Marking the skin for oral surgical procedures: improving the WHO checklist

We present a system for marking the skin during oral surgical operations. This system identifies teeth to be extracted or exposed under general anaesthesia. Removal of the wrong tooth can cause appreciable morbidity and leaves the surgeon and organisation liable for litigation and scrutiny by regulatory bodies. A recent review of claims to the NHS litigation authority between 1995 and 2010 showed that in the field of oral and maxillofacial surgery, dentoalveolar surgery resulted in the largest number of claims for negligence, of which removal of the wrong tooth was one of the most common. In 2010/2011 the National Reporting and Learning System (NRLS) of the National Patient Safety Agency (NPSA) were notified of 20 incidents when the wrong tooth had been extracted, which accounted for 5% of all incidents reported. We have therefore developed a robust marking system for oral surgical procedures in our hospital, which improves on the World Health Organisation (WHO) checklist. We have audited patients' perceptions and the clinical application of our marking system, and have shown that the system is welcomed by patients, and is simple and effective for clinicians to use.