A dental practice in the Shropshire area

Incorrect care and treatment

4. Mr A complains about incorrect care and treatment from a dentist on 11 June and 23 August 2018. He says:

• during treatment on 11 June 2018 for an infection in an upper left premolar (UL5), the dentist removed the tooth instead of trying to save it • on 23 August 2018 the dentist filed a different tooth (UL6) too far.

5. Mr A says as a result he experienced ongoing pain with his UL6 and it needed to be removed. He says the tooth would not attach to the permanent bridge he was given and he lost the attachment. He also says he lost one of his front teeth because of the treatment. He explains he paid £,1045 for private treatment to put things right. He says these events made him lose confidence.

Complaints meeting

6. Mr A complains that during a meeting with Practice staff on 15 October 2021, he was shown X-Rays that were not his. He said the Practice used these to suggest he had received treatment somewhere else which had caused the pain. He said the Practice also told him his teeth were bad.

7. He says this meeting left him feeling confused, low, and frustrated. He says the Practice made him feel his teeth were bad and this was causing the pain, not its treatment.

Delayed referral

8. Mr A complains there was a delay in the Practice doing a referral for extraction (removal) of his UL6 as a priority.

9. He says it was stressful to wait for the referral to be made and there was a delay to the extraction.

10. Mr A would like financial compensation of £1,045 to cover the money he spent on private treatment to correct the problems. He would like the Practice to accept what it got wrong, and apologise for how he has been affected and made to feel during the meeting on 15 October 2021.

11. On 2 May 2018 Mr A went to the Practice. It did an X-Ray and diagnosed him with an infection in his tooth (UL5). The Practice discussed that the tooth was unlikely to recover due to chronic gum disease and infection. On 11 June the Practice removed the UL5. On 14 June the Practice diagnosed a dry socket (a painful condition that can happen after a tooth is removed) and prescribed antibiotics.

12. On 5 July the Practice prepared a temporary bridge, which was fitted on 19 July. On 23 August the Practice smoothed down two teeth (UL4 and UL6) to hold the permanent bridge which was fitted on 6 September. On 10 January 2019 the permanent bridge was lost, and the UL6 had broken at gum level needing removal. The Practice put a temporary filling on the remaining tooth, and a referral for extraction was organised. On 26 September the tooth was removed.

13. Mr A met with the Practice on 15 October 2021 to talk about his complaint. Mr A and the Practice have different accounts of the meeting. We will discuss these accounts when explaining our decision.

14. The Practice was unsure if it could remove the tooth completely, so it organised a referral to a hospital on 10 January 2019. Mr A said the hospital asked him for a priority referral from the Practice. Mr A is unsure of the dates he requested this referral and chased it up, but he believes he asked about it three or four times between January and September. He says the Practice said it only did priority referrals for people with cancer.

Incorrect care and treatment and delayed referral

17. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Mr A to understand the reasons why he did not bring his complaint to us sooner. We have also considered the time the Practice took to reply to his complaint.

18. Mr A said he realised his dental treatment was bad in January 2019. This means he would need to bring his complaint to us by January 2020 to meet the time limit. Mr A brought the complaint to us in March 2022, meaning his complaint is over two years out of time.

19. Mr A said he knew the referral was delayed back in January to September 2019. Mr A needed to come to us about this issue in 2020. He complained to us in 2022, meaning it is over two years out of time.

20. Mr A first raised concerns with the Practice on 11 October 2021 and had a meeting with the Practice on 15 October. Mr A made his first formal complaint to the Practice on 17 January 2022. He got responses on 9 and 16 February.

21. It took the Practice four months to deal with Mr A’s concerns. This is in line with NHS Complaint Handling regulations. We do recognise there is some delay here which was outside Mr A’s control.

22. Mr A told us why he did not complain to us sooner.

23. Firstly, he said the delay in complaining about care and treatment was due to a delay in the Practice referring him for a tooth extraction in the hospital. While he may not have realised all the issues until the tooth was removed on 26 September 2019, he was unhappy with his treatment in January 2019. Even if we were to say 26 September 2019 is the date Mr A knew there was a problem, his complaint to us would still be two years out of date.

