Patient Harm From Orthodontic Care (Part I): Types and Frequency of Patient-Reported Harms From a National Database

Patient safety is a fundamental prerequisite for high-quality healthcare and central to clinical practice, including orthodontics. Despite the widespread emphasis on safety in healthcare delivery, knowledge specific to patient safety in orthodontics remains limited.

(1) To analyse the reasons why patients file claims for compensation related to orthodontic care, (2) to summarise the events that lead to patient harm, and (3) to describe the types of harms associated with the provision of orthodontic care.

Data from the Danish Dental Compensation Association (DDCA), a national compensation scheme established by law, were retrospectively extracted from the electronic database and included all patient-reported claims between June 2017 and August 2024 related to orthodontic care.

A total of 644 patient-reported orthodontic-related claims were reviewed. Of these claims, 196 (30.4%) were recognized as patient harm and led to compensation. Orthodontic treatment was the most frequently reported source of harm (51.5%, n = 101), followed by delayed diagnosis (24.5%, n = 48) and retention-related complications (9.2%, n = 18). Among the 196 approved claims, the most common harm was apical root resorption leading to tooth loss (14.8%, n = 29), followed by gingival or soft-tissue injury (13.3%, n = 26), worsening of occlusion after treatment (9.2%, n = 18), and other harm such as diagnostic delays causing tooth damage (8.2%, n = 16).

Harm events can occur at any stage during the orthodontic treatment process, including the diagnostic and planning stage. Orthodontic harm mostly occurs in the active phase of treatment and is frequently a result of root resorption, soft tissue damage, and worsening of the occlusion. There is a discrepancy in patient-perceived harms and actual harm events that lead to compensation. This study highlights the importance of thorough risk assessment, optimal diagnostics and planning, clinical vigilance throughout treatment, and clear communication regarding potential side effects and patient concerns, particularly where perceptions of harm and compensability diverge.