5. Mr R complains about the care and treatment he received from the Practice, he says:
•the Practice removed him from its register when he needed urgent dental treatment •the Practice did not refer him to a specialist
6. Mr R says because he has not been able to get the dental treatment he needs, his confidence and mental health has been affected, and he is struggling to eat.
7. By bringing the complaint to us Mr R would like financial compensation.
8. Mr R was removed from the Practice register in 2019 due to a period of no contact. In May 2023 he was put back on the Practice waiting list to rejoin but was warned about his previous attendance history.
9. On 28 September 2023, Mr R asked about treatment a different dentist had previously suggested to him to help correct his bite. The Practice advised Mr R he would need to see a restorative specialist for that treatment. No referral was made at this time.
10. In January 2024, a request was placed for change of dentist forms to be completed. Mr R attended two further appointments on 29 April and 25 June, but the specialist referral was not discussed.
11. Mr R raised a complaint with the Practice on 27 June about an appropriate treatment plan not being put in place and a referral not being made to a specialist.
12. In July and August, the Practice provide responses to Mr R’s complaints and advised on both responses that he looked for a new dentist. The Practice said this was due to his previous attendance history and a breakdown in relationship.
13. On 11 September 2024, Mr R joined a new dental Practice.
Referral to a specialist service
17. 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 seen any indications that something has gone wrong.
18. Mr R complains the Practice did not refer him to a specialist following his appointment on 28 September 2023.
19. The Practice said on 28 September 2023 it advised a specialist referral might be necessary due Mr R having gaps from missing teeth and extensive wear and cracking. It said this was only discussed and Mr R did not confirm he would like to go ahead with a referral.
20. The national referral network for restorative tooth wear says advice on the options for management of tooth wear will be provided, but only the most complex cases are accepted for treatment. If a referral to a specialist service had been made for the management of Mr R’s tooth wear, according to the restorative services referral guidelines it would have resulted in advice-only, not active treatment.
21. The Essex Local Dental Committee (LDC) does not provide restorative referral services on the NHS, so an NHS service outside of Mr R’s area would need to have been considered. Alternatively, Mr R may have considered private restorative dental treatment.
22. Our dental adviser explained if advice had been given, treatment can be complicated and the dental practice may have been unable to provide this. Mr R would have then needed to seek another dentist who could deliver the treatment.
23. It was implied that Mr R’s dentist could not provide the treatment he had enquired about on 28 September. She had already told him he would need a specialist referral for treatment because of gaps due to missing teeth, and extensive wear and cracking.
24. There was no indication that the Practice or Mr R discussed a specialist referral at his next examination on 29 April. The dentist recommended a treatment plan of fillings on Mr R’s front upper teeth (UR1 and UL1) and the lower right first molar (LR6). This appears to be a different problem to the issues with gaps raised at the 28 September appointment.
25. No further diagnosis or treatment was considered except for a night guard, which the Practice was also able to provide. Mr R decided to wait until after his restorative treatment for this.
26. On 25 June 2024, the Practice fulfilled its treatment plan. This included fillings on the upper front teeth and lower back tooth and oral hygiene instructions. There is no indication that either the Practice or Mr R discussed the need for a specialist referral at this appointment.
27. There is no indication that further treatment was required following the appointment on 25 June. This is supported by Mr R’s first appointment with his new dentist on 8 October 2024, where we can see no immediate treatment was required.
28. In conclusion, we have seen no indication that something has gone wrong with the Practice’s treatment. It provided care to Mr R in line with the treatment plan Mr R agreed to. There is no indication that there was any further discussion about a specialist referral following the initial discussion 28 September 2023. There is also no indication that Mr R requested or agreed to a referral after that appointment.
29. We acknowledge the impact these events have had on Mr R’s confidence and mental health. Because there is no indication something has gone wrong here, we will not consider this part of the complaint further. We understand Mr R will be disappointed by our decision.
Removal from the Practice register
30. Mr R also complains the Practice removed him from its register when he needed urgent dental treatment and feels the decision to remove him was not fair.
