A dental practice in the Birmingham area

3. Mr D complains about the care and treatment provided by the Practice following the fitting of his braces in April 2024 onward. He raises the following concerns:

• The Practice told him his teeth were not clean enough for braces.

• The Practice refused to allow Mr D’s mother in the appointment due to unreasonable behaviour at a previous appointment, which Mr D disputes.

• He was discharged from the Practice without prior discussion or consent.

• The Practice have failed to arrange further care following an Integrated Care Board (ICB) decision.

4. Mr D believes these failings led to a lack of appropriate dental care for over a year, resulting in worsening dental health. He also says he experienced significant emotional distress and financial pressure to seek private treatment.

5. To put things right, Mr D seeks:

• An apology from the Practice for the handling of his care and what he believes was a misrepresentation of events.

• Reinstated for treatment with another NHS dentist.

• Full reimbursement of any treatment costs incurred as a result of the discharge and delay.

6. In April 2024 the Practice fitted braces to Mr D’s top row of teeth. Mr D signed a document explaining his agreement to the treatment as well as the Guide to Orthodontic treatment which highlighted the risks of the treatment.

7. In July Mr D was seen by the Practice with his mother in attendance. The Practice noted Mr D presented with poor oral hygiene and confirmed to him the treatment may be abandoned if this remains an issue.

8. The Practice provided guidance on how to help with his oral hygiene going forward. The notes also indicate Mr D’s mother was arguing regarding some of the guidance given.

9. The Practice noted further instances of poor oral hygiene in an appointment in September. The Practice recorded it informed Mr D that they cannot fit a lower brace if the oral hygiene remains poor.

10. In a further appointment in November, Mr D was accompanied by his mother. The Practice refused to allow Mr D’s mother in the appointment due what it described as her rude and argumentative behaviour in previous appointments.

11. The Practice also noted that Mr D presented with poor oral hygiene. Mr D disputed this and said he had a professional clean that morning. Mr D’s mother asked to speak to the orthodontist who refused.

14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs of service failings or maladministration which the organisation has not put right. Having done so we have not seen any signs anything went seriously wrong.

The Practice told him his teeth were not clean enough for braces

15. BOS guidance says good oral hygiene is essential during orthodontic treatment. Orthodontists help spot and manage gum and dental health problems early, and they play a key role in making sure patients keep their teeth clean and follow a healthy diet.

16. The BOS guidance highlights that before starting orthodontic treatment, patients must have good oral hygiene, and no untreated tooth decay. If decay occurs during treatment, it can delay progress because parts of the braces may need to be removed to fix the tooth first.

17. Mr D’s orthodontist records show in each of his orthodontic appointments in July, September and November the dentist noted he displayed with poor oral hygiene. The Practice has acted in line with BOS guidance in refusing braces whilst Mr D’s oral hygiene remained poor.

Refused his mother access following an argument

18. Mr D says his mother’s behaviour was not unreasonable and the Practice were wrong to stop her entering the room.

19. It is clear from both Mr D’s account and the Practice’s response that a disagreement occurred in the appointment in July. Both parties have explained how the other one acted unreasonably during this discussion. We appreciate this was a distressing experience for them both.

20. Contemporaneous notes clearly state the Practice considered Mr D’s mother to be arguing with them.

21. NHS England’s guidance for employers explains NHS staff should not tolerate any form of inappropriate behaviour towards them. It is clear from the Practice’s contemporaneous notes that staff perceived Mr D’s mother’s actions to be inappropriate and it declined to allow her into the treatment room.

22. Mr D does not deny an argument took place but states the response was unjustified. Whilst the parties may differ on their views of what constitutes inappropriate behaviour, we recognise that it would be difficult to provide medical care whilst a discussion of that nature was taking place. For this reason we are not critical of the Practice’s decision to deny her access to the room. We consider this to be in line with NHSE’s guidance.

Deregistration from the Practice

23. Mr D complains the Practice removed him from its patient list on 19 December 2024 due to a breakdown in its relationship with him.

24. The GDS regulations state where there is a breakdown in the dentist-patient relationship, the dentist may decide to no longer provide treatment to the patient.

25. GDC standards say the trust between a dentist and a patient may break down, and the dentist may find it necessary to end the professional relationship. The dentist must be satisfied their decision is fair and must be able to justify their decision. A letter should be sent to the patient notifying them of their decision and the reasons for it.

26. We have looked at the response provided by the Practice and can see it informed Mr D of the reason for its decision to deregister Mr D in December 2024.

27. The Practice described a breakdown in the relationship and they did not feel comfortable in continuing with Mr D’s treatment and would therefore be discharging him from their care.

28. Mr D’s dental records refer to occasions when practice staff felt the behaviour of his mother was unacceptable. Following the complaint being raised, the Practice felt the version of events described in the complaint raised were false.

29. Additionally, Mr D’s complaint letter referred to the orthodontist being sarcastic and combative, and how Mr D was concerned about bullying.

30. Based on the evidence we have seen, we consider the Practice was right to consider there had been a complete breakdown in its relationship. Evidence from both parties indicate this being the case.

31. On this basis the Practice acted in line with the GDS regulations and GDC standards by deciding it could no longer treat Mr D and deregistering him from the Practice and it did so in line with the correct process.

32. There is no indication anything went seriously wrong in this part of the complaint.

Practice have failed to arrange further care

33. Mr D told us he had raised the complaint to the ICB about his treatment, but the Practice had failed to arrange for another orthodontist to take over his treatment. GDC standards say dentists must co-operate with commissioners of health (such as the ICB).

34. Mr D had provided emails showing the ICB communications. From the information provided the ICB have not instructed the Practice to arrange further treatment; there are discussions around continuing NHS treatment.

35. Whilst the Practice initially said continuing treatment was available at another of its sites, this was later withdrawn as the relevant patient list had since been filled.

36. We have seen nothing that shows the Practice had been instructed to arrange further treatment from the ICB, or that it promised Mr D it would do so, or it commits to do this in its processes. For this reason we cannot see any signs the Practice failed to act in line with the guidance. There are no signs anything went seriously wrong in this part of Mr D’s complaint.

Conclusion

37. For the reasons outlined above, we will not be taking any further action on Mr D’s complaint about the Practice. We hope our through consideration of the issues reassures him about the actions of the Practice.

38. We understand this decision may be disappointing for Mr D, especially given the time and effort he has invested in bringing this complaint. We thank Mr D for bringing his complaint to us and appreciate the opportunity to consider it.

1. We have carefully considered Mr D’s complaint about the Practice. Having done so we have not seen any signs anything went seriously wrong.

2. We are sorry to hear about the circumstances of Mr D’s complaint. We understand the challenges he has faced and his continued struggles in receiving the treatment he needs. We recognise the strength of feeling and how important it is to him to receive the treatment.