Diagnosis Errors in Oral Surgery: What Should We Learn from This Medical Error?

Medical errors could happen anywhere and anytime in the health care system: In hospitals, clinics, doctors’ offices, pharmacies, and patients’ homes. Scientific literature indicates that such problems widely involve medicines, lack of current scientific evidence regarding treatment, diagnosis, equipment, or lab reports. Medical errors leading to adverse events can occur in dental practice, and especially in oral surgery. The purpose of this paper is to bring out one aspect of errors in oral surgery: diagnostic errors or failures. This subject is rarely discussed in the world of dentistry with lack of references about it in medical literature. The authors report five clinical cases that were wrongly diagnosed either due to omission of careful preoperative examination, or due to a clinical experience’s deficiency.


Introduction
Medical errors could happen anywhere and anytime in the health care system: In hospitals, clinics, doctors' offices, pharmacies, and patients' homes. Scientific literature indicates that such problems widely involve medicines, lack of current scientific evidence regarding treatment, diagnosis, equipment, or lab reports.
Medical errors leading to adverse events can occur in dental practice, and especially in oral surgery. The purpose of this paper is to bring out one aspect of errors in oral surgery: diagnostic errors or failures. This subject is rarely discussed in the world of dentistry with lack of references about it in medical literature. The authors report five clinical cases that were wrongly diagnosed either due to omission of careful preoperative examination, or due to a clinical experience's deficiency.

Case 1
Medically compromised patient: A 60-year-old man referred to our department because of postoperative continuous bleeding after dental extraction of two lower incisors in general private practice.
The hemorrhage did not stop for 24 hours (Figure 1). Examination of the patient found that he has mechanical valves and under anticoagulants therapy, with a severely advanced periodontitis. The first dentist did not consider these elements in the management of the patient; the latter confirmed to us that the dentist performed the extractions without preoperative medical check-up. We deduce from the case that preoperative examination of patients can avoid practitioners to harm patients by medical errors related to a misdiagnosis of their health and oral conditions, which will respect ethical, legal, and risk-management considerations. defined, ulcero-proliferative lesion could be visualized ( Figure   2A). He presented also two left submandibular lymph nodes that was palpable. Orthopantomogram showed a maxillary left posterior bone lysis ( Figure 2B). Incisional biopsy revealed a welldifferentiated squamous cell carcinoma. In this case, we notice that the wrong first diagnosis had delayed his management. The first dentist had not provided any effort to make a complete diagnosis, which was clearly related to insufficient knowledge about oral pathology.

Case 3
The third case is about a young patient whose reason for consultation was the persistence of a left facial swelling for two months with a severe trismus ( Figure 3A). He reported that he

Case 4
Another misdiagnosed case related to a wrong approach of clinical examination: the patient consulted a dentist because of appearance of an ulcerative cutaneous sinus tract in her left submandibular area ( Figure 4A). Ignoring to make a correct diagnosis of her condition, he sent her to a dermatologist since the lesion was in her skin. The dermatologist prescribed only topic medication without any good improvement. The patient was referred to our department. Orthopantomogram showed a presence of radiopaque lesion in the left molar mandibular region ( Figure 4B). Biopsy of the lesion had concluded a suppurative osteomyelitis, which was the principal etiology of the cutaneous sinus tract.

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Discussion and Conclusion
Diagnosis forms the key to treatment planning, which is important to initiate the appropriate management at the right time.
A diagnosis could be erroneous when the practitioner has lacked vigilance. Habit, routine, lack of involvement on the part of the practitioner; or on the contrary; a strong pressure from the patient, are a common factor that conduct the therapist to make the wrong diagnosis. In oral surgery and pathology, the conditions most often Theoretical knowledge and clinical experience too matter in