Good dental risk management can prevent or minimize some malpractice claims and provide a better defense for the others. There are a number of clinical techniques that can be used to minimize the chance that an object will be ingested or aspirated during treatment.
Rubber dam arguably the best preventive device; however, it is not always possible or practical to use
Pharyngeal gauze block
High velocity evacuator to remove tooth and restoration fragments
Dental floss tied to rubber dam clamps and other small instruments; tied around bridges
More upright chair position
Modified patient head position turn the patients head toward the side of treatment, allowing objects or debris to fall onto the buccal mucosa or into the buccal vestibule
Other preventive steps include good patient communication and proper staff training.
Warn patients that temporary crowns can loosen and unseat.
Provide written home care instructions to patients who have received a temporary crown.
Develop an action plan to respond to in-office swallowed and aspirated object incidents and train your staff on its implementation. A recent Journal of the American Dental Association (JADA) article proposes an office protocol. See JADA, May 2014
Train all office personnel in basic life support, including the Heimlich maneuver.
If you do run into a problem, remember to contact your malpractice insurance agent in a timely manner to report the swallowed or aspirated object incident.
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