SPSO Individual Decisions

C complained about being de-registered from their dental practice. C also complained that the practice failed to handle their complaint reasonably. Due to a broken tooth, C phoned for an emergency appointment and was told they could attend the same day. However when C arrived, they were given a temporary substance to place over the tooth until an appointment the next day. When C later phoned the practice to explain their situation had worsened, they were told to wait until the following day. C emailed the practice to complain about the service they had received but returned the following day to have the tooth treated. A year later, C requested an emergency appointment but was told that they had been de-registered and would not be seen. We found that there was only very limited evidence to show that the de-registration letter was ever sent and that there was a delay in doing so. We found that the lack of record keeping in this case has made it difficult to assess the practice’s complaint handling. This in itself is unreasonable, given the concerns C raised. Overall, we upheld both complaints.

Mrs C complained to us on behalf of her husband (Mr A) about dental treatment he had received from the practice. Mr A went to his dentist regarding a tooth that was causing him pain. The tooth was x-rayed and subsequently filled. Mr A experienced severe pain overnight after having the filling, and booked an emergency appointment for the following day. At the appointment, Mr A was seen by a different dentist. The dentist performed an extraction of the tooth. Mr A complained to the practice and said that he did not consent to having his tooth extracted. Mr A said he had discussed with his previous dentist that if the filling was not effective, then a root treatment would be the next course of action. Mr A said he would not have wanted his tooth extracted because there was already a missing tooth next to it. Mr A also complained that he had been told the level of bleeding he experienced was normal and he did not agree with this. We took independent advice from a dentist and found that the dental records indicated that the dentist did consult with and obtain consent from Mr A. The adviser also confirmed that Mr A was correctly advised regarding bleeding. As a result of Mr A's complaint, the practice have included the extraction of wisdom teeth in the list of procedures that require written consent. Our investigation found that the practice did not fail to obtain consent to extract Mr A's tooth and that they correctly advised him regarding the level of bleeding following a tooth extraction. We therefore did not uphold the complaints. Related reading View Decision Report 201608073 as a PDF (11.33 KB) Updated: March 13, 2018

Mr C complained about his dentist's charging policy. However, the complaint was resolved when the dental practice offered to change it. There were therefore no grounds for investigation and we closed the case. Related reading View Decision Report 201505349 as a PDF (10.66 KB) Updated: March 13, 2018

Mr C saw a dentist at the practice. Arrangements were made for future treatment and Mr C attended a further appointment a few weeks later. In the interim, ownership of the practice had changed and Mr C was seen by a new dentist. He complained that the practice had not advised him of this change. The practice responded to Mr C's complaint and explained that they had been assured by the previous owner that all patients would be advised of the changes prior to the transfer. They also advised that no other patients had reported problems with this and that they were reassured that it had been an isolated incident. After investigating Mr C's complaint, we accepted his position that he was not made aware of the upcoming changes at the practice. However, as the practice expected all patients to have been informed of this by the previous owner, we considered it was reasonable that they did not take steps to separately advise Mr C of the changes. Consequently, we did not uphold this complaint. We made a recommendation to the practice that they review their complaints handling procedure as, during our investigation, it was noted that some parts were not in line with Scottish Government guidance on NHS complaints.

Ms C was charged by her dental practice for a missed appointment. Ms C felt this was unreasonable in the circumstances and complained to the practice about this. She was dissatisfied with the practice's response and made further complaints. Following a subsequent visit to the practice she and her daughter were removed from the practice's treatment list. Ms C complained about this and was dissatisfied with the response she received. She complained further and also received a reminder for a check-up despite her having been removed from the practice's treatment list. Ms C complained about these matters but did not receive a response from the practice. She raised her complaints with this office. We attempted to resolve the matter but this was unsuccessful. Following consideration we decided that the practice's actions in charging Ms C for the missed appointment, failing to send a reminder for an appointment and sending two copies of the letter advising Ms C that she had been removed from their treatment list were not unreasonable. We also found that there was insufficient evidence to determine whether the practice had refused to treat Ms C's daughter due to Ms C's outstanding debt. However, we did decide that the practice's actions in refusing Ms C's request for a meeting to discuss her complaints, the process by which they removed Ms C from their treatment list, their response to Ms C's complaints and their having sent her a reminder for a check-up after they had removed her from the treatment list were unreasonable and upheld these aspects of the complaint.

Miss C complained to us about her dental practice's handling of a complaint she made. She said that the practice's response to her complaint was inadequate, as it failed to address all the questions she had asked, and did not include comments from two of the three dentists she had complained about. After investigating the matter, we upheld Miss C's complaint. We found that the staff member who dealt with Miss C's complaint had only sought comments from one of the dentists involved, and the other two had been given no opportunity to comment. The staff member also failed to check the response, to ensure that it addressed all of the relevant points of the complaint. While the dentist who did respond answered Miss C's questions relevant to the care he provided, and apologised appropriately for some aspects of treatment, the lack of coordination meant that the overall response was poor. We also found that the complaints handling policy used by the practice appeared to be out of date and did not meet the Scottish Government's requirements for managing complaints about health services. This meant that the practice had failed to meet relevant requirements, such as including information in their acknowledgement letter about the complaints handling process and Miss C's right to bring her complaint to us. The policy also had incorrect information on where to direct customers if they remained dissatisfied, as it said that complaints could be directed to the board (instead of us).

