PSOW Individual Decisions

Ms A complained about the dentalcare and treatment provided by the Dental Practice for her son’s injured front tooth. Ms A said that the Dentist had given contradictory and incorrect advice about her son’s treatment plan and the need for specialist referral. Ms A was also concerned that Dentist who had provided her son’s care had written the response to her complaint. She said that the response was not objective and had failed to answer the complaint that she made. The Dental Practice also wanted to charge her for providing a copy of her son’s dental records. In response to the investigation, the Dental Practice agreed to review the requirements around providing written treatment plans for NHS patients to prevent misunderstandings about care in the future. The Dental Practice also agreed to provide the following to Ms A: a) a fulsome apology for the for the shortcomings in communication and the poor response to her complaint b) a more comprehensive and objective response to her complaint c) a copy of her son’s dental records free of charge As Ms A’s son had already been referred by the Dental Practice for specialist care and his injured tooth had been restored, the Ombudsman considered that it was proportionate to discontinue the investigation based on the actions agreed.

Mrs L complained that although she had raised several formal complaints to the Dental Practice by telephone and in writing, she had not yet received a response to the concerns raised around her husband’s dental care. The Ombudsman found that Mrs L’s complaint had been overlooked and that this had caused delays and frustration for Mrs L. The Ombudsman sought and gained the Practice’s agreement to seek authorisation for Mrs L to act on behalf of her husband, offer an apology for the delays and provide a formal complaint response within 30 working days.

Mrs T complained that the Dental Practice wrote to her and informed her that she had been removed from its patient list on the basis she had been rude and aggressive. Mrs T further complained that despite her writing to the Practice to reconsider the decision, she had not received a response. The Ombudsman was concerned that Mrs T had not yet received a responds to the concerns raised and therefore contacted the Practice. The Practice explained that there was a new Practice Manager at the Dental Practice and that she was not in post when Mrs T was removed from the practice list. As an alternative to an investigation, the Practice agreed to respond in writing to Mrs T’s complaint and provide her with options about her continuing dentalcare within 30 working days

Mr A complained to the Health Board about the service provided at his local branch of Dental Practice after experiencing multiple appointment cancellations at short or no notice. Mr A said that the Health Board failed to ensure that the Dental Practice addressed the issues raised in his complaint about access to services. He was then unreasonably removed as a patient from the Dental Practice list, along with his wife, because he had complained. The investigation identified that the Health Board failed to ensure that the Dental Practice responded to Mr A’s concerns about access to services in accordance with the NHS Complaints Procedure. Although the Health Board tried to resolve the complaint by arranging check-ups for Mr & Mrs A, it did not hand the complaint to the Dental Practice to investigate and respond when those appointments were subsequently cancelled. Consequently, there was a missed opportunity for the Dental Practice to learn from Mr A’s complaint and his family’s poor experience of waiting for care. The Health Board also gave a false expectation that it would help Mr & Mrs A to find a new dentist when they were removed from the Dental Practice list, although this was not a service it provided. The Dental Practice failed to follow professional guidelines and its own policy when making the decision to remove Mr & Mrs A from the patient list at the Dental Practice. There was a lack of evidence to support the reasons given for the decision to remove Mr & Mrs A and a failure to warn them before services were withdrawn. To settle the complaint, the Dental Practice and the Health Board agreed to apologise and each pay financial redress of £250 to Mr & Mrs A in recognition of the failings and the unnecessary time, trouble and upset caused. Both organisations also agreed to share the findings with the appropriate staff to ensure the learning from the complaint. In addition, the Dental Practice agreed to offer the family the opportunity to register as patients at

The Ombudsman found that the concerns were investigated and responded to by the Health Board. The Health Board’s response stated that the Dental Practice had apologised to Mr X, but he said it had not. Following contact from the Ombudsman’s office, the Dental Practice agreed, and immediately took action, to formally write to Mr X to offer its apologies directly to him. The Ombudsman was satisfied that a direct apology had been provided and complaint was therefore resolved.

