East Kent Hospitals University NHS Foundation Trust

3. Mr A complains in July 2024 East Kent Hospitals University NHS Foundation Trust (the Trust) refused him dental implants. Mr A says when assessing him the Trust did not take account of his regular dentist’s view or his medical history (crowded mouth and Ehlers-Danlos syndromes) or his previous intolerance to dentures.

4. He says consequently the Trust inaccurately concluded he had gum disease and evidence of untreated tooth decay.

5. As a result of the Trust’s assessment, Mr A says he was unable to get dental implants. He says he continues to suffer from pain, distress, and now has dental phobia.

6. As an outcome, Mr A would like the Trust to reconsider its decision, or a financial remedy to pay for the treatment privately.

7. Mr A says he has crowded mouth and suffers from Ehlers-Danlos syndromes (EDS). This is a term used to cover a group of rare inherited conditions that can affect connective tissue that holds your teeth in place.

8. Crowded mouth is a condition where there is not enough space in the jaw for all teeth to fit normally. This results in teeth overlapping, twisting, or being pushed to the front or back. These problems can mean it's harder to keep your teeth and gums clean and your teeth are more likely to become damaged.

9. Mr A says he cannot wear dentures as they become loose, and within weeks they break and cause damage to his mouth.

10. Mr A says his dentist referred him to the Trust for implants. This is due to intolerance with his current dentures because of his medical history.

11. Mr A told us before seeing him, the Trust asked for a list of checks. Mr A says he and his dentist did what was asked and took full 3D X-rays of Mr A’s jaws and teeth. He received an appointment at the Trust for 3 July 2024.

12. Mr A says he was told he had to bring in his old dentures for the appointment, but Mr A told us he stopped wearing them and has had several teeth out since then. The Trust records say he reported haven thrown them away because they were so painful.

13. Mr A attended his appointment without his dentures, as he says he was unable to wear them at all without experiencing significant pain and discomfort.

14. During this appointment, Mr A was reviewed by a dentist at the Trust and then a consultant. Mr A says the dentist advised him he met the criteria for dental implants, while the consultant disagreed.

15. The consultant told Mr A he had evidence of tooth decay and gum disease. They said on this basis he was not a suitable candidate for implants, and he needed to return to his regular dentist to stabilise these conditions.

16. In its complaint response the Trust said Mr A’s dentist had referred him to the Trust due to difficulties tolerating dentures. The Trust said following this type of referral, before considering dentures it assesses a patient’s current dentures and looks at if they can be improved.

17. The Trust told Mr A it would accept a further referral and assess his dentures once he had stabilised his tooth decay and gum disease. Mr A disputes he has any decay or gum disease. He is also concerned he cannot tolerate dentures at all.

21. 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 found any indications something went wrong.

22. RCS guidance says patients being considered for dental implant treatment on the NHS must have no evidence of untreated primary dental disease (this includes conditions such as tooth decay and gum disease).

23. Restorative dentistry guidance says:

• A relevant specialist must assess the quality of the existing dentures and must confirm that all conventional options for denture construction have been exhausted and deemed unsuccessful before considering implants.’

24. Mr A failed to bring a set of dentures to be assessed.

25. The Trust assessed Mr A required improvements in his oral hygiene level. He presented with basic periodontal exam scores of 2 and 3 (BPE, a screening tool used to assess periodontal health and guide treatment decisions in dental care) and radiographic bone loss which would indicate active or ongoing tooth decay and gum disease.

26. Our adviser confirmed Mr A showed symptoms of gum disease and as he did not take his dental implants for assessment, he did not meet the requirement set out in NHS guidance.

27. Mr A’s records show his dentist had requested he be considered for implants on account of his difficulties wearing dentures. We can see the Trust was aware of his medical history at the point of his assessment.

28. We can see the records show Mr A did not take his dentures to his consultation. As such the Trust could not first assess the quality of his existing dentures and confirm that all conventional options for denture construction have been exhausted and deemed unsuccessful.

29. Restorative dentistry guidance says specialist must assess the quality of the existing dentures and must confirm that all conventional options for denture construction have been exhausted and deemed unsuccessful before considering restorative surgery.

30. Although Mr A was wanting implants, the Trust acted in line with guidance in asking Mr A to attend with his dentures to consider their suitability first.

31. RCS guidance says before considering implants patients must have no evidence of untreated primary dental disease such as tooth decay or gum disease.

32. GDC guidance also says clinicians should work with colleagues in a way that is in the patient’s best interests.

33. When Mr A did not attend with dentures the Trust completed what assessment it could. The dental assessment recorded BPE scores and 2 or 3, in half of Mr A’s mouth. It also noted decay on one tooth and damage to another.

34. The Trust recommended a five-point treatment plan which included Mr A having professional plaque removal and stabilising his gum health over the next 12 weeks. It also recommended repair to the two teeth and new dentures be made.

35. We recognise Mr A disputes he had tooth decay or gum disease. We also understand that Mr A attended the appointment under the impression he was being assessed for implants, which added to his frustration.

36. We asked our adviser if the assessment was in keeping with what we would expect to see, and if the findings were evidence.

37. Our adviser explained that Mr A’s medical history may be a contributory factor to his dental health, but that would not mean he should be automatically accepted for dental implants. They also explained his medical history makes him more likely to experience gum disease.

38. However, gum disease cannot be overlooked because it caused by a health condition, it must still be well managed.

39. Our adviser explained it was appropriate to assess Mr A’s dental health and given the documented findings, refer him back to his regular dentist to stabilise his dental health.

40. Considering the records, the guidance and the advice from our clinical expert, we are satisfied the Trust assessed Mr A in line with RCS and restorative dentistry guidance.

41. It then appropriately referred him back to his regular dentist in line with GDC guidance.

42. We have not seen any evidence that suggests the clinical findings of the Trust were not supported. Despite this we understand how disappointing the outcome was for Mr A

43. As we have not identified any indications of service failure in the complaint, we will not consider it further. We appreciate how disappointing this will be for Mr A. We hope our explanation helps reassure him of the Trust’s assessment.

1. We have carefully considered Mr A’s complaint about East Kent Hospitals University NHS Foundation Trust (the Trust). We are sorry to hear about the very difficult time Mr A has experienced while obtaining approval for dental implants.

2. We have not seen any indications that things went seriously wrong with the Trust’s assessment. This means we will not be taking any further action at this time.