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Learning from clinical data on the subject of safety in dentistry is still in its early stages and current evidence does not provide epidemiological estimates on adverse events (AEs) associated with dental care. The aim of this dental practice study was to quantify and describe the nature and severity of harm experienced in association with dental care, and to assess for disparities in the prevalence of AEs.

Fatigue has been explored by other healthcare professions for many years and is acknowledged as a potential risk factor for incidents of unintended harm as well as for the wellbeing of the healthcare team. As dentistry is a profession and service that has a central focus of patient safety, it could be perceived as irresponsible not to consider fatigue in risk strategies.

This report sets out information on the current delivery of NHS dentistry services and the development and progress of the plan for 2024-25. It looks at: access to NHS dentistry before the plan development of the 2024 dental recovery plan the government’s progress against the dental recovery plan’s objectives and plans for evaluation. It concludes that the dental recovery plan aspires to deliver more than an additional 1.5 million courses of treatment in 2024-25 but is not currently on course to do so. Even if these additional courses of treatment are delivered by the end of 2024-25, the plan would still mean that 2.6 million fewer courses of treatment would have been delivered than in 2018-19.

People experiencing homelessness, looked after children and vulnerable migrants are among those groups being supported by initiatives to improve access to dental services for underserved communities in Yorkshire and Humber. Following publication of the paper “Inclusion Health: applying all our health”, which calls on health and care professionals to take action to reduce healthcare inequalities, local stakeholders identified a number of opportunities for targeted interventions to improve access, experience and outcomes for socially excluded and vulnerable groups known to have high dental needs in the area.

The impact of the pandemic on dental services was devastating. While the data is showing that the situation has improved since the first year of the pandemic, there is much more work to be done - particularly to improve the provision of care across England. The government has announced a plan to make dental services faster, simpler and fairer. It aims to improve dental services by making them: faster for patients through our new patient premium to support dentists to take on new patients and a new marketing campaign to help everyone who needs one to find a dentist simpler for patients and for dental staff by streamlining and tackling bureaucracy, with a wider set of workforce reforms to maximise the skills across the entire dental clinical team fairer, particularly for our rural and coastal communities, by introducing new dental vans to bring dental care to our most isolated communities, offering ‘golden hello’ incentives to encourage dentists into under-served areas and supporting those practices with the lowest rates of payment for their work The plan has 3 components. In 2024, we will significantly expand access so that everyone who needs to see a dentist will be able to. This will begin with measures to ensure those who have been unable to access care in the past 2 years will be able to do so - by offering a significant incentive to dentists to deliver this valuable NHS care. We are introducing mobile dental vans to take dentists and surgeries to isolated under-served communities. We will launch ‘Smile for Life’ - a major new focus on prevention and good oral health in young children, to be delivered via nurseries and other settings providing Start for Life services, and promoted by Family Hubs. We will also introduce dental outreach to primary schools in under-served areas, and take forward a consultation on expanding fluoridation of water to the north-east of England - a highly effective public health measure. We will ramp up the level of dental provision in the medium and longer term by supporting and developing the whole dental workforce, increasing workforce capacity as we have committed to do in the NHS Long Term Workforce Plan, reducing bureaucracy and setting the trajectory for longer-term reforms of the NHS dental contract.

The Royal College of Surgeons of Edinburgh launched a series of blogs in recognition of the World Patient Safety Day (WPSD) 2024 theme of "Improving Diagnosis for Patient Safety". RCSEd World Patient Safety Day 2024 A Novel Facial Cellulitis Pathway: Improving the Time to Surgery for Facial Necrotising Fasciitis Improving Diagnosis for Safety in Dentistry Using Audit to Improve Outcomes for Patients with Upper Tract Urothelial Cancer Diagnostic Safety in Surgery WHO World Patient Safety Day 2024: Improving Diagnosis for Patient Safety The Importance of Teamwork for Surgical Diagnostic Safety in Outpatients Challenges in the Diagnosis of Twin Silent Killers: Aortic Aneurysm and Acute Aortic Dissection Improving Diagnostic Safety in Orthopaedics NCEPOD: Prioritising Diagnostic Safety for Better Health Outcomes Protecting our Precious Gift of Life World Patient Safety Day 2024 — A View from the Bridge Can My Stool be Tested for Bowel Cancer? Virtual Diagnostics The Potential of AI to Help Reduce Diagnostic Errors Non-Technical Skills for Surgeons (NOTSS). Vignette 3 of 3. Leadership in Surgery: A Case Study Non-Technical Skills for Surgeons (NOTSS). Vignette 2 of 3. Team Communication: The Key to Clarity and Precisio Non-Technical Skills for Surgeons (NOTSS). Vignette 1 of 3. Situation Awareness: Staying Ahead of Potential Issues Enhancing Diagnostic Safety in Surgery Through Non-Technical Skills Diagnosing Acute Aortic Dissection – The Patient Perspective