Mrs C complained that the Practice failed to undertake adequate and appropriate monitoring of the condition of her teeth following root canal treatment (“RCT”) in April 2016. She also complained that she did not receive prompt and appropriate treatment when complications arose following that RCT. The Dentist who carried out the treatment has since left the Practice. The investigation found that a degree of dental decay would have occurred in any event due to Mrs C’s approach to oral hygiene. However, the Practice did not follow the relevant guidance regarding the frequency of intervals between X-rays of Mrs C’s teeth. This meant Mrs C suffered an injustice because her decay could have been identified and treated earlier, with smaller fillings. Consequently, the first complaint was partially upheld. However, Mrs C’s second complaint was not upheld because she consented to the RCT treatment, having received a warning that complications could arise. In addition, the Dentist’s overall care and monitoring of the tooth following the RCT reflected good clinical practice. The Ombudsman recommended that the Practice should write to Mrs C to apologise for the fact her teeth were not X-rayed as often as they should have been for her recorded risk level. The Practice accepted the Ombudsman’s recommendation. The Ombudsman further invited the Dentist to reflect on the findings of the investigation and to review the appropriate guidance as part of her continuing professional development. The Dentist agreed to do so.

Mrs A complained about a Dentist in the area of Hywel Dda University Health Board (“the Dentist). She said that inaccurate information provided during an appointment in June 2019 led her to believe that her daughter’s application for NHS orthodontic treatment had been declined due to her not meeting the Index of Treatment Need. Mrs A said that, on the basis of this information, she made the decision to seek private treatment. Mrs A said that in September 2021 the NHS informed her that the application had been declined due to the Dentist’s failure to provide the correct paperwork for the application to be processed. The Ombudsman found that there was no evidence to support that Mrs A was at any time informed that the reason the application was declined was due to an administrative error on the part of the Dentist. She also found that the complaint response issued to Mrs A by the Dentist made no reference to the June 2019 appointment at all. Further, she found that information contained within Mrs A’s daughter’s records was inaccurate. The Ombudsman concluded that there was evidence of maladministration and poor record keeping on the part of the Dentist, and that Mrs A’s decision to seek private treatment for her daughter was made on the basis of inaccurate information provided to her in June 2019. The Ombudsman sought and gained the Dentist’s agreement to apologise to Mrs A and to reimburse her for the private treatment costs (£1800) incurred in respect of her daughter’s orthodontic treatment.

Ms X complained to the Practice on behalf of Ms Y on 14 December 2021. Ms X complained to the Ombudsman on 6 April 2022 as the Practice had failed to respond to the complaint. The Ombudsman contacted the Practice as she was concerned about the length of time it has taken to conclude its investigation. The Practice agreed to issue its apology and response no later than 31 May 2022 as an alternative to an investigation by the Ombudsman .

Miss X complained that she was left with financial loss due to the treatment received at the Dental practice, and despite putting a formal complaint forward, she had not yet received a response. The Ombudsman was concerned that Miss X had yet to receive a response to her concerns and contacted the Dental Practice. As an alternative to an investigation, the Dental Practice agreed to provide Miss X with a formal response to her complaint by 31 May 2022. The Ombudsman accepted this as a resolution to Miss X’s complaint.