24. Therefore, we view any referral delay to have had no impact on Mr A’s ability to complain to us. We are not setting aside our time limit for this reason.

25. Secondly, Mr A said the COVID-19 pandemic caused a delay. He said he needed an advocate to help him complain to the Practice and then to us. He said he reached out to an advocate around late 2021. He said during the pandemic advocates had not been offering face to face appointments, which he needed.

26. The pandemic started in March 2020. To meet our time limit, Mr A would have needed to come to us before the pandemic began.

27. We think Mr A would still have had enough time (at least five months) to refer his complaint to us before the pandemic started. In any case, we do not accept the pandemic in general as a reason for delay. Therefore, we do not consider this a reason to set aside our time limit.

28. Thirdly, Mr A also explained he has experienced poor mental health since before 2018 and continues to. He gets support within the community for this. He said he experiences this on and off, and during some periods he does not feel like being around or talking to anyone and wants to be alone.

29. While we accept and in no way minimise Mr A’s experience of poor mental health, we do not see good reason to put our time limit to one side. This is because Mr A said his poor mental health had been on and off over this period, and it has not significantly improved in the past year. As Mr A was able to reach out to an advocate and complain to us in March 2022, we think he would also have been able to do this at some point before 2020.

30. Having looked at these factors we see no good reason to set aside the time limit in this case. There is a long gap where Mr A could have complained to us but did not. Had Mr A complained to us quickly when realising there was an issue, we may have been able to investigate the complaint.

31. During a conversation with Mr A he explained he himself was concerned this complaint could now be out of time. We hope he understands the reasons for our decision.

Complaints meeting

32. We need to balance the evidence we have fairly and consider all information available, to make sure our decisions are impartial and based on evidence. We have two different versions of what happened in the complaints meeting on 15 October 2021. Mr A, a Practice partner, and a dental nurse were at the meeting.

33. Mr A says he was told he had a screw in his jaw from treatment at another practice. He says he was told this was causing his pain and the Practice showed him X-Rays of a screw to support this. Mr A remembers the Practice pointing to the screw in the X-Ray and saying, ‘We didn’t do that to you’. Mr A said he has not had dental treatment anywhere else before this for 25 years and has no memory of a screw or implant being done. Mr A also said the Practice told him his teeth were bad and made him feel it was his fault he was having pain.

34. The Practice said it showed Mr A X-Rays to explain other treatment options that were available. It said it showed general photos of implant treatment, to explain what is involved. The Practice apologised if this was not explained in as much detail as Mr A would have liked, and for any misunderstanding that might have happened.

35. The Practice said it now uses tooth models to avoid confusion. The Practice also said that during the meeting, Mr A said he felt his teeth were crumbling. It said staff explained tooth decay can be caused by several factors.

36. We cannot say which account is correct because we do not have any other evidence, such as an audio recording or video of the meeting, to prove which account is accurate.

37. We sympathise with Mr A’s experience of the meeting and how it has affected him. As we were not there we cannot say what was discussed and how clear this was.There is no other available evidence to help us reach a decision. For this reason, we are not investigating this issue further.

38. We understand Mr A may be disappointed with our decision and we are sorry for any distress this causes. We must be impartial and honest in explaining our decision. We hope Mr A understands the reasons for our decision and we thank him for bringing his complaint to us.

1. We have carefully considered Mr A’s complaint about a dental practice in the Shropshire area (the Practice). We realise how important his complaint is to him. We recognise this has been a difficult time for him and we are sorry to hear about the impact this has had on him.

2. We are not taking further action on Mr A’s complaint about incorrect care and treatment and the delayed referral, as these issues fall outside of our time limit. We have also decided to take no further action on the complaint about the complaints meeting with the Practice, as there is not enough available evidence for us to reach a decision. We will explain the reasons for our decision in detail below.

3. We understand our decision may be disappointing. We are sorry that we cannot help further.