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Healthcare risk assessment

Dentistry and Oral Health Care Risk Assessment: Infection, Treatment Safety and Records Controls

A worked example of how a general dental practice identifies, scores and controls risks to patient safety, infection control, consent, records, equipment and staffing, with owners, warning indicators and review triggers.

Updated November 2026 8 hazards assessed Review every 6 months Highest risk: High to Medium
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Executive summary

This assessment shows how a general dental practice can find, rate and control the risks that matter most to patients and staff. Eight risks were chosen because they are plausible in everyday dental work, record keeping and clinic management. Cross-infection, wrong-site treatment and medicine reactions carry the highest inherent scores because harm can be serious. Each risk is scored before controls and again after existing and added controls. Most risks fall to Medium or Low once added controls are in place, but sterilization and site checks stay High until the checks are routinely recorded. The first actions are a sterilization log review, a read-back at the chair, a medicines check on the day of treatment and a written emergency sequence. The practice is a teaching example, so every score illustrates method, not a real clinic.

Focus area
Dentistry and oral health care
Setting
General dental practice delivering routine and restorative oral care in an outpatient clinic
Method
Five by five likelihood and impact risk register

Scope

This assessment covers a general dental practice providing examinations, cleaning, restorations, extractions and referrals, from booking and consent through treatment, recording, sterilization and follow-up. It covers risks to patients, staff, equipment, records and the practice. Jurisdiction, licensing rules, practice size and systems are assumptions made for teaching and must be checked against local requirements by a qualified reviewer.

Context

The practice has two dentists, a dental hygienist, two dental nurses, a practice manager and a reception team. Treatment takes place in surgery rooms with dental chairs, suction, compressed air, hand pieces and an X-ray unit. Instruments are cleaned and sterilized in a central decontamination area. Patient records, radiographs and payment details are held in a practice management system with some paper consent forms. Each risk is scored before controls to show its natural level, then again after existing and added controls.

Objectives, assets and stakeholders

The objective is to provide safe, effective and respectful oral care, protect patients and staff from harm and infection, keep accurate and private records, and meet professional and regulatory duties. The assets in scope are patients, the dental team, surgery equipment, sterilization facilities, clinical records, radiographs and payment data. Stakeholders include patients and their families, the dental team, the principal dentist, contractors who service equipment, referring doctors and the regulator. Clear roles matter: every risk has one owner role, and the principal dentist reviews the register with the practice manager each quarter.

Risk matrix: before and after controls

Each cell shows hazard numbers placed by likelihood and impact. Compare the two grids to see how controls move each hazard.

Before controls

Inherent risk

Risk before controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely Likelihood 4, impact 3, score 12, high: H05 Likelihood 4, impact 4, score 16, high: H01
3 Possible Likelihood 3, impact 4, score 12, high: H04 H07 Likelihood 3, impact 5, score 15, high: H02 H03
2 Unlikely Likelihood 2, impact 4, score 8, medium: H06 Likelihood 2, impact 5, score 10, high: H08
1 Rare

After controls

Residual risk

Risk after controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely
3 Possible
2 Unlikely Likelihood 2, impact 2, score 4, low: H06 Likelihood 2, impact 3, score 6, medium: H01 H02 H04 H05 H07 Likelihood 2, impact 4, score 8, medium: H03
1 Rare Likelihood 1, impact 4, score 4, low: H08
  • Low 1 to 4
  • Medium 5 to 9
  • High 10 to 16
  • Critical 17 to 25

Hazard register

A summary first, then the detail for each hazard.

Summary of hazards with scores before and after controls
No.HazardBeforeAfterOwner
H01 Cross-infection from inadequate instrument reprocessing 16 High 6 Medium Decontamination lead
H02 Wrong tooth, wrong site or wrong procedure 15 High 6 Medium Principal dentist
H03 Adverse reaction to local anaesthetic or medicines 15 High 8 Medium Clinical lead for medicines
H04 Consent and treatment information gaps 12 High 6 Medium Clinical governance lead
H05 Clinical record and radiograph privacy or accuracy failure 12 High 6 Medium Information governance lead
H06 Failure of chair, suction, compressor or X-ray equipment 8 Medium 4 Low Practice manager
H07 Staffing shortfall, competence gaps and poor handover 12 High 6 Medium Practice manager
H08 Medical emergency with delayed recognition or response 10 High 4 Low Clinical lead for emergencies
H01

Cross-infection from inadequate instrument reprocessing

Safety Before 16 After 6

Instruments are not cleaned, packed, sterilized or stored correctly, or handpieces are not maintained, so bacteria and viruses can pass between patients and to staff.

