15. Before we decide if we should conduct 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 indications that something has gone wrong.
Fit and quality of dentures
16. Mrs O told us her dentures were poorly made by the Practice and do not fit her mouth. She told us that as they do not stay in her mouth, she has been unable to eat properly for several months, struggles with her speech and is self-conscious of her appearance.
17. She told us the Practice had recommended a private referral for her dentures, as it was a complicated case. This was because she would have no teeth and had a previous set of dentures for over 20 years, which she had become accustomed to. Despite this, she did not expect the Practice would provide such a poor fitting denture through the NHS.
18. We sought advice from our adviser to help establish whether the Practice made the dentures to standard. We also looked to establish if Mrs O was sufficiently warned about the likelihood of poor fitting dentures being made by the Practice. They referred to the GDC standards which say the dentist must explain what the risks and benefits of the treatment proposed are. It also says the dentist must document the discussions had with patients in the process of gaining consent.
19. Our adviser said the Practice’s conversations with Mrs O were well documented in the records. It was made clear to her that not only was it a difficult case, but a specialist would have a much better chance at being able to make a satisfactory denture.
20. Our adviser also said it would be impossible to comment on the fit of Mrs O’s dentures provided by the Practice without her being examined. However, Mrs O’s case was very difficult and required a specialist prosthodontist (specialist in restoration and replacement teeth) to provide the best chance of a well-fitting denture. We consider it was clear the risks of the Practice’s dentures were explained to her, and she consented to the treatment despite this.
21. As per the guidance and discussion with our adviser, we can see no indications of a failing. We consider the Practice acted in accordance with the GDC standards by clearly explaining to Mrs O that the chance of success was much greater with a specialist than with the Practice.
22. We are also of the view that given Mrs O’s previous long term dentures and complicated current dental situation, the Practice making a denture which was not satisfactory to her, does not indicate a failing in this case. This is because we consider the Practice clearly informed her of its limitations and our adviser explained such a complex case would require a specialist for a well-fitting denture.
23. We are of the view that on the balance of probabilities, a denture made by anybody other than a specialist would have unfortunately been unsatisfactory for Mrs O, due to the complex nature of her dental situation. Therefore we do not consider there are any indications the Practice did anything wrong with the making of Mrs O’s dentures.
The Practice provided dentures, despite recommending a private referral
24. Having been told that a private specialist was likely to make a better fitting denture, Mrs O agreed to a private referral on 10 July 2023. Unfortunately, the private dentist was off work and Mrs O returned to the Practice on 31 July. She told us she was in a lot of pain and consented to the treatment as she did not know how long she would have to wait to see the specialist.
25. Mrs O feels the Practice should not have agreed to make her new dentures if it continued to have concerns over its ability to make a satisfactory one. She told us the Practice clearly had concerns, otherwise it would not have referred her to the private specialist in the first place.
26. Our adviser referred again to the GDC standards which say the dentist should always put the patients’ interests first. They explained the Practice has a duty of care to treat a patient who is in pain, which Mrs O was. If she was in pain, wanted her teeth removed and a new denture made sooner rather than waiting for the private specialist, then the Practice did the right thing by not sending her away.
27. As addressed above, we consider Mrs O was adequately informed of the risks of proceeding with the Practice rather than waiting for the private specialist and consented to the treatment.
28. We understand Mrs O’s concerns about the dentist completing the treatment despite having an uncertain outcome. In this case, we can see no indications anything went wrong. We consider the Practice acted in line with the guidance to put Mrs O’s interests first in treating her, given she was in pain and requested treatment.
The Practice only offered an NHS referral after a complaint was made
29. Mrs O told us how she was offered an NHS specialist referral after she made her complaint. The Practice confirmed this was offered after Mrs O voiced her concerns about the fit of the new denture and was not offered prior to her denture being made.
30. We sought further advice to help establish whether Mrs O should have been offered a specialist NHS referral at the same time a private referral was offered. Our adviser explained how dental referrals in the NHS are often very long and even after being in a long queue, referrals are often not accepted by hospitals. Because of this, the private option is often favoured by patients.
31. They explained that in Mrs O’s case, the dentist was concerned about their ability to make satisfactory dentures, as it is incredibly difficult to do so for a patient who has had a previous denture for such a long time.
32. Our adviser said there is no standard which says an NHS dentist must offer an NHS referral. The FGDP standards section 2.3 says the dentist should indicate whether the referral is NHS or private. This was documented in Mrs O’s case and the dentist had no obligation to offer an specialist NHS referral.
33. We do not consider the Practice was required to offer Mrs O an NHS referral and therefore have seen no indication anything went wrong. However, we have liaised with the Practice regarding a good practice learning point from the adviser for the Practice to clearly document any discussion around the possibility of an NHS referral. It has agreed to make sure this is implemented in future.
34. We recognise Mrs O has suffered without adequately fitting dentures. We are sorry that the impact is ongoing and hope her situation improves going forward. We hope she is reassured that the Practice acted in accordance with the relevant guidance and has agreed to take forward our adviser’s learning point for good practice.