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DU ISSN 0305-5000
Salutary lessons
‘The first requirement of a hospital is that it should do no harm’
Florence Nightingale, 1820–1910
FJ Trevor Burke
Readers will note that this issue of Dental Update contains three articles which
deviate to some degree from the normal clinical fare that is Dental Update, but, on
reflection, they don’t, insofar as the papers discussing the so-called Francis Report
are central to UK’s clinicians' understanding of how they should treat patients. The
articles will also provide a legal backdrop to all that we do in our practices.
The statement attributed to Florence Nightingale may readily be adapted to
the dental surgery and recent issues of Dental Update contain salutary lessons for dental
professionals. For example, in the early days of dental implants, there was widespread expectation
that these would provide long-lasting treatment solutions, with 100% success rates. We now
know that this is a long way from the truth, with the work of Simonis and colleagues indicating
that 65% of implants (with their associated crowns) survive for 16 years,1 perhaps a salutary lesson
in the dental field. In addition, the term peri-implant disease has only come into dental speak in
recent years, with the article by Warreth and colleagues in the last issue providing an in-depth
review of this problem2 and indicating that, in some studies, 40% of implants were affected. The
lesson is obvious – in most circumstances, keep teeth going for as long as possible!
Salutary lessons arrive from time to time. The restoration for toothwear that failed
(unexpectedly) when I thought that I had done everything right, but had obviously not examined
the extreme lateral occlusal excursions, the resin-retained bridge in which I had not achieved
sufficient resistance form to protect the bond. We work in a difficult environment, with saliva
and blood as potential contaminants, and patients who don’t really want to be in our chairs.
However, it is how we deal with the failures, and learn from the salutary lessons (to do more
thorough occlusal analysis and a wrap around preparation for the resin retainers in the cases that
I mentioned above), that matters. That is what the Francis Reports are all about. How we deal
with the gangster treatments in which a vast amount of sound tooth substance is destroyed in
the name of appearance is a different matter, given that the clinician who is carrying out such
treatment (it is still going on – I saw a case yesterday!) has a total lack of insight and has probably
never heard of the Francis Report.
I recently read a book entitled Complications – A Surgeon’s Notes on an Imperfect
Science.3 In this, the author, Atul Gawande, describes a variety of mis-diagnoses and failed
operations. What is particularly relevant to us is the M&M (the Morbidity and Mortality
Conference), which takes place, once per week, in the hospital in which he is a surgeon.
All surgeons are expected to attend this meeting, which is held behind closed doors. In it,
the mistakes, untoward events and deaths that have occurred over the week are reviewed
and discussions follow regarding what to do differently next time, with ‘nothing’ being an
unacceptable answer. Of course, some of the presentations are awkward. The author adds that
‘unlike the courts or the media, human error is not something that can be deterred by punishment’. In
one’s practice, for M&M, substitute the practice meeting, in which the good points and bad points
of how patients’ clinical problems and/or complaints have been dealt with, noting the lessons and
auditing whether changes or improvements have been instituted. However, for the provider of
the gangster treatment, punishment might, alas, be the only option.
I am sure that readers, having read the articles on the Francis Report, will see their
relevance to the dental surgery. Another three short articles on the subject will follow in the next issue.
References
The Dental Faculty of the Royal College of Physicians
and Surgeons of Glasgow offers its Fellows and Members
Dental Update as an exclusive membership benefit.
1. Simonis P, Dufour T, Tenenbaum H. Long-term implant survival and success: a 10–16-year follow-up
of non-submerged dental implants. Clin Oral Impl Res 2010; 21: 772–777.
2. Warreth A, Boggs S, Ibieyou N, El-Helali R, Hwang S. Peri-implant diseases: an overview. Dent Update
2015; 42: 166–184.
3. Gawande A. Complications. A Surgeon’s Notes on an Imperfect Science. New York: Picador, 2002.
All articles published in Dental Update are subject to review by specialist referees in the appropriate dental disciplines.
April 2015
DentalUpdate 205