Who or what is affected: Patients, dental team and visitors

Causes

Rushed turnover between patients, worn instruments and unclear ownership of cleaning steps.

Consequences

Infection in patients or staff, treatment delay, regulatory action and loss of patient trust.

Existing controls

  • Instruments are cleaned and sterilized after every patient in a validated cycle.
  • Sterilizer printouts are filed for each load.

Control gaps

Load records are checked only at audit, so a failed cycle can go unnoticed for weeks.

Additional controls

  • Prevent: Use a written single-direction flow from dirty to clean areas with a fixed sequence for each step.
  • Detect: Run weekly biological indicator tests and review any failed or missing load records within one day.
Likelihood 4 x impact 4 before; 2 x 3 after Owner: Decontamination lead Target: Within 30 days Early warning: Any failed biological indicator or sterilizer load without a complete record.
H02

Wrong tooth, wrong site or wrong procedure

Safety Before 15 After 6

A treatment is carried out on the wrong tooth, surface or side, or a planned procedure is changed without updating the record, causing harm and the need for correction.

Who or what is affected: Patients and treating dentist

Causes

Similar-looking teeth, fast changes of plan and interruptions during treatment.

Consequences

Unnecessary tooth loss, pain, repeat treatment, complaints and possible claims.

Existing controls

  • A charted tooth diagram is completed before each treatment plan.
  • The dentist confirms the tooth number with the patient before starting.

Control gaps

The read-back step is skipped when the list is busy, and changes are not always charted.

Additional controls

  • Prevent: Use a written site check at the chair, with the nurse reading the plan back to the dentist before any cut.
  • Respond: Stop treatment, inform the patient and record the event at once when a site error is suspected.
Likelihood 3 x impact 5 before; 2 x 3 after Owner: Principal dentist Target: Within 30 days Early warning: A treatment plan changed at the chair without a matching update in the record.
H03

Adverse reaction to local anaesthetic or medicines

Safety Before 15 After 8

A patient reacts badly to a local anaesthetic, analgesic, antibiotic or sedative because of an unknown allergy, an interaction or an overdose, leading to pain, swelling or a serious reaction.

Who or what is affected: Patients, especially those with heart, liver, kidney or allergy conditions

Causes

Incomplete history, outdated records, unfamiliar medicines and multiple drugs prescribed by others.

Consequences

Allergic reaction, toxicity, emergency transfer and serious harm.

Existing controls

  • Medical history is taken and updated at each visit.
  • Drug doses are calculated from a written dose chart.

Control gaps

The history is not re-checked when a patient returns after a long gap or a new prescription.

Additional controls

  • Prevent: Check current medicines and allergies on the day of treatment and record the dose and weight before injection.
  • Respond: Keep an emergency kit and a written reaction protocol that every team member can follow without delay.
Likelihood 3 x impact 5 before; 2 x 4 after Owner: Clinical lead for medicines Target: Within 30 days Early warning: A patient history with a missing allergy field or a medicine that is not on the current list.
H04

Consent and treatment information gaps

Legal and compliance Before 12 After 6

Patients agree to treatment without understanding the options, risks, costs or alternatives, or consent is recorded late, unclear or not renewed when the plan changes.

Who or what is affected: Patients, guardians and the treating team

Causes

Time pressure, language barriers, complex plans and changes made during treatment.

Consequences

Complaints, disputes, refunds and regulatory concern about valid consent.

Existing controls

  • A written consent form is used for each planned course of treatment.
  • Costs are given in writing before work begins.

Control gaps

Consent is re-confirmed only for major changes, so smaller changes can go unrecorded.

Additional controls

  • Prevent: Use a standard script to explain options, risks and costs, with a space on the form for questions and answers.
  • Detect: Audit a sample of records each quarter to confirm consent was signed before the first treatment step.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Clinical governance lead Target: Within 60 days Early warning: A treatment step recorded before the matching consent form is signed.
H05

Clinical record and radiograph privacy or accuracy failure

Technology and data Before 12 After 6

Records are incomplete, altered, shared with the wrong person or left visible, and radiographs are filed under the wrong patient, which harms care and breaches confidentiality.

