Poorly managed or persistent pain is one of the most common reasons for patient complaints and resultant litigation. It is imperative that the treating clinician seeks appropriate support in managing the complex issue of chronic orofacial pain.

This website is provided with exactly that role... To support patients and clinicians in the prevention and management of chronic orofacial pain.

Do dentists have a requirement to report all incidents under The Care Quality Commission (Registration) Regulations 2009 (SI 2009 3112)? 

Dentists are "registered persons" for the purposes of the Regulations (see regulation 2, sections 8 and 10 of the Health and Social Care Act 2008 and Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010).

By virtue of regulation 18 therefore dentists are required to report an incident to the CQC without delay if it occurs when carrying out dental treatment or as a result of dental treatment.

However the incidents that must be reported are limited. They are listed in paragraph (2) of regulation 18.

(2)(a) an injury to a service user (i.e. a dental patient) must be reported if, in the reasonable opinion of a health care professional (i.e. a doctor, dentist, pharmacist etc), it has resulted in one of the outcomes listed at (i) to (iv). If there is no such reasonable opinion then there is no need to report an incident. There is no requirement for a speculative report on the basis that an injury to a patient during dental treatment might or could lead to one of the outcomes listed at (i) to (iv).

The outcomes listed at (i) to (iv) are themselves limited and would not appear to cover all injuries that might be suffered as a result of dental procedures under local anaesthesia. Only outcomes (i) and (iv) provide for any element of reasonable speculation as to future health status outcomes. The outcomes which would lead to a report are:

(i) an impairment to sensory, motor or intellectual functions, which is not likely to be temporary. [Paragraph (g) explains this to mean an impairment which has lasted or is likely to last for a continuous period of at least 28 days. Again, the question is not whether such impairment could last for 28 days, but whether in the dentist's or doctors' reasonable opinion it is likely];

(ii) changes to the structure of the dental patient's body. [This phrase is not explained, but similar legislation in other areas requires reports to CQC of serious injuries];

(iii) the patient experiencing prolonged pain or psychological harm [again, explained at (g) as meaning a period of at least 28 days]

(iv) the shortening of life expectancy.

You also refer to one third of the 5,300 annual events being non-temporary and to the difficulty you see in this when the regulation also calls for incidents to be reported "without delay". You ask whether all incidents should not be reported. The answer to this must be no and that the legislation does not envisage all injuries being reportable.

The legislation is interested only in reporting very serious outcomes when a dentist is of the reasonable opinion that the outcome is attributable to an injury suffered as a result of the dental procedure. However, the serious outcome has to have occurred and as noted, the legislation does not require speculative reports.

Non- temporary events are reportable if sufficiently serious. In practice many incidents resulting in outcomes (i), (ii), (iv) and sometimes (iii) will not be reportable until sometime after the dental procedure.

Once a dentist (or doctor etc) has formed the reasonable opinion as to one of the outcomes then (but not before then) the obligation to report to CQC without delay applies. 

In effect therefore, serious outcomes only need be reported to CQC by a dentist once there is some certainty as to that seriousness and longevity of the outcome. However, once an outcome is serious (in the criteria of regulation 18), then any further delay in reporting is not allowed.

It should be added that there are other mechanisms to call to account a dentist who injured a patient, or who otherwise caused a long term detriment to health. Only regulation 18 has been considered for present purposes.