Mrs X complained about the care and treatment her mother, Mrs Y, received from a Dental Practice (“the Practice”) in the area of Swansea Bay University Health Board. The investigation considered whether: a) There was a failure to provide appropriate dental treatment on 24 February 2021, and whether this resulted in Mrs Y suffering with trigeminal neuralgia (a sudden, severe facial pain often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums). b) Mrs Y’s follow-up dental care was appropriate. The Ombudsman found that the treatment Mrs Y received on 24 February was within the range of appropriate dental practice and in line with relevant standards; there was no evidence of service failure in the treatment provided or that there was a causal link between the anaesthetic injections given to Mrs Y before the tooth extraction procedure on this date and the later diagnosis of trigeminal neuralgia. The Ombudsman did not uphold this complaint. The Ombudsman found that it was appropriate not to schedule a follow-up appointment for Mrs Y and that any follow-up appointment was a matter for Mrs Y. However, by the dentist’s own admission, follow-up care on 17 March was not in line with relevant guidance and she had taken action to reflect on the appointment and to re-familiarise herself with relevant guidance. Whilst failure to follow guidance is generally considered to be maladministration, there was no indication that the treatment received had any measurable adverse impact on Mrs Y. The complaint was not upheld.

On 16 September 2019 Mrs X attended the Practice and complained of pain to her tooth and that it smelt. On 18 September a porcelain crown was fitted to the left second premolar tooth (“the UL5”). Mrs X said that the “wrong tooth” was treated, she said that the left second premolar tooth (“the UL4”) should have been treated. Mrs X said that the Dentist had not explained the procedure. Mrs X said that a few days later the UL5 fell out. Mrs X complained that she has been left with a gap in her teeth, she now speaks with a lisp and is unable to smile or have photographs taken. Mrs X sought quotations for private dental work for restoration to the UL5 by an implant. The Ombudsman found that comparison of X-rays taken on 1 April 2020 and 16 April to those taken on 3 March 2021 corroborated that there was no problem with UL4. He found that UL5 was appropriately treated with a crown, the “wrong tooth” was not treated. The Ombudsman found that the uncertainty of treatment with Mrs X and UL5’s limited prognosis should have been discussed. He also found that Mrs X should have been presented with options – removal of the tooth, restoration with either a crown or a large filling, but a crown was preferable. He found that an implant is not provided by the NHS that only offers dentures. The Ombudsman upheld the complaint on the basis that options were not given to Mrs X. The Practice agreed to implement the Ombudsman’s recommendations within 1 month to apologise to Mrs X for the failings, ensure its dentists are reminded to discuss and consider treatment options, and to make a redress payment of £367 as a reasonable contribution towards a denture for UL5 (reflective of a percentage for treatment to the UL5 by denture only).

Ms A complained about the care she received from 2016 onwards from a dentist (“the First Dentist”) based at the Dental Practice and questioned whether it was of an adequate standard. She also remained unhappy with the First Dentist’s handling of her complaint. The Ombudsman’s investigation concluded that the care provided to Ms A by the First Dentist was broadly reasonable and appropriate. However, he identified that there was a failure by the First Dentist to carry out X-rays to monitor Ms A’s teeth between 2018 and 2020 in accordance with the Faculty of General Dental Practice (“the FGDP”) guidance. Whilst this was a failing, he was satisfied that the X-rays taken in March 2020 showed that with clinical intervention, Ms A’s periodontal disease progression might have been prevented. Unfortunately, the delay in treatment due to the COVID-19 pandemic led to a rapid progression of Ms A’s disease to the point that it was untreatable. The Ombudsman concluded that whilst the failings amounted to service failing, they had not caused an injustice to Ms A and this aspect of Ms A’s complaint was not upheld. However, the First Dentist was reminded of the importance of adhering to the FGDP guidance in such cases. The Ombudsman was concerned about the way in which Ms A’s complaint was handled by the Dental Practice, as it did not appear to be in accordance with the NHS complaints procedure Putting Things Right (“PTR”) or its own complaints policy. The Ombudsman was of the view that the matter should have been treated as a complaint against the Dental Practice. This would have enabled better management of the complaint process and meant the Dental Practice was not acting as a “post box” by passing Ms A’s complaint to the First Dentist. The hands-off approach adopted by the Dental Practice and the lack of senior oversight and review of Ms A’s complaint by a senior partner meant the opportunity to learn lessons, an important component of the PTR process, was lost. The Ombudsman fo