3. Mr I complains the Practice:
• removed a tooth in December 2021 without good reason • has not replaced his tooth with a dental bridge.
4. Mr I says he has been left without a replacement tooth which is causing him issues with chewing food because he cannot use one side of his mouth.
5. Mr I would like a financial payment so he can replace his tooth.
Removal of the tooth
9. We use guidance and standards to establish what should happen and then investigate the evidence to show what did happen. If there is a difference between what should have happened and what did happen, this is a failing.
10. Then, we look at if the claimed injustice (how the person was affected) can be linked to the failing and what the organisation has done to put it right, and if this is enough.
11. The GDC standards say dentists ‘must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation.’
12. The GDC also says dentists must make sure they have valid consent before starting any treatment or investigation and they should note the discussions they have with patients to get consent. Although a signature on a form is important in checking that a patient has given consent, it is the discussions with the patient that decide if the consent is valid.
13. Mr I complains his tooth could have been saved. In his complaint Mr I says the dentist advised him it would be ‘best to remove the tooth’. When Mr I asked for the tooth to be saved, the dentist explained he would need several appointments, and it would be expensive as root canal treatment is not included under the NHS. A root canal is a procedure which involves removal of the soft tissue inside the tooth (pulp) to repair a decaying or infected tooth.
14. The Practice says the dentist first saw Mr I as an emergency patient on 16 November 2021 as he was in pain. The dentist took an X-ray and told Mr I that his tooth had a radiolucency (dark spot on the X-ray) which is likely to be an infection. The Practice diagnosed him with irreversible pulpitis and a periapical area and gave him antibiotics. Irreversible pulpitis is a condition where the inflammation of the pulp is severe and cannot be reversed. Periapical periodontitis is an acute or chronic inflammatory lesion (abnormal area) around the top of a tooth root.
15. The Practice says Mr I went back for follow up treatment on 4 December, and he had increased swelling on the buccal (outer) part of his tooth. The Practice did a full examination.
16. The dentist discussed what treatment could be done. The dentist advised Mr I could either have root canal treatment or an extraction (removal). They said Mr I was unwilling to have multiple appointments for root canal treatment and he preferred to have the tooth removed The dentist said Mr I chose to have the tooth extracted and signed a consent form.
17. Our adviser explained the options of root canal or extraction were correct for Mr I’s diagnosis. They explained because Mr I grinded his teeth, tooth surface loss was noted in his checks ups, and the decay was likely caused by fractures within the tooth leading to nerve death. They explained once the nerve is dead, an extraction or root canal needs to be done.
18. There is a clear difference in the account of events by the Practice and Mr I.
The Practice tells us Mr I did not want multiple appointments. Mr I tells us he did not want to pay for root canal treatment.
19. We have no independent evidence to say which account of events is correct. Despite this difference, it is clear that a root canal was not an option because Mr I did not want to pay for it or have several appointments. This means the only option for treatment was extraction.
20. We have looked at whether Mr I’s consent for the extraction was complete and valid. We have seen a consent form signed by Mr I on 4 December. We have also seen that Mr I gave verbal and written consent for the extraction.
21. We can see the right treatment options were offered. Mr I chose to have an extraction and signed a consent form. We have not seen evidence of any failings with the consent process. We do not think the Practice did anything wrong with this part of the complaint.
The Practice did not do a dental bridge
22. Mr I complains the Practice has not replaced his tooth with a dental bridge. A dental bridge is a replacement for a tooth that has been removed. He said he expected this to happen within two months. He says he asked the dentist at least three times in five months and the dentist just kept saying ‘next time’.
23. The Practice said Mr I had a check-up on 5 July 2022 and said he was interested in replacing the tooth. The dentist did an examination and said they discussed the options which were to leave and monitor it, do a denture or a private implant.
24. The dentist says Mr I returned on 20 August and they spent a lot of time discussing the options, including a bridge.
25. From the dental records on 20 August, we can see Mr I and the dentist had a discussion about a bridge. The dentist reminded Mr I that it is advised that the removal takes three to six months to heal, and a replacement option may not be given until it has healed.
26. From the records we can see Mr I spoke with the practice manager (PM) on 23 August. The PM offered Mr I a bridge or a partial denture which Mr I accepted.
27. The Practice removed Mr I as a patient in early September due to aggressive behaviour, which Mr I disagrees with. Being removed as a patient (de-registration) is not part of this investigation.
28. Our adviser explained there are no standards to say when Mr I should have been given a dental bridge. This is because it is acceptable to not replace a tooth after extraction, especially when the patient has all their other teeth.
29. They explained a dental bridge cannot be done until at least three to six months after a tooth has been extracted because it takes time for the bone to heal and settle
30. They also explained that if this treatment was done any earlier, as the bone and gum heals Mr I would be left with a large gap above the false bridge tooth that can cause problems with eating, more discomfort and problems with nearby teeth.
31. The Practice explained to Mr I the site had not fully healed, and it was not appropriate to give him a bridge at that time. Mr I left the Practice before a bridge could be fitted. We have seen no sign of a failing with this part of the complaint. We thank Mr I for bringing his complaint to us.
1. We have carefully considered Mr I’s complaint about a dental practice in the Lambeth area (the Practice). We are sorry to hear of the events that led Mr I to raise his complaint with us and thank him for sharing his concerns.
2. We have seen no sign of a failing and are not taking any further action. We have explained our decision below.