Primary care – general practice, community pharmacy, optometry and dental services – delivers 90% of NHS interactions, face to face, by phone or online. The Primary care patient safety strategy describes the national and local commitments to improve patient safety in primary care, supporting all areas in this sector to fully implement the NHS Patient Safety Strategy. This strategy has three core areas of focus: Developing a supportive, learning environment and just culture in primary care, with sharing across the system so that the services can continually improve. Ensuring that the safety and wellbeing of patients and staff is central, and that our approach to managing safety is systematic and based on safety science and systems thinking. Involving patients in the identification and co-design of primary care patient safety ambitions, opportunities and improvements. This strategy seeks to continuously improve patient safety through existing processes and structures as much as possible, rather than adding work. The timeframes for the implementation of the local commitments are intentionally flexible to allow for the piloting of different approaches, and, while this strategy is for all areas of primary care, some improvements will be implemented first in general practice and the successes and learning then used in the rollout to community pharmacy, optometry and dental services. In summary: Safety culture: participate in the NHS staff survey. Safety systems: complete patient safety syllabus training. Insight: register for and use the new incident recording (LFPSE) and incident response (PSIRF) systems. Involvement: identify patient safety leads and lay patient safety partners. Improvement: review and test patient safety improvements in diagnosis, medication, referrals, optometry and dental services.

