What we do?

It is a dentist’s worst fear: an instrument breaks inside a patient’s mouth during a procedure. What do you do? Well, don’t panic.

Let’s talk about needle breakage.

During a mandibles block, the 27 gauge long needle breaks inside the patient’s mouth. While maintaining your composure, you must inform the patient of what has occurred and try to reassure the patient that everything will be fine. Unless the needle is sticking out of the tissue so that you can remove it with a hemostat, you’re best to contact an oral and maxillofacial surgeon to have the patient seen immediately.

Avoid phrases such as “Oh no, I broke the needle!” or any other comments that would indicate you did something wrong. If the patient is visibly upset, you might even want to drive the individual to the oral surgeon’s office most oral surgeons are skilled in dealing with this situation and will be able to successfully remove the broken needle. It is also advisable to keep the hub of the needle in case the situation turns into a lawsuit.

Another broken instrument scenario is a root canal file separating during an endodontic procedure.

You must always inform the patient and document it in your records. It is also recommended that you take an X-ray of the tooth to verify the location of the file within the root canal. On rare occasions, the file may separate beyond the apex of the tooth which would necessitate an immediate referral. However, most of the time a root canal file will remain within the root canal. Depending on the condition of the tooth and where the file separated, it may be within the standard of care to monitor the tooth. Other times, it may be necessary to attempt to remove the file.

If a general dentist is performing treatment and the file separates, he or she may want to consider referring the patient to an endodontist. Once again, try to reassure the patient that you will make every effort either to try to retrieve the separated file or to refer the patient to a specialist to see if the file can be removed or bypassed. From my experience, most lawsuits result from the dentist or endodontist failing to inform the patient of the separated file and they later learn about it from a subsequent treater.

What happens when a dental bur or an elevator breaks inside the patient’s mouth?

Obviously, check the oral cavity and try to retrieve the broken instrument with pliers or suction. If you can’t locate the broken instrument, check the trap of the suction to see if it was suctioned up by the dental assistant. If you still are unable to locate the broken instrument then take an X-ray of the area of the mouth that you were working on to see if it is in the soft tissue. If you suspect that the patient might have aspirated it, send the patient for a chest X-ray.
As with the other broken instrument scenarios, you must always inform the patient of the situation and document it in their records. Staying calm and reassuring the patient will go a long way to keeping the situation from becoming chaotic.

Keep in mind that many malpractice policies have what is called a “Medical Payment Provision” which reimburses the patient for bills for medical or dental treatment to correct the problem. Any payment made to the patient under this provision is typically not reportable to the Data Bank. Furthermore, if you have to send the patient to the hospital for a chest X-ray, for example, I recommend that you talk to the patient about paying the hospital bill (either personally or through your Medical Payment Provision).

Payment of a bill is not an admission of liability. If a patient feels that he or she has to foot the medical or dental bill then it may create an environment for a patient to sue.

Remember, if an instrument breaks, stay calm, inform the patient, document the incident, and, if necessary, refer the patient to another healthcare provider to retrieve the broken instrument.

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