4. Mrs Y complains the Trust refused funding for a dental implant in May 2023, when it funded dental repairs after an accident before.
5. She says because the Trust refused her treatment, she continued to have difficulty eating and is upset with how her missing teeth look.
6. Mrs Y wants a payment of £3,500 to cover the cost of private treatment to replace her teeth.
7. Mrs Y had funded NHS dental treatment between 2018 and 2020 because of damage caused to her mouth and teeth after an accident in 2005.
8. The Trust completed root canals, implants and crowns for Mrs Y and it reported the dental work as stable to her dentist on 5 November 2020. Mrs Y’s dentist asked the Trust for more funded treatment in May 2023, because she had a large gap between her side teeth that caused her difficulties when eating.
9. The Trust refused Mrs Y funding on 12 May 2023.
13. Before we decide if we should do a detailed investigation of 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. We have done this and have not found any signs that something went wrong.
14. The Trust said Mrs Y did not meet its criteria for funding because her treatment is considered a low priority.
15. Implants are funded on the NHS in only very limited circumstances. Information on the Trust’s website explains it can only fund implants in certain high priority patients.
16. The PubMed guidance tells dental professionals:
‘the minimum number of teeth needed to satisfy functional demands has been the subject to many studies… Many studies demonstrate shortened dental arches comprising of anterior and premolar teeth can meet the requirements of a functioning dentition.’
17. This means a person’s teeth will be considered functioning if made up of front and grinding teeth. Mrs Y’s records show she has supporting teeth for a shortened dental arch (SDA) and had restorative dental treatment on her teeth to meet the functioning requirements.
18. The records show Mrs Y had many root canal treatments, implants, single crowns and a bridge funded by the NHS between 2018 and 2020.
19. The records also show the Trust updated Mrs Y’s dentist in 2020, to say the treatment given was stable and dental hygiene could be continued with her dental practice.
20. Mrs Y’s dentist applied for funding because she had a missing back tooth, that meant she found it difficult to eat and this caused her distress. The referral confirmed Mrs Y understood funding was not guaranteed and may be rejected.
21. The Trust rejected the funding request saying the replacement of posterior (back) teeth was considered low priority and not usually accepted. It said the molar tooth replacement would not be without risk as there is less bone to secure an implant the further back it is in the mouth. It asked Mrs Y to find alternative arrangements outside of the Trust.
22. Our adviser told us they referred to the Science Direct guidance that says:
‘dental arches comprising of the anterior and premolar regions (teeth) meet the requirements of a functional dentition (21 or more teeth present in the mouth). Therefore treatment is not necessary on the basis of function or quality of life.’
23. Because Mrs Y had what is considered an acceptable amount of teeth for eating, the tooth implant was rejected. Our adviser also confirmed a person with missing teeth does not necessarily need treatment for function or quality of life.
24. The Trust’s dental guidelines for implant treatment tells referring clinicians about its considerations for funding. It says, ‘Replacement of posterior teeth is considered low priority and not usually accepted.’
25. Mrs Y’s dentist referred her to the Trust for a review for the possibility of funding to replace her missing teeth, but this was not guaranteed. The Trust’s policy confirmed this treatment did not meet its criteria and she was told about the decision made by a panel, which is in line with the Trust’s guidelines. Our adviser confirmed Mrs Y would not meet the criteria for high priority so we can see no sign of a failing in how this decision was made.
26. We are satisfied the Trust considered Mrs Y’s dental condition and gave its reason clearly. We are sorry Mrs Y felt the Trust’s decision was wrong and understand this has been an upsetting time for her. We hope she is reassured that we saw nothing to suggest something went wrong.
1. We have carefully considered Mrs Y’s complaint about Guy’s and St Thomas’ NHS Foundation Trust (the Trust). It is clear from what Mrs Y told us that events at the Trust have been an upsetting experience for her.
2. Regarding the Trust’s decision not to offer Mrs Y dental funding, there is no sign that anything went wrong. The Trust followed recognised guidelines in making this decision.
3. We want to thank Mrs Y for the time she has taken to bring her complaint to us. Our intention is not to ignore her distress and upset. We hope the below information clearly explains why we will not be taking her complaint further.