Who or what is affected: Patients, the dental team and any future clinician

Causes

Shared screens, busy reception desks, manual filing and staff who share logins.

Consequences

Wrong treatment, a privacy breach, loss of trust and enforcement action.

Existing controls

  • Each user signs in with an individual password.
  • Records are backed up each night.

Control gaps

Access logs are kept but are not reviewed, and screens can be seen from the waiting area.

Additional controls

  • Prevent: Confirm two identifiers before opening a record, retrieving an image or sending any clinical letter.
  • Detect: Review access logs monthly and check that each image is linked to the correct patient identifier.
Likelihood 4 x impact 3 before; 2 x 3 after Owner: Information governance lead Target: Within 30 days Early warning: Access log entries that show a record opened by a user with no matching appointment.
H06

Failure of chair, suction, compressor or X-ray equipment

Operational Before 8 After 4

Essential equipment fails during a procedure or imaging session, interrupting care, exposing patients to longer treatment and causing unsafe radiation dose or loss of suction.

Who or what is affected: Patients, dental team and maintenance contractors

Causes

Ageing equipment, missed servicing and power interruptions.

Consequences

Treatment delay, longer sedation or anaesthesia, extra radiation and cancelled appointments.

Existing controls

  • A service contract covers the X-ray unit and compressor.
  • Staff run a short check of suction and lights before the first patient.

Control gaps

Daily checks are not written down, so a fault that starts gradually is missed.

Additional controls

  • Prevent: Keep a planned maintenance log with due dates and the name of the engineer for each item.
  • Recover: Keep a backup suction unit and a plan to move patients to a second surgery if equipment fails.
Likelihood 2 x impact 4 before; 2 x 2 after Owner: Practice manager Target: Within 60 days Early warning: A maintenance item overdue or a repeated fault logged for the same equipment.
H07

Staffing shortfall, competence gaps and poor handover

People Before 12 After 6

Absence, untrained cover or unclear handover between clinicians means that tasks are missed, procedures are carried out by someone without current competence, or follow-up is not passed on.

Who or what is affected: Patients, dental nurses and covering clinicians

Causes

Short notice absence, rota pressure, training gaps and busy handovers.

Consequences

Missed follow-up, unsafe procedures, staff stress and complaints.

Existing controls

  • Each role has a written job description and a training record.
  • A handover sheet is used at the end of each day.

Control gaps

Competence records are not checked against the list of planned procedures each week.

Additional controls

  • Prevent: Assign competence sign-off for each procedure and do not allow untrained cover for sedation or surgical tasks.
  • Respond: Use a named cover list and stop any list that cannot be staffed to the agreed standard.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Practice manager Target: Within 60 days Early warning: A planned procedure with no competence-checked member of staff on the rota.
H08

Medical emergency with delayed recognition or response

Safety Before 10 After 4

A patient collapses, has a fit, breathes with difficulty or reacts to a medicine, and the team is slow to recognize the signs, lacks equipment or does not call emergency help in time.

Who or what is affected: Patients, the dental team and bystanders

Causes

Rare events, infrequent practice, expired medicines and unclear roles.

Consequences

Serious harm or death, legal action and damage to the practice reputation.

Existing controls

  • Emergency drills are held and recorded each year.
  • Oxygen and an emergency kit are kept in each surgery.

Control gaps

Drills are not repeated for new staff, and kit checks are not signed.

Additional controls

  • Prevent: Check the emergency kit and oxygen supply at the start of each session and record the result.
  • Respond: Follow a posted emergency sequence and call emergency help early, with one person named to lead.
Likelihood 2 x impact 5 before; 1 x 4 after Owner: Clinical lead for emergencies Target: Within 30 days Early warning: An emergency kit item that is expired or missing at a routine check.

Rating method and evaluation

Each risk is rated on two five-point scales. Likelihood runs from Rare to Almost certain, and impact runs from Insignificant to Catastrophic. Multiplying the two gives a score from 1 to 25, which falls into one of four bands: Low from 1 to 4, Medium from 5 to 9, High from 10 to 16 and Critical from 17 to 25. The score guides the order of work and is not a measurement. Inherent risk is the score before any controls. Residual risk is the score after the existing and added controls. Impact is judged on physical harm, distress, time to correct, effect on care and harm to trust, and a clinical risk is never rated down only because it has not yet happened. Anything Critical or High needs senior attention and a dated plan. Anything Medium needs routine controls with a named owner, and anything Low is accepted and watched. Team members should challenge the ratings at each review, and any risk is re-scored whenever an indicator reaches its threshold or an incident occurs.

