Dental News - Misadventures in endodontics: Turning a negative into a positive

Dr. Gary Glassman

Fri. 24. September 2021

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As a specialist, I have seen a significant portion of my patients present after endodontic treatment has failed or was abandoned mid-treatment owing to an unforeseen complication. Throughout my career, I have experienced my fair share of my own failed treatments, and I have witnessed the distress these situations can cause my colleagues. I certainly know they have caused me many a sleepless night.

Among dentists, perfectionism is common. Many of us have strived for excellence our entire lives, so when mistakes happen—and they inevitably do—we become like an ostrich and bury our heads in the proverbial sand, hoping the problem just goes away. Choosing not to dwell on failures ensures that they will continue to happen, and making this choice means the loss of what parents love to call a “teachable moment”.

Businesses work tirelessly to anticipate mistakes and outright failures in the hope that they can avoid problems and, when errors do occur, learn how to do better in the future. Dr Abraham Wald, a Hungarian mathematician, took survivorship bias into consideration during World War II when calculating how to minimise the loss of bombers. When planes riddled with bullet holes made it back, the first thought was to reinforce the planes where they noticed the shrapnel had done the most damage. Wald thought otherwise. He rightly stated that these planes returned safely despite the damage, so it was best to reinforce planes in between these “most-hit” areas, as that was where the planes that had not returned had been fatally damaged. It is crucial, therefore, that we share our failures with an open mind and enthusiasm as we do our successes, so that we may all learn how to serve our patients even better. Imagine an Instagram page devoted to failed treatments! It may be difficult to post but, oh, the learning that could be had!

Owing to the nature of our work, information sharing does not happen as often as it should. Clinicians in hospitals are mandated to share their errors in morbidity and mortality conferences to ensure that, to the best of their ability, these errors never happen again. Dentists often work in isolation, toiling away in their own clinics without the benefit of regular interactions with their colleagues in a “safe space” where ego is removed from the equation in order to ensure the best in patient care. I am lucky to be a part of a large network of clinicians with dedicated support teams who regularly host study clubs to openly discuss failures so that we may objectively dissect the treatment into its component parts to attempt to find the source of the problem.

We need to reframe the lens through which we view failure. Mistakes are painful, but from defeat, with a focus on education and mutual collegial support, we can learn more and do better.

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