As oral health care providers, we rightfully take pride in the progress we have made in the prevention and treatment of oral diseases, and we continue to acquire scientific knowledge to further improve health care delivery in our fields of expertise. However, professional progress is not built on success alone, but also on the recognition of failures. Startling data from the Institute of Medicine’s (IOM’s)¹ 1999 report entitled "To Err Is Human: Building a Safer Health System," generated great concern and resulted in numerous studies examining the incidence and prevalence of mistakes and errors in medical settings.

IOM estimated that 44,000 to 98,000 deaths occur annually in the United States owing to medical errors. Although this figure of mortality has been challenged as being too high, it is clear that a substantial number of mistakes resulting in adverse events routinely take place. Not all unintentional injuries caused by medical management result in death. Life-threatening injuries and illnesses, protracted hospital stays and postdischarge disability also must be recognized.

In a general dental practice setting, death due to dental interventions fortunately is an extremely rare event. Less dramatic complications, such as unnecessary pain, prolonged bleeding or inflammation, are more common and may be caused by broken restorations, ill-fitting prostheses, overfilled or underfilled root canals, broken files within canals or inadequate attention to underlying medical problems. Harm resulting from failure to diagnose, delay in diagnosis, rendering a misdiagnosis or an inappropriate prescription of medications may be less evident, but some obvious errors, such as the extraction of a wrong tooth, may result in legal actions.

Establishing a tracking system for adverse outcomes will help to identify categories and discern patterns of errors. This methodology will reveal problem areas and will allow for the creation of performance standards. Furthermore, after trends are identified, it will be possible to institute more efficient courses of action to prevent mistakes from reoccurring.

This kind of undertaking is complex and problematic. Errors may not result in adverse events, and adverse events may not be caused by a practitioner’s errors. Even more problematic is the ability to differentiate between adverse events caused by lack of skills as opposed to mistakes. Apart from the more apparent errors, how often do we recognize adverse events, or admit to ourselves that they may have taken place as a consequence of our own actions? Yet, we need to acknowledge that adverse events inevitably occur, and we need to address this problem before other professional organizations or associations, review boards or government agencies do it for us.

Defining adverse events, while possible, may be cumbersome. Establishing standards from evidence-based analysis may provide a framework and a starting point. Yet, the uniqueness of each individual patient challenges the concept of generalizing expected outcomes. Affirming responsibility for our own actions, disclosing errors to patients, the specter of legal liability, compliance with reporting requirements and even financial liabilities are only a few of many issues that need to be addressed.

An intrinsic motivation to perform better already exists within our profession. Continuing education and lifelong learning are integral parts of our professional lives. We have to appreciate that true knowledge is not only what we know, but also a realization of what we don’t know. Acknowledging fallibility, rather than infallibility, as the norm is a good place to start.

Ethical and moral principles direct our professional interactions with patients and are the basis for the dentist-patient relationship. Human errors cannot be avoided. How we recognize and rectify these errors will define us as professionals. The time has come for an unbiased self-exploration of mistakes and adverse events in the dental setting.