Patient Harm From Orthodontic Care (Part II): Incident Analysis of Contributory Factors and Perceived Avoidability of Harm.

Abstract

Background: Patient safety, defined as the absence of avoidable harm, in orthodontics is still in its early stages of development. Knowledge on the subject is limited.

Aim: (1) To conduct an incident analysis, (2) to measure avoidability, (3) to investigate the relationship between contributory factors and perceived avoidability of harm from orthodontic care, and (4) to suggest methods to mitigate potential patient harm incidents.

Materials and methods: Data were retrospectively collected from consecutively filed orthodontic-related claims from the Danish Dental Compensation Association (DDCA) and included all approved-for-compensation claims from September 2019 to August 2024. Reason for filing the claim, harm category, and harm-causing events were recorded. Incident analysis was conducted for each claim based on the Eindhoven criteria and AI-assisted qualitative analysis. A large language model was used to identify and interpret the interplay between the contributory factors. Perceived avoidability of harm was based on a 6-point rating system.

Results: A total of 125 claims of approved patient harm were included and reviewed. Based on the Eindhoven incident analysis, the most frequent root causes were human related factors (monitoring, verification and clinical knowledge among others) followed by organizational factors (management priorities, protocols and workplace culture), illustrating complex interrelationships. The majority of claims (70.1%, n = 82) were avoidable harm, being rated as either probably avoidable in more than 50% of cases, high certainty of avoidability, or completely avoidable. While low-avoidability harm events were characterized by few contributory factors, high-avoidability cases were characterized by the involvement of numerous human and organizational failures.

Conclusion: The analysis of 125 compensated orthodontic harm cases showed that 70.1% of the cases were deemed avoidable and most harms were multifactorial in nature, with human and organizational contributors playing the primary role. This multifactorial pattern provides new insights and forms a foundation for future patient-safety initiatives in orthodontic practice and research.