiencies in the premises or surrounding area. Examples of environmental risk include: 

• slips and trips
• inadequate fire safety
• inadequate security
• inappropriate lighting.

Risks relating to premises are assessed and dealt with as part of health and safety requirements (see Health and Safety – General).

Other examples of risk-reduction measures include:

• maintaining systems such as heating and the fabric of the building
• ensuring appliances are switched off at the end of each day
• ensuring all windows and doors are shut and locked at the end of each day, and more than one person is present when locking up
• installing and maintaining a security system
• setting alarms at the end of each day
• obtaining appropriate insurance cover
• ensuring fire exit routs are kept clear.

Dentists are responsible for the actions of their employed staff, and may be responsible for the actions of their self employed associates. Problems might arise as a result of:

• inadequate training
• poor communication (e.g. lack of understanding of responsibilities within the dental team).

Examples of risk-reduction measures include:

• ensuring there are written contracts in place for employed and self employed staff
• ensuring ongoing registration and regulatory bodies
• confirming current and adequate indemnity cover with defences unions
• regular training of staff in all aspects of their job, including keeping continuing professional development up to date
• ensuring team members work within the GDC scope of practice for their role
• maintaining good communication among the dental team (see Communication).