Adverse Events - Reporting

How to report adverse events in orthodontics

The BOS is undertaking a study of Adverse Events in Orthodontics. The form here gives an indication of the information being sought. To download the form as a Word document for submission to BOS click here

BRITISH ORTHODONTIC SOCIETY

CONFIDENTIAL

ADVERSE EVENTS IN ORTHODONTICS

YELLOW CARD REPORTING SCHEME

If you are suspicious that an adverse event has occurred relating to orthodontic treatment please complete this Yellow card. Don’t be put off if some details are not known. * denotes mandatory field.

PATIENT DETAILS
	Patient Identifier (Your Practice / Hosp Ref No. or Initials) *
	Sex *	Male Female
	Age (At time of event) *
	ADVERSE EVENT (Please describe the event(s) and any treatment given): *
Please indicate by marking a box below the category of adverse event that occurred
	TISSUE DAMAGE - INTRA ORAL	Demineralisation - white spot, frank caries Severe root resorption Pulpitis Irreversible hard tissue damage - enamel Damage to teeth with previous trauma Periodontal disease Soft tissue - operative trauma Soft tissue - chemical damage Soft tissue - allergy, cytotoxicity Soft tissue infection Extraction of incorrect tooth
	SYSTEMIC EFFECTS	Skin allergy, cytotoxicity Bacterial endocarditis Cross infection Radiation
	TISSUE DAMAGE - EXTRA ORAL	Eye damage - headgear Eye damage - operative instrument Eye damage - arch wire splinters Ingested or inhaled foreign body Skin damage Facial profile compromised Temporomandibular joint problem
	OTHER REACTION *	Yes No
	Do you consider the event to be serious *	Yes No
	If yes, please indicate why the event is considered to be serious (please tick all that apply):	Patient died Involved hospitalisation Life threathing Caused disability or incapacity Caused loss of tooth/teeth May caused loss of tooth/teeth in future
REPORTER DETAILS
	Specialist Orthodontist Trainee Orthodontist GDP Dental Nurse/Hygienist
	Name and Professional Address *
	Post Code *
	Tel No. *
	Signature *
	Date *