Care and treatment
11. Miss A complains the Practice would not permanently fill a gap in her teeth by the end of her course of NHS orthodontic treatment.
12. The Practice said a general dentist would provide the treatment needed to fill the gap. It explained it is not treatment an orthodontist provides.
13. Miss A had a natural missing upper left incisor tooth and an impacted ectopic upper left canine tooth. An impacted ectopic tooth is one that has developed in an abnormal position and is unable to move into its normal position.
14. The orthodontic treatment plan was to correct the position of the impacted ectopic canine tooth and align Miss A’s teeth through the use of braces. Once the orthodontist completed this treatment, this would allow a general dentist to provide tooth replacement treatment for the missing upper left incisor tooth so the gap was closed. At the end of the orthodontic treatment, the orthodontist provided Miss A with a removable retainer containing an additional tooth embedded to close the gap in her teeth as a temporary measure.
15. Our adviser explained that the orthodontic treatment plan did not involve the permanent closure of the gap in Miss A’s teeth which was correct. They said an orthodontist would not be responsible for offering a permanent replacement for the closure of the gap in Miss A’s case.
16. They outlined that there are two different options for such treatment (known as restorative dental work) involving either a bridge or an implant. A bridge is a false tooth which is bonded to the natural teeth on either side of a gap while an implant consists of a titanium screw fixed into the jawbone then topped with a replacement tooth.
17. Our adviser further explained that a general dentist (either NHS or private) would carry out bridge treatment while a specialist implant dentist (on a private basis only) would provide implant treatment in Miss A’s situation.
18. Our Principles of Good Administration state organisations must act in accordance with recognised quality standards, established good practice or both when delivering clinical care. In this situation, we will use the professional judgement of our adviser which is based on established good practice.
19. We are satisfied the Practice acted in line with established good practice in relation to it not offering a permanent replacement for the gap in Miss A’s teeth as part of her treatment plan. This is because orthodontists do not provide this type of treatment.
20. On that basis, we will take no further action because the Practice did not do anything wrong in not providing this treatment to Miss A.
21. Our decision here is not made without recognising how challenging it was for Miss A to undergo orthodontic treatment over a number of years and for there to still be a gap in her teeth at the end of this treatment. We hope she is able to get restorative treatment from a dentist in the near future.
Communication
22. Miss A says the Practice did not fully inform her until July 2023 that it would not be able to complete her treatment. She says before that the Practice indicated all her treatment would be completed on the NHS.
23. The Practice said it explained to Miss A what would happen in relation to fixing the gap in her teeth on 15 November 2022 and 4 July 2023.
24. Miss A’s orthodontic records show staff at the Practice discussed and explained the treatment plan to her at appointments on 3 December 2019, 17 June 2021, 30 September 2022, 15 November 2022 and 4 July 2023.
25. Staff also discussed the options for restorative treatment with her when she attended for a review appointment on 3 October 2023. On 14 August 2024, during a final review appointment of her orthodontic retainer, the orthodontist advised Miss A to contact the Practice again once she had undergone restorative treatment so it could arrange a new orthodontic retainer.
26. General Dental Council (GDC), Standards for the Dental Team, explains that staff must communicate effectively with patients by giving them the information they need to know in a way they can understand so that they can make informed decisions. It also outlines that when providing a treatment plan staff should explain to patients about the proposed treatment, provide a realistic indication of the cost and indicate whether elements are provided under the NHS or privately.
27. We understand from our adviser that the Practice communicated with Miss A about her treatment plan in line with GDC guidelines throughout the course of her treatment.
28. We are satisfied the Practice communicated with Miss A about her treatment plan in line with relevant guidelines. We will, therefore, take no further action as there is no indication the Practice did anything wrong.
29. We fully appreciate Miss A does not think the Practice explained things to her effectively. We are sorry to hear that she was surprised when she realised that staff would not carry out the restorative aspect of her treatment and she would have to seek treatment from another dentist. Again, we hope she is able to arrange this treatment soon.