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Welcome to the Dental Patient Safety Foundation SAFETY REPORTS. Please feel free to browse and share these reports. Cases are categorized and labelled by year and month of publication followed by a short title. Reports involving anesthesia are labelled with an “A”, when they involve anesthesia (local only, minimal, moderate or deep sedation by any route). Cases not involving anesthesia (wrongful tooth extraction, inadvertent patient injury, myocardial infarction, etc.) will not have the “A” label.

Levels of reporting can include Safety Alerts, Case Reports, Advisories, or Best Practice Recommendations. DPSF Welcomes all feedback and can be contacted HERE.




 Case 2022.10A: Pediatric Ventilatory Trouble or Obstruction.pdf


 Case 2022.2A: Medication Dosing Errors,


 Case 2021.9A: Life Threatening Complications
can occur during/after moderate
sedation TOO!.pdf


 Case 2021.4: Use of a Contaminated Needle
for Local Anesthesia.pdf


 Case 2019.4A Nalbuphine Induced Opioid


 Case 2018.8A Delayed Awakening.pdf

 Case 2018.3A Unmonitored Recovery.pdf

 Case 2018.2A Lost Airway.pdf

 Case 2018.1A Crossed O2-N2O Gas Lines.pdf

 Case 2017.12A Patient Fire.pdf




 Case 2023.4: History Taking Error.pdf

 Case 2021.7: Iatrogenic Subcutaneous


 Case 2020.4: Flawed EMR: Accept/Resolve
Error/Shame ASAP.pdf


 Case 2018.3 Red Flags of Syncope.pdf

 Case 2017.12 Wrong Site Surgery.pdf

 Case 2019.2 Epinephrine and β Blockers.pdf


Dental Patient Safety Foundation
16011 S. 108th Ave.
Orland Park, IL 60467

Tel: (708) 403-8880
Fax: (708) 460-7919


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