Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 30, 2019
Date Accepted: Feb 3, 2020
Date Submitted to PubMed: Feb 10, 2020
Non-expert online reports may enhance expert knowledge about causes of deaths in dental offices available from scientific publications: Qualitative and quantitative content analysis and search engine analysis
ABSTRACT
Background:
Fatalities occur rarely in dental offices. Implications for clinicians may be deducted from internet reports and scientific publications about deaths in dental offices.
Objective:
Data involving deaths in dental facilities were analyzed using Google as well as the PubMed database. Comparing both sources, it is examined how internet data may enhance knowledge about deaths in dental offices obtainable from scientific medical publications and which causes of death are published online.
Methods:
To retrieve relevant information Google was country specifically searched for deaths in the dental practice using keywords "death at the dentist", "death in dental practice" and "dying at the dentist". For PubMed keywords: "dentistry and mortality", "death and dental treatment", "dentistry and fatal outcome" and "death and dentistry" were searched. Deaths associated with dental treatment in a dental facility, an attributable cause of death and documented age of the deceased were included. Deaths occurring in maxillofacial surgery or pre-existing diseases involved in the death (e.g. cancer, abscess) were excluded. 128 cases from online publications and 71 deaths from PubMed meeting inclusion criteria were analyzed using Chi-Square statistics after exclusion of duplicates.
Results:
The comparison between the fatalities in internet publications (n=117) and in PubMed (n=71) revealed that online more casualities affecting minors appeared than in the PubMed listed literature (online: 68, PubMed: 20, P <.001). In PubMed ten fatalities with an age exceeding 70 years are described, online sources published five (P=.02). Most deaths, both in internet publications and PubMed literature, could be assigned to the category Anesthesia/Medication/Sedation (online: 80, PubMed: 25, P <.001). Deaths assigned to the categories Infection and Cardiovascular system appear more often in the PubMed literature (Infection online: 10, PubMed: 15, P=.01, Cardiovascular system online: 5, PubMed: 15, P<.001). Furthermore, in a larger proportion sedative drugs were involved in fatal incidents listed online compared to PubMed (after excluding duplicates: online: 41, PubMed: 14, P=.03). In the US (n=44), more deaths occurred under sedation compared to the other countries (Germany/Austria n=1 P=.002, United Kingdom n=1 P=.006).
Conclusions:
Online and PubMed databases may increase awareness of life-threatening risks for patients during dental treatment. Aspects of anesthesia and sedation as well as deaths of young patients are underestimated when only reviewing PubMed listed literature. Patient medical history, medication dosages and vital function monitoring are significant issues for practitioners. Underestimation of risks when performing sedation and even general anesthesia is a high impact finding especially extractable from online reports. Detailed knowledge of ”deep sedation“ and ”general anesthesia“ definitions is of major concern.
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