Likelihood, impact and rating bands

Likelihood

  • 5 Almost certain: Expected to happen in most circumstances.
  • 4 Likely: Will probably happen in many circumstances.
  • 3 Possible: Could happen at some time.
  • 2 Unlikely: Not expected, but it could happen.
  • 1 Rare: Only in exceptional circumstances.

Impact

  • 1 Insignificant: No lasting effect. Handled within routine work.
  • 2 Minor: Small effect that is quickly corrected.
  • 3 Moderate: Noticeable effect that needs managed effort to correct.
  • 4 Major: Serious effect on people, delivery or reputation.
  • 5 Catastrophic: Severe or lasting effect that threatens the whole activity.

Bands (likelihood x impact)

  • Low (1 to 4): Accept and monitor.
  • Medium (5 to 9): Manage with routine controls.
  • High (10 to 16): Senior attention and a treatment plan.
  • Critical (17 to 25): Act first. Do not proceed until reduced.

Monitoring, escalation and review

Review this assessment every 6 months, and sooner when an indicator below reaches its threshold.

Early-warning indicators and escalation thresholds
Indicator to watchEscalate when
Failed biological indicator or sterilizer load with an incomplete record.Escalate to the decontamination lead at once and stop use of the affected instruments until cleared. Escalate to the principal dentist if not resolved within one day.
Treatment plan changed at the chair without a matching record update.Escalate to the principal dentist at the end of the session. Review the case within a week and record any patient follow-up needed.
Medicine given without a current allergy and medicines check on the day.Escalate to the clinical lead for medicines at once, and to the principal dentist if any reaction is seen.
Access log showing a record opened with no matching appointment.Escalate to the information governance lead within one working day. Suspend the user account until the reason is confirmed.
Maintenance item overdue or a repeated fault on the same equipment.Escalate to the practice manager when an item is overdue, and to the principal dentist if equipment is unavailable for a planned session.

Contingency arrangements

If a serious event occurs, such as a patient reaction, a wrong-site error, a sterilizer failure or a records breach, the treating dentist stops the treatment and gives immediate care. The practice manager secures the area, keeps the affected records and informs the principal dentist. Emergency help is called as the protocol requires. Patients and families are told what happened early and plainly, and affected staff receive support. The information governance lead and regulator contacts are made as required in the relevant jurisdiction. Equipment is replaced from the backup stock, and affected lists are moved to a second surgery or rebooked.

Prioritized action plan

  1. Review sterilization logs weekly and act on any failed indicator within one day, owner decontamination lead, within 30 days.
  2. Introduce a read-back at the chair before any cut and record every change of plan, owner principal dentist, within 30 days.
  3. Check medicines and allergies on the day of treatment and keep the emergency kit signed, owner clinical lead for medicines, within 30 days.
  4. Restrict screen access, use two identifiers and review access logs monthly, owner information governance lead, within 30 days.
  5. Set a maintenance calendar and a competence check for each planned procedure, owner practice manager, within 60 days.

Conclusion

Safe dental care depends on steady habits: confirming the patient and site, checking medicines and allergies, keeping consent and records complete, sterilizing and logging every load, and maintaining equipment on schedule. The highest scores sit with infection, wrong-site treatment and medicine reactions, and each has actions that bring the residual score down. Treat the register as a living record, review it on the stated cycle, and seek qualified clinical, legal and privacy advice for any real patient or regulatory question.

Assumptions and limitations

Assumptions

  • The practice is a general dental service with clinical governance led by a principal dentist.
  • Staff are registered and trained for their roles, and equipment is serviced under a maintenance plan.
  • Jurisdiction and regulator are not specified, so legal duties are described in general terms only.

Limitations

  • The scores are examples for learning and do not describe any real practice, patient or incident.
  • Clinical, infection control and privacy requirements differ by location and change over time, so specialist review is needed.
  • This is educational content and does not replace a formal site-specific assessment or licensed clinical advice.

Related frameworks to study

  • Clinical governance cycle with audit and feedback
  • Hierarchy of controls
  • Three lines model of risk ownership

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For Learning Reference Only: This assessment demonstrates how risk assessment principles are applied in a practical setting, providing a useful reference for learning and understanding. Actual assessments may be adapted to suit specific site conditions and circumstances.

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