A dental practice in the Birmingham area

5. Miss A complains that dentists at the Practice: • failed to identify that she needed a second root canal before 10 March 2021 • attempted to do a second root canal on 20 April 2021 despite not having the skills.

6. She says she still has pain in her head, jaw and ears. She says she has trouble eating and sleeping and she has lost weight. She says the Practice gave her false hope that her problems may be solved by a second root canal.

7. She wants financial compensation of £5,000. She also wants the Practice to pay for treatment to be done and to reimburse the cost of her tooth cleaning.

8. On 23 November 2020, Miss A had a root filling and on 1 December the dentist fitted a crown.

9. She returned on 30 January 2021 still in pain. Records show the dentist advised Miss A to floss more and to return if the pain had not gone.

10. She returned in February as she was still in pain. The dentist prescribed antibiotics as the tooth might be infected.

11. After the course of antibiotics had not improved the pain, Miss A returned to the Practice. The dentist advised that a different tooth may need a root canal.

12. On 25 March, the dentist prescribed another course of antibiotics but this did not resolve her pain.

13. The next month, Miss A attended the Practice again. The records show the dentist advised her that they could either attempt a root canal or refer her back to the dentist who did the earlier work.

14. Miss A said she would like the second dentist to complete the root canal treatment. The dentist attempted to do a second root canal but was unable to complete the work. The dentist advised that Miss A would need to see a specialist dentist.

Identifying the need for another root canal treatment

18. FDGP gives guidelines for recording ‘anything of significance’ on a radiographic report after an X-ray is taken. The Oxford Handbook of Clinical Dentistry says that notes after any radiograph should include any periodontal-endodontic lesions (infection) as well as any abnormalities in root length.

19. After reviewing the records our adviser explained that the root filling is visibly short and the 13 November 2020 X-ray shows evidence of an infection. Our adviser added it was difficult to say at that time if this was a new or old infection, but the first dentist should have mentioned it in their radiographic report. Our adviser said the first X-ray does not show whether the first root canal had failed, because it is unclear whether the original infection had grown, had shown signs of healing, or if this was a new infection altogether.

20. The Practice took two more X-rays over a five-month period, on 23 November and on 30 January 2021. The notes for these X-rays (completed by the second dentist) state that the infection seems larger than it did on the first X-ray meaning the root canal was failing and causing Miss A’s pain.

21. Our adviser explained that, based on this, the infection should have been mentioned to Miss A after the 13 November 2020 X-ray. But that does not mean that either dentist should have identified a need for a second root canal any earlier. A root canal was not the only course of action available to Miss A.

22. Our adviser said the Practice should have made Miss A aware of the continued presence of infection after the 13 November 2020 X-ray. They explained that this could have better prepared her for later being told the root canal had failed and she needed more treatment. This does not mean the need for a second root canal should have been identified sooner, only that the dentists could have done a better job of preparing Miss A for the possibility.

23. We recognise how frustrating it must have been to be in pain and to learn that the original treatment had failed. We are satisfied that the Practice acted in line with the relevant guidance when deciding when the root canal treatment needed to be redone. Although the dentists could have communicated with Miss A better, the Practice did not do anything seriously wrong.

The second root canal

24. The Endodontic Guide sets out the different levels of treatments and who should do them. Level one includes a root canal on a previously treated tooth with a short, poorly condensed root filling. Level three would need specialist referral for canals where X-rays and clinical evidence suggest there are complications.

25. In Miss A’s case, our adviser said level one applied. Her tooth had been treated before with a poorly condensed root filling, Because of this, it was appropriate for the dentist to attempt to treat this with Miss A’s consent.

26. Our adviser explained all dentists get the training to do a root canal again and so should be able to attempt this. But they also said it is a very skilled procedure and will sometimes need specialist attention.

27. Our adviser considered that the dentist had done everything correctly. They gave Miss A a list of treatment options including another root canal, extraction (tooth removal), referral to a specialist and having no treatment. The dentist explained the risks involved with each option and discussed NHS wait times compared with private referrals.

28. The records show the dentist advised Miss A that they could attempt another root canal but it may not be successful. This would leave extraction or specialist referral as the only treatment options left. Miss A then consented to treatment which was sadly unsuccessful.

29. It was unfortunate that the dentist could not complete the root canal at the time. Our adviser explained that until the tooth is opened up and the process is started, the dentist cannot know what the filling will be like and if the treatment can be completed.

30. We are satisfied that it was appropriate for the dentist to attempt this treatment. They were fully qualified and the treatment was in line with the Endodontic Guide. We understand Miss A is in ongoing pain and encourage her to speak to her dentist to explore the options available to h

1. We have carefully considered Miss A’s complaint about a dental practice in the Birmingham area (the Practice). We have decided to take no further action.

2. We think the Practice identified the need for a second root canal at the right time. Though an infection was visibly present as early as 13 November 2020, it was unclear whether it had got worse or improved. It did not become clear that it had got worse and the first root canal had failed until early 2021.

3. We also think it was appropriate for the dentist to attempt a second root canal on 20 April 2021 with Miss A’s consent. The dentist was properly trained but this treatment can sometimes need specialist attention.

4. We understand this has been and continues to be a tough situation for Miss A, and our decision is not meant to take away from what she has experienced.