3. Mr A complains that a dentist at the Practice tried to remove one of his teeth in May 2021 without adequate pain relief and did not acknowledge he was in pain.
4. Mr A tells us he is still in pain and has not been able to find another dentist to assist him.
5. He wants an apology, specifically acknowledging the failings.
6. In May 2021, Mr A attended the last of four root canal treatments, complaining of pain, and said he did not feel the root canal treatments were working. The dentist agreed to a tooth extraction but failed to extract the whole tooth. Mr A says the dentist ignored him when he said he was in pain.
7. The Practice received a complaint from Mr A that stated he was still in pain and so an appointment was made to attempt further treatment.
8. Given his previous experience, Mr A cancelled the appointment shortly before it was due to start as he did not feel they could be of any further help.
Pain relief
12. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.
13. The GDC; Standards for the Dental Team says: ‘You must manage a patient’s dental pain and anxiety appropriately’ (section 1.2.4). ‘You must discuss treatment options with patients and listen carefully to what they say’ (section 1.1.1). ‘You should take patients preferences into account and be sensitive to their individual needs and values’ (section 1.2.2)
14. On three occasions, in emails between 6 and 13 April 2021, Mr A explicitly requested his tooth be removed, in place of ongoing root canal treatment. The clinical records document a discussion between Mr A and the dentist, in which the dentist advises against the extraction. They warn Mr A of complications associated with the procedure, such as excess bleeding and the possibility they would not be able to complete the extraction. This is evidence the dentist took Mr A’s preferences into account, in line with the GDC standards. The records say that a surgical referral may be required if the extraction failed, and this had been discussed with Mr A before the procedure took place.
15. The records show Mr A became flustered in the appointment and was offered a glucose drink. He confirmed he was happy to proceed with the extraction. This indicates the dentist has managed Mr A’s anxiety appropriately, in line with the GDC standards.
16. The clinical records show that Mr A received an injection of local anaesthetic, Articaine. This is designed to directly numb the area. Mr A was given one cartridge of 2.2 serum, which is 88mg. Doses are calculated based on the average adult weighing a minimum of 70kg. The manufacturers provide guidelines on the maximum anaesthetic a person should receive. There is no minimum dose. The guidelines state that the lowest dose of Articaine, leading to effective anaesthesia, should be used. Our Dental Adviser said the starting dose of anaesthetic given was in line with the manufacturer’s guidance. Because pain is unique to each patient, effective pain management relies on communication between the patient and dentist, rather than on calculating formulae.
17. We have different accounts of what happened in the management of Mr A’s pain. Mr A says the dentist did not use enough anaesthetic, did not acknowledge that he was in pain and carried on with the extraction regardless. The Practice says Mr A did not give any indications he was in pain during the extraction. It says this was confirmed by another dentist and a dental nurse. There is no record of pain expressed during the extraction. In the absence of anything additional being recorded in the records, we do not know whether the dentist communicated with Mr A about his pain.
18. The records do show the dentist provided Mr A with additional care and was attentive when Mr A became flustered. But we do not know whether this was due to discomfort or anxiety about the procedure. The dentist paused the procedure until Mr A gave consent to continue. This is in line with GDC guidance which says dentists must make sure the patient’s consent remains valid at each stage of investigation or treatment.
19. In early June 2021 the dentist called Mr A to discuss what he wanted to do following the failed extraction and agreed to stay late to see him. This suggests the dentist wanted to assist Mr A with his dental problems. The records show Mr A cancelled the appointment 12 minutes before it was due to start, saying he no longer wanted to be seen and would seek another dentist.
20. In summary, the evidence we have seen suggests that, overall, the Practice followed relevant guidelines in discussing and documenting the treatment options and risks with Mr A and respecting his wishes. It also shows the Practice provided an appropriate starting dose of anaesthetic, managed Mr A’s stress after the injection, and attempted to provide further treatment when the extraction was unsuccessful.
21. We do not know what happened in the communication about Mr A’s pain levels. Nothing is documented in the clinical records, and we have different accounts from Mr A and the Practice. We recognise it would have been distressing if Mr A expressed he was in pain and felt he was not listened to. Unfortunately, there is no further evidence available that would help us reach a confident view on whether the dentist did anything wrong here. Because of that we have decided not to conduct a detailed investigation.
1. We have carefully considered Mr A’s complaint about a dental practice in the Bedfordshire area (the Practice). We can appreciate that the pain Mr A has suffered has been very difficult to endure. A detailed investigation would not provide a satisfactory conclusion for any involved party and so we have decided not to proceed further with his complaint.
2. To reach our decision we reviewed the information provided by the Practice together with the information Mr A provided in writing and over the telephone. We also sought clinical advice.