A dental practice in the Bexley area

3. Mrs O complains the Practice refused to provide her with a new extended bridge for her teeth between June and October 2022. She says the Practice said the only option to fix her pain was tooth extraction (removal) and a denture.

4. Mrs O also complains the dentures she was fitted with in October were not fit for purpose and kept falling out. She complains the Practice will not fit new dentures as part of the last course of NHS treatment she paid for.

5. Mrs O says she feels humiliated and embarrassed in front of other people when she speaks, has difficulty talking and now has a lisp. She says she has difficulty eating and finds it easier to eat without the dentures, but that is not possible when she is with other people.

6. She says the experience left her feeling stressed and isolated. She explains she experienced pain while waiting for treatment and felt forced into agreeing to the dentures because of the level of pain she was in.

7. Mrs O would like an apology and a financial payment to pay for implants privately. She would also like a new denture to be provided for free on the NHS.

8. Mrs O has had many dental problems over a number of years. She has had root canal treatment on several teeth and root amputation surgery (removing a root to save a tooth). At the time of this complaint, she had a bridge on her front upper teeth.

9. Mrs O was first told her bridge may be failing in May 2018. In May 2022 Mrs O was suffering from pain and swelling. She was referred to the endodontic service (root canal treatment) for an opinion on whether the front teeth could be saved.

10. Mrs O was advised it was likely the bridge would be lost and it was recommended the root canal treatment on her UR2 (upper right) tooth was redone. She originally agreed to this treatment but then decided against it, saying she wanted the tooth removed instead.

11. She then attended a private clinic for another opinion and was told an extensive bridge may be an option. She went back to the Practice who declined this treatment for clinical reasons. A second opinion from the Practice came to the same conclusion.

12. In August 2022, Mrs O had more pain and agreed to the extraction of two teeth and an immediate denture. This procedure was done in October.

13. Mrs O returned to the Practice several times between October 2022 and May 2023 and had the dentures readjusted and clasps added.

Refusal to give Mrs O a new extended bridge

17. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.

18. Mrs O told us the Practice repeatedly refused to give her a new extended bridge. She says this was needed to replace the current bridge that was failing. She explained she was in a great deal of pain but was only offered tooth extraction and an immediate denture.

19. She got a second opinion from a private dentist who told her an extended bridge was an option for her, despite several different dentists from the Practice saying it was not clinically appropriate.

20. Our adviser reviewed Mrs O’s dental notes and X-rays. They told us an extended bridge was not clinically appropriate as it would not have given good long term dental health. This was due to the rest of her teeth already having an expected poor prognosis (outcome).

21. They explained her remaining original teeth, on which a new bridge would be reliant, were weak as they had been treated with a root canal before. One tooth also had a apicectomy (treatment when a tooth has become reinfected after a failed root canal treatment).

22. To assess whether these teeth could have been restored for a new bridge, they would have had to be deconstructed first. This would have involved drilling the teeth down and removing the protective enamel layer. This procedure comes with a high risk of tooth fracture and the tooth would potentially have to be removed as a result.

23. Our adviser said Mrs O has a small number of posterior (back) teeth. These teeth have naturally short roots which can easily fracture when there is a heavy load on them. Without more posterior support, the load on the front teeth with a new bridge would have been too much, causing root fractures.

24. They said the reason the private dentist quoted Mrs O for an extended bridge was because this would involve more of the back teeth into the bridge design, to help navigate the issue of a lack of posterior support. But, they said this is not clinically justified, as many teeth would need to be restored at the back of the mouth to replace a small number of teeth at the front with a bridge.

25. As a result of the restoration, these back teeth would die off and need either root canal treatment or extraction in the future. They said healthy teeth would be compromised to restore these back teeth for an extended bridge.

26. The NHS website says, ‘the NHS will provide any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain. Decisions about which treatment is appropriate will be based on a clinical assessment and clinical judgement.’

27. This means that NHS treatment focuses on maintaining a basic level of dental health to keep patients mouths free of disease and pain free. Unfortunately, NHS care does not extend beyond this. In this case, our adviser said the clinical assessment was correct and the most appropriate, clinically necessary treatment was given to Mrs O under the level of care the NHS can give.

28. The BSRD guidance says, ‘the decision to provide a crown or fixed bridge whether tooth or implant supported depends on many factors, including … the condition of the remaining teeth and tooth tissues, the periodontal [gum] condition and oral hygiene maintenance and analysis of the benefits, disadvantages and long-term consequences of providing a crown or fixed prosthesis [artificial part].’

29. Our adviser confirmed the dentist weighed up the benefits, disadvantages and long-term consequences of the treatment options and offered an appropriate treatment based on the overall dental condition of the remaining teeth.

30. We can see no signs of a failing. The Practice acted in line with the relevant standards, and we think the Practice offered Mrs O the most appropriate treatment to keep her mouth, teeth and gums healthy.

The Practice provided ill-fitting dentures and would not replace them for free

31. Mrs O told us she started having problems with her denture soon after it was fitted. She says it was originally causing her pain when she returned to the Practice in November 2022. Then in January 2023, she returned as the denture had become loose. The Practice tried to adjust it but it would not give her a new denture under the last course of NHS treatment.

32. Our adviser explained that because the laboratory making the denture has to estimate the shape, it is not always possible to get an accurate fit. The denture will loosen as the mouth heals. This is well known and expected to happen.

33. Our adviser noted Mrs O had signed a detailed consent form covering all parts of the immediate denture treatment. This included accepting the limitations of dentures and the difficulties they may cause. This also included how the denture will become loose with time and that fees for new dentures would not be included in that course of treatment.

34. The GDC guidance says the dentist must get valid consent before starting treatment. In this case, the dentist got consent. We see the Practice told Mrs O about the limitations of the treatment.

35. Our adviser said the treatment offered to Mrs O to try and reduce her problems with the denture included adjusting, completing a chairside reline (applying a new layer to the denture to help them fit better) and adding clasps. This is the standard course of action in these circumstances. They also said the chance of the immediate denture becoming ill fitting and needing a new one in the future was made clear to Mrs O in appointment notes and the consent form.

36. The NHS website discusses dental charges and says a patient does not have to pay if their dentures need repairing, but if they need new ones they will have to pay for these. Our adviser confirmed there is no evidence the dentures were faulty. They said it is clear they became loose (as advised would likely happen) due to changes in the shape of Mrs O’s gums. A new denture is not available under the last course of treatment. It would be classed as a new course of treatment with a new cost.

37. We understand this has been a difficult time for Mrs O and the experience caused her distress. We have carefully considered the evidence and see no sign of a failing. The Practice acted in line with the relevant guidelines and gave her the right level of care available under the NHS.

1. We have carefully considered Mrs O’s complaint about a dental practice in the Bexley area (the Practice).

2. We have seen no sign that anything went seriously wrong because from what we have seen, the Practice offered Mrs O the most appropriate treatment. We have also seen evidence to show that new dentures would not have been included in the course of treatment Mrs O paid for before.