3. Mr P complains about the care and treatment he received from the Dental Practice in July 2023. Specifically, he complains:
• the dentist removed all his teeth against his will and did not give him any other options before doing so.
4. Due to this, he says:
• he cannot wear his dentures due to the pain and in turn, this has affected his eating and cannot smile. He also says his mental health has deteriorated.
5. As a result of this, he is seeking:
• financial remedy between £600 - £1200.
6. On 10 July 2023, Mr P attended the Practice, on the basis of the Stabilisation Scheme. The Stabilisation Scheme is where the course of treatment is provided by the Dental Practice, and there is no continuing care when the initial remedial treatment plan has been completed.
7. During this appointment, the dentist agreed with Mr P to remove his teeth and supply dentures.
8. On 17 July, the dentist removed Mr P’s teeth, which were the following lower right teeth: LR5, LR4, LR2, LR1, and the following lower left teeth: LL1, LL2, LL3, LL4, LL5 and LL7.
9. On 24 July, the dentist removed Mr P’s teeth, which were the following upper right teeth: UR5, UR4, UR3, UR2, UR1, and the following upper left teeth: UL1, UL2, UL3, UL4, UL5 and UL7. They fitted upper and lower dentures, and the dentist advised Mr P the dentures will loosen during remodelling.
10. Mr P reported to the Dental Practice on 18 September that he was experiencing pain when wearing the dentures.
14. General Dental Council (GDC) standards principle 1 says ‘patients expect: that all aspects of their health and well-being will be considered, and they will receive dental care that is appropriate for them’.
15. Mr P says the Dental Practice removed all his teeth against his will and did not give him any other option, during his appointment in July 2023.
16. The Dental Practice said in its response it took a large X-ray of his mouth to assess the teeth and roots and advised removing all his remaining teeth due to the poor prognosis of the teeth and the retained roots present.
17. It said Mr P agreed to this and extracted the teeth during the appointments on 17 and 24 July. It said it disagrees it removed teeth against his will, confirming the process verbally and signing his treatment plan.
18. We have reviewed the records and have seen on 10 July; Mr P had teeth extractions at hospital the previous week and was taking amoxicillin (a penicillin antibiotic).
19. During the appointment, the dentist discussed options which were to ‘1) do nothing – not in patient’s best interest, patient declined 2) full clearance and supply acrylic dentures (removable prosthetic devices designed to replace all the natural teeth), patient accepts and understands his mouth will change shape and shrink due to remodelling. Accepts’.
20. On 17 July, the notes show ‘extraction under local anaesthetic of LR5, 4, 2, 1 (this means certain lower right teeth), LL1, 2, 3, 4, 5, 7 (this means certain lower left teeth). Associated risk explained to the patient…teeth removed successfully with forceps (an instrument used to extract teeth) and elevators (specialised instruments to loosen and elevate teeth or roots before extraction)’.
21. On 24 July, the notes show ‘extraction under local anaesthetic of UR5, 4, 3, 2, 1 (this means certain upper right teeth), UL1, 2, 3, 4, 5, 7 (this means certain upper left teeth) …teeth removed successfully using forceps and elevators…upper and lower dentures fitted successfully. Patient aware that the dentures will loosen during remodelling. Discharged today’.
22. We have sought advice on this from a dentist. They explained the dentist should have removed the teeth they did, due to the condition of the teeth.
23. Our adviser explained UR1 (an upper right tooth) is not mentioned in the notes as being carious (decayed) or mobile (the tooth’s movement horizontally and/or vertically). They explained the dentist should have given Mr P the option to keep this tooth due to this.
24. They said, however, there would have been risks associated in keeping this tooth which could have affected the aesthetics, retention, and stability of the upper denture.
25. We have reviewed whether the Dental Practice should have explored other options with Mr P.
26. Our adviser explained the LL5 (lower left tooth) could have had root canal treatment (a dental procedure to remove inflamed or infected pulp on the inside of the tooth which is then cleaned and disinfected, filled and sealed) and a crown (a tooth-shaped cap that restores a decayed, broken, weak, or worn-down tooth). They explained if oral hygiene was inadequate, the tooth would then also need extracting.
27. As the treatment was part of the stabilisation scheme, our adviser said root canal treatment would not have been done at the Dental Practice and instead Mr P would have had to find a different Dental Practice.
28. This would have then likely led to a significant wait, in finding another Dental Practice to carry out the treatment which could have led to further pain.
29. We consider the Dental Practice acted in line with GDC standards as above by removing the teeth, as they were working in line with Mr P’s best interests.
30. We have reviewed if the Dental Practice had explored other options with him, whether this could have changed the outcome, in the dentist removing his teeth and as a result being unable to wear his dentures due to pain.
31. After careful consideration, we do not think we can reach a view on whether, if the Dental Practice had explored alternative treatment with UR1 and/or LL5, if Mr P would have chosen the alternative treatment, rather than extraction.
32. We have therefore decided it is very unlikely we can reach a decision on whether Mr P would have chosen to keep UR1 or LL5.
33. We hope it provides some reassurance to Mr P that we consider the Dental Practice acted in line with GDC standards by removing his teeth.
34. We also hope he understands why we cannot reach a view on whether, if alternative treatment had been explored, we will never know which option he would have chosen.
35. We were sorry to hear of the impact this has had on Mr P, in being unable to wear his dentures due to pain. We wish him all the best for the future.
1. We have carefully considered Mr P’s complaint about the care and treatment he received from the Dental Practice. We have decided we would likely not be able to reach a clear, independent decision about this complaint and therefore cannot investigate it further.
2. We are sorry to hear about the pain he experiences when wearing his dentures, and the effect this has had on him in being unable to wear them.