31. The Practice acknowledged on 10 July 2024 that Mr R had requested to see a new dentist. It told him he had already moved around all the dentists in the Practice since joining the Practice. It also said he had previously failed to attend many appointments, including two root canal treatments in 2019. The Practice explained based on these two factors, it believed the relationship had broken down and it removed him from the Practice list.
32. We looked at the policies the Practice relied upon to remove him from the register. Its appointments and failed to return policy says ‘more than two failed appointments may result in the Practice not being able to accept the patient for any further NHS treatment’.
33. The records show Mr R did not miss more than two appointments when he rejoined the Practice in 2023. He cancelled two appointments on 11 March 2024 and 22 August 2024.
34. The GDC standards say where the trust between the clinician and a patient breaks down, the clinician may find it necessary to end the professional relationship. This should not be caused solely by a patient’s complaint. The clinician should explain their rationale to the patient and take steps to ensure that arrangements for continuing care of the patient are made promptly.
35. It appears a change of dentist form was requested on 30 January 2024, but there is nothing in the records to indicate Mr R requested this. There is no other documentation in the records which shows Mr R requested a new dentist during his time at the Practice. We cannot confirm any previous change of dentist was at Mr R’s request.
36. Looking at the background set out above, we can see that during 2024, a request of dentist form was completed, and Mr R attended two appointments. Following this, Mr R submitted a complaint about the lack of referral. It seems it was only after Mr R submitted a complaint that the Practice told Mr R to look for a new dentist.
37. Considering this, we think the Practice appears to have failed to act in line with the GDC guidance. We considered what impact there may have been to Mr R because of the Practice’s decision to remove him from the register.
38. Mr R told us before he was removed from the Practice, he had an appointment scheduled for his back tooth which he believed needed a filling. He says by the time he found a new dentist the damage had got worse, and the tooth required an extraction.
39. We requested the records from Mr R’s new dental practice. The records show Mr R attended an appointment on 8 October 2024 but no immediate treatment such as fillings or tooth extraction was required.
40. The new dentist told Mr R that he had periodontal disease (gum disease) and would need to see a restorative specialist and offered a referral. He told his new Practice he would like to consider it before going ahead.
41. Our dental adviser explained periodontal disease (gum disease) is caused by a build-up of plaque on the teeth. This can be prevented by brushing and cleaning teeth regularly.
Based on the records from the new Practice we are unable link the clinical impact Mr R claims about needing a tooth extraction because he was removed from the Practice when he had an appointment scheduled for a filling. We have seen no indication Mr R has had, or needed, a tooth extraction after changing dental practices.
42. We acknowledge Mr R experienced inconvenience and frustration when he had to find a new dental practice, after the Practice had removed him.
43. We consider the impact he describes falls into level one of our severity of injustice scale. This includes injustices such as annoyance, frustration and inconvenience, typically arising from a single (one-off) incidence of maladministration or service failure, where the effect on the person complaining is of short duration, and where there are no other adverse effects or ongoing wider impact. We will usually consider an apology to be an appropriate remedy for these cases, rather than financial remedy.
44. Mr R has only requested financial remedy. We acknowledge the inconvenience and frustration of him having to look for a new Practice. We think this impact was only suffered over a short duration, as he was removed from the Practice register in August 2024 and joined the new Practice in September 2024.
45. We conclude that a financial remedy is not required to put right this injustice. As this is the only outcome Mr R is seeking, we will not consider this part of the complaint further.
46. We understand how distressing dental issues can be. We are pleased Mr R has identified a new dental Practice who can support with any ongoing dental concerns he may have. We wish him the best with his new Practice.
1. We have carefully considered Mr R’s complaint about the Practice.
2. After careful consideration, we have seen no indication that anything went wrong when the Practice did not refer Mr R for specialist treatment on 28 September 2023.
3. We have also considered the complaint Mr R brought to us about the Practice’s decision to remove him from its register and the impact this had on him. We do not think the impact we have seen would warrant a financial remedy on our Severity of Injustice scale. This is the only outcome Mr R is seeking.
4. We appreciate Mr R was worried about his ongoing dental needs and it was inconvenient to need to find a new Practice. We were pleased to hear he has since found a different Practice to continue his treatment.