In this anonymous blog, a patient shares their experience of orthodontic treatment which they undertook to reduce overcrowding of their teeth. However, instead of solving the problem, the treatment caused multiple, complex dental issues that have resulted in severe pain and a high financial cost. The patient talks about how their orthodontist has been unwilling to take any responsibility for the issues caused, threatening legal action if the patient pursues any claims against them. They also discuss the reluctance of other orthodontists to get involved in trying to treat the issues they now face, and call for regulators and governments to look into the issue of negligent orthodontic treatment. I underwent an orthodontic treatment that unfortunately turned into a complete nightmare. My motivation for pursuing this treatment was to address overcrowding in my teeth so as to reduce the risk of decay due to overlapping. An orthodontist assured me that it would be a straightforward treatment and that it would last approximately two years. As a result I decided to move forward with the treatment, which consisted of fixed braces. Throughout the treatment, I diligently attended all scheduled appointments, trusting in the orthodontist's expertise. The orthodontist did not raise any concerns regarding the progress even though after 2.5 years, it became evident that the treatment was far from completion, and my teeth appeared worse than when I started the treatment. I started to get concerned about the treatment but the orthodontist assured me that the treatment would be finalised within a few months. As the treatment progressed, I was chipping my upper front teeth with the brackets on my lower front teeth and the orthodontist added posterior bite stoppers to my molars. I was getting concerned about my bite (occlusion) and was asking the orthodontist about this and about the stoppers. However, despite expressing my concerns to the orthodontist multiple times, I was dismissed as a perfectionist, and my worries were brushed aside. The orthodontist insisted that any potential remaining imperfections in my bite would be resolved through selective grinding after removing the braces and bite stoppers. After enduring four years of treatment, the braces and bite stoppers were finally removed. To my surprise, I realised that I was only biting on some of my front teeth and that I had no contact in my back teeth. I immediately raised this issue with the orthodontist, but was advised to wait for my bite to settle naturally. I also voiced concerns about the visibility of the rough surface of my teeth, but once again, I was told that it would resolve on its own. However, my bite felt extremely uncomfortable with every passing second and this discomfort did not subside—I couldn't chew properly and I soon realised that it was not a matter of simply adjusting to a new bite. As a result, I sought a second opinion from another dental specialist. In the meantime, after a few weeks of biting on my front teeth, I also started to experience pain in two of my front teeth which continued to increase to the point that I was literally crying in pain. The dental specialist suggested removing the high spot on my front teeth as this could lead to damage, but they advised me to go back to the original orthodontist who did the treatment as they did not want to intervene in the matter. Upon trying to do so, the original orthodontist declined to address the issue or to even see me and advised me to communicate only through a lawyer. Despite numerous attempts to find resolution through additional dental appointments, I continued to suffer from pain and discomfort in my front teeth due to the unresolved high spot, since all the biting forces were being placed on just two front teeth. Eventually, another orthodontist and several other dentists tried to reduce this high spot by shaving from my front teeth, which slightly reduced the extreme pain. However, my front two teeth had already endured significant trauma from bearing the brunt of the bite pressure for an extended period and as a consequence, I continue to experience persistent pain in my front teeth to this day. The original orthodontist and the clinic refused to provide my treatment notes and records, and instead presented a report that shifted blame for the unfavourable outcome onto me. Eventually, through legal channels, I acquired my treatment notes and records. The orthodontist provided photos of my post treatment clay models that depicted contact points on my back teeth which I did not possess. This discrepancy was subsequently corroborated by another orthodontist, revealing that the original orthodontist had manipulated the clay models' contact points to create a false impression that I was biting on all my teeth. Furthermore, after shaving to reduce the high spot on my front two teeth as explained above, a thorough occlusion checkup and several 3D scans confirmed that I was left with only two pairs of contact in my teeth and that I had a bilateral posterior open bite. The majority of the dental specialists I visited in the same country refused to treat me with another orthodontic treatment, and advised me to go back to be treated by the previous orthodontist. Eventually, I had to travel to a different country to assess if my issue could be truly fixed and to assess if any damage had been done to my teeth. Unfortunately, things turned out to be worse than anticipated since further examinations and scans by specialists abroad revealed that I had severe root resorption especially in my upper front tooth, permanent enamel damage on all teeth caused during incorrect bracket removal, and bone loss due to incorrect the orthodontic movements and techniques that had been used. Some teeth were also improperly positioned in the bone, including some teeth with roots pointing outwards. I also got confirmation that the original orthodontist managed both my vertical and horizontal dimensions incorrectly through bad use of bite stoppers which pushed my molars into my gums (intrusion) and bad anchorage management respectively. It is very concerning that the orthodontist was so negligent and/or incompetent that even after I repeatedly expressed my concerns during the treatment, they still failed to identify and address several mistakes that were being made. Unfortunately, this had a cascading effect on my dental health, leading to root resorption, bone loss, incorrect tooth torque and several other effects. Furthermore, the fact that the same orthodontist has shown a complete lack of accountability and refused to take any responsibility, gaslit me and assured me to wait for my bite and roughness (the latter turned out to be permanent enamel damage) to settle is also very alarming behaviour. The selective grinding that I was advised about during the treatment also turned out not to be a solution for the extent of malocclusion I was left with. Moreover, the fact that I was left to bite solely on my front teeth for months once the braces and bite stoppers were removed led to more trauma and damage to the affected teeth. The experience of enduring trauma and its aftermath becomes even more distressing when victims find themselves subjected to gaslighting not only from their initial orthodontists, but also by other dental specialists within the same country. Such instances involve attempting to conceal the severity of the issues faced by the patients so as to avoid entanglement in legal matters, rather than prioritising the best interests of the patient, as outlined in their professional oath. Moreover, seeking an orthodontist willing to provide expert testimony in legal proceedings poses an additional challenge to the victims. All of this further exacerbates the already challenging journey of those enduring such a trauma, adding another layer of complexity to the ordeal. The impact of this ordeal has extended far beyond my dental health, affecting various aspects of my life, including my physical wellbeing, my career and my personal relationships. My ability to chew food and enjoy a normal diet has been severely compromised and I cannot even enjoy a pizza, amongst several other foods. I have already had a year and a half of my life literally taken away from me. The extensive time and effort I spent researching orthodontic solutions, seeking someone that could help me, and advocating for my own health has also only added to the distress caused by the initial treatment. In an attempt to regain some functionality, I now find myself facing the prospect of undergoing another one to two years of orthodontic treatment with the added concern of potential tooth damage or loss due to the damage that has already been done by the previous treatment. Unfortunately, orthodontists still cannot guarantee that contact will be achieved since a posterior open bite should ideally be fixed with braces, however, I have to resort to Invisalign treatment as it seems to be the only viable option considering the trauma and root resorption that prohibits me from using traditional braces on my front teeth due to the forces. The process is far from straightforward, and the cost involved to "fix" all the issues that had been created by the original orthodontist runs into tens of thousands of euros. What should have been a 1.5-2 year treatment has now become a prolonged and distressing 7-8 year nightmare. The original orthodontist turned down requests to settle the damages and has even raised the threat of legal action against me should I choose to pursue further claims regarding the damages I have suffered. Patients place their trust and well-being in the hands of medical experts, and negligent treatment can lead to significant physical and emotional distress. I felt compelled to share my story, hoping to raise awareness about the importance of compassionate and responsible care within the dental field. I would like to seek acknowledgment of the seriousness of this matter and urge authorities to consider the potential consequences of such negligence and/or incompetence and this situation calls for measures to prevent similar distressing and traumatic incidents in the future.