Uncovering diagnostic errors in dentistry through critical incident reports: a mixed-methods analysis

Diagnostic errors and near misses threaten patient safety in dental practice. In Sindh, the service delivery standards require documentation and review of critical incidents, supporting incident reporting as a platform for ensuring patient safety. This study aimed to describe incident patterns using critical incident reports, a structured patient safety reporting mechanism used to document adverse events, near misses, and diagnostic process failures in clinical practice.

A sequential mixed-methods study reviewed 300 de-identified incident reports from Karachi from January to June 2024. Associations with urgency were assessed using chi-square or Fisher’s exact tests and logistic regression analysis. Reflexive thematic analysis of narrative fields was supplemented by face-to-face interviews with 20 selected reporters.

Incidents were classified as urgent in 173/300 (57.7%) cases, and corrective action was required in 289/300 (96.3%) cases. Recurrence was most commonly coded as 20–40% (148/300, 49.3%). The most frequently coded diagnostic domains were pulp diseases (87/300, 29.0%), periodontal ligament diseases (85/300, 28.3%), and temporomandibular joint disorders (80/300, 26.7%). The leading contributing factors were a lack of diagnostic resources (142/300, 47.3%), lack of postgraduate training (119/300, 39.7%), and gaps in undergraduate teaching (103/300, 34.3%). Recurrence category showed the strongest association with urgency (p < 0.001). In multivariable logistic regression, urgent classification was less likely in private clinics (aOR 0.16, p = 0.013) and among male reporters (aOR 0.37, p < 0.001) and more likely in reports filed by senior faculty (aOR 2.48, p = 0.025); the 20–29 patients/week group also had higher adjusted odds of urgency (aOR 2.26, p = 0.023). Qualitative themes highlighted incomplete assessments, limited access to and interpretation of imaging, gaps in supervision and referral pathways, and communication failures.

The registry demonstrates recurrent, high-urgency patterns linked to resource and training constraints and supports structured critical incident reporting as a practical tool for teaching triage, escalation, and safer diagnostic workflows for safer and more effective dental care.

Not applicable.