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Classifying Adverse Events in the Dental Office

Kalenderian, Elsbeth*; Obadan-Udoh, Enihomo*; Maramaldi, Peter; Etolue, Jini; Yansane, Alfa*; Stewart, Denice§; White, Joel*; Vaderhobli, Ram*; Kent, Karla§; Hebballi, Nutan, B.; Delattre, Veronique; Kahn, Maria; Tokede, Oluwabunmi; Ramoni, Rachel, B.; Walji, Muhammad, F.

doi: 10.1097/PTS.0000000000000407
Original Article: PDF Only

Background Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as “unnecessary harm due to dental treatment.” In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office.

Methods Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications.

Results A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient.

Conclusions Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

From the *University of California, San Francisco, School of Dentistry, San Francisco, California; †Simmons School of Social Work, Boston, Massachusetts; ‡Harvard School of Dental Medicine, Boston, Massachusetts; §Oregon Health & Science University, School of Dentistry, Portland, Oregon; ∥University of Texas Health Science Center, School of Dentistry at Houston, Houston, Texas; and ¶Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.

Correspondence: Elsbeth Kalenderian, DDS, MPH, PhD, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 707 Parnassus Ave, San Francisco, CA 94143-0758 (e-mail:

The authors disclose no conflict of interest.

This research was supported in part by an NIDCR 1R01DE022628-01A1 protocol.

E.K. and E.O.U. are shared first authors.

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