How a faucet of blood after a simple extraction changed my approach to surgery for the better
Dr. Stacey Gividen recounts a personal experience where a simple 11-second tooth extraction transformed into a 30-minute we-can't-stop-the-bleeding crisis. She explains how she took what she learned from that scenario, implemented positive changes into her patient consent forms for surgery, and improved her practice's protocol.
Editor's note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
A simple new-patient exam. All paperwork reviewed. Nothing extraordinary marked or written down. However, after asking the patient a question with the intent to know her better, she randomly said, "OH YEAH, I HAVE A BLEEDING DISORDER."
"Really?" I said to her. "Mrs. Jones, this is very important information in the event you should ever need any kind of surgery. Please remember to disclose that in the future on any consent forms you fill out."
I wrote down everything in the progress notes. I added a note to obtain an INR with the potential to refer to an oral surgeon. My hygienist also mentioned it when she did the cleaning.
As things turned out, the patient did need a tooth extraction, and that’s where things got interesting.
Time went by.
The patient called and stated that the tooth planned for an extraction was bothering her. She was appointed for a simple removal of a carious, periodontally involved No. 30. Easy, right? Blood pressure was taken, consent form reviewed and signed, a little pre-op chitchat, I delivered some local, and we were a go!
That tooth came out in probably 11 seconds or less, but my time with the patient for the next 30 minutes was anything but glorious.
When I removed the tooth, it was as if a faucet of blood was turned on. At that point I remembered that this was the patient with the bleeding disorder. Not only that, but I had talked to her about referring her out for surgery or, at the very least, getting an INR checked so I could properly manage any complications. Somehow, through it all, that got missed by everyone from the front desk, to the assistant, to—yes, of course—even me. I absolutely take full responsibility, plain and simple.
After finally getting the bleeding under control (which was an absolute nightmare), the patient was on her merry way.
I sat at my desk afterward in a daze.
I was relieved that I had been able to manage the situation and bring it to a satisfactory outcome, but I was utterly frustrated with myself for not catching the issue and being more diligent in my care. What if I hadn’t been able to stop the bleeding? What then?
There were two things I could do: (1) come up with a lot of excuses as to why the scenario happened and offer a cowardly attempt to save face in front of my staff, or (2) create a positive learning experience for everyone so that this type of problem wouldn’t happen again. I chose number two.
I backtracked the entire scenario and realized that my consent forms for tooth extractions listed the risks and complications for removing a tooth, informed the patient of alternative treatment options (if there were any), and subsequently gave us permission to remove the tooth. That was it. Missing were the reminders that helped my front desk staff, assistants, and me to cross-check ourselves while appointing and prepping the patient for surgery.
These are some of the items our checklist was missing:
⬛️ Osteoporosis meds
⬛️ Blood thinners/bleeding disorders
⬛️ Last INR and reading
⬛️ Blood pressure
⬛️ Other health issues or surgery restrictions
Up until this incident there haven’t really been any major issues in our office, but it only takes one scare to make you realize that your status quo needs improvement. We have amended our consent forms to include checklists for those important reminders, and since those simple changes have been implemented, things have gone much more smoothly. Our patients appreciate the extra care we give, we’ve reduced the risk of surgical complications, and our treatment outcomes have been more predictable.
I realize that some of you who are reading this may be thinking all those coulda, woulda, shoulda thoughts. I get that. The reason I'm drawing attention to this error is because considering all of the procedures we do day in, day out, it's amazing that things go as smoothly in our practices as they do. We are all human and in medicine, things are never black and white.
I’m sure we have all had experiences that have set us back a little and made us think, What the hell just happened? So, in those situations, what did you do to resolve the problem? How did your staff react? Were further modifications needed? Let's hear your stories, friends, because I know I’m not the only one who has had a hand-to-forehead moment in the dental office.
Cheers,
Stacey L. Gividen, DDS
Editorial Director, Breakthrough Clinical
LAST MONTH >> I made my mom cry in the dental chair, and I couldn't have been happier!
Editor's note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
For more articles about clinical dentistry, click here.
Stacey L. Gividen, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Gividen is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, Breakthrough Clinical,and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Gividen can be reached at [email protected].For the most current dental headlines, click here.