Mrs C attended the practice for a routine check-up, and returned several days later for treatment to fill a small hole in her upper left molar. Mrs C assumed that the person who carried out the procedure was a dentist, although they were actually a dental therapist. That evening, the side of Mrs C's face became extremely swollen and next day she had a large area of bruising and was in pain. The following week, an x-ray showed that there was an infection in the tooth, and the practice prescribed a course of antibiotics. The pain settled four days later, and the bruising took another four days to disappear. Mrs C said that a dentist at the practice told her that it had been a very deep filling, which had possibly damaged the nerve, and he would have to remove the crown to treat it. Mrs C was concerned when she saw the extent of the planned work, and that it would cost over £400 to restore the appearance of her tooth. We took independent advice on this complaint from one of our advisers, who is a dentist. The adviser said that it was reasonable not to carry out an x-ray before the procedure, but that there were communication failures. There was no evidence that Mrs C's consent was obtained in relation to the status of the healthcare professional carrying out the procedure, and during the procedure it appeared that Mrs C was not told about the degree of the decay and possible consequences of future treatment. However, the adviser also said that the treatment Mrs C received when she went back and the proposed course of treatment to address the problems were reasonable. Overall, we upheld Mrs C's complaint as although we were satisfied there was no evidence that the treatment was unreasonable, we found failures in care in relation to communication and consent.

Miss C complained that her dental practice had decided to remove her from their patient list without providing her with treatment for a three month period in accordance with national guidance. She also told us that she made a complaint to the practice in 2012 and that she had not been told the outcome. We found that, although the practice had the right to give notice of removal from the list, they also had a statutory duty to provide dental treatment for a three month period after their decision. Their final letter to Miss C did not mention this, and so gave the impression that termination would take effect immediately. We also found that the practice did not deal with the previous complaint appropriately and should have told Miss C of the outcome of their investigation into that complaint.

Mr C raised a complaint about how a dental practice had handled his representations about treatment that he had received by a dentist at the practice. Although it was difficult to establish the exact sequence of events after Mr C complained, our investigation found that the practice had not handled his complaint in line with their complaints procedure and we upheld his complaint.

Miss C attended the dental practice complaining of pain in her lower left five tooth. She said that she specifically pointed this out to her dentist. The dentist recorded in the notes that the lower left seven tooth was mobile with a discharge of pus coming from the buccal aspect (cheek side of the tooth). The dentist then extracted the lower left seven tooth. After around 20 minutes, Miss C returned to the practice and complained that the wrong tooth had been extracted. The dentist recorded that the lower left five tooth was mobile and then removed it. The dentist also recorded that she had apologised to Miss C and explained that the lower left seven tooth was not treatable by any means other than extraction. In her complaint to us, Miss C understood that the dentist said she would not charge her for this extraction. Our investigation found that the notes completed at the time said that the lower left seven tooth was to be extracted, so we could not say for sure whether the wrong tooth was extracted. However, Miss C clearly thought that it was the lower left five tooth that was to be extracted. We found that the dentist did not obtain consent appropriately and did not communicate with Miss C effectively. In responding to Miss C's complaint, the dental practice said that the dentist was aware of the crucial importance of securing valid consent prior to any treatment and would not have proceeded with the removal of the lower left seven tooth unless she believed that Miss C understood and agreed to this treatment. We concluded, however, that this was not the case and upheld Miss C's complaint that the practice had provided incorrect explanations as to why the tooth had been removed.

Mr C complained that his 14-year-old son (Master A) had six baby teeth extracted by his dentist. At the time the family were told that this was necessary to allow room for his adult teeth to come through. Master A also had an adult molar removed, again to allow space for the rest of his adult teeth to come through. Mr C has now learned that his son has a congenital problem (a condition present at birth) that means he has no further adult teeth to come through. Mr C said that the dentist was wrong to have extracted the teeth when there was no clinical need to do so. We upheld Mr C's complaints. We found that overall there was a lack of documentation to show what the dentist discussed with him. Although there was no evidence about whether it was clinically appropriate to have extracted Master A's baby teeth, we found that the dentist should have sought specialist orthodontic advice before carrying out the procedure. We found that the adult tooth which was extracted had been heavily filled. However, while it may have been appropriate for the dentist to have extracted it, there was no evidence that a treatment plan had been carried out or that informed consent had been obtained.

Mrs C complained about treatment she received from a dental practice. She had had a replacement bridge fitted which caused her difficulties. The practice and Mrs C had different views about what had happened. Mrs C said her dentist had advised her to have the bridge replaced, but the practice said that Mrs C had expressed dissatisfaction with her original bridge and had made several requests for it to be replaced. When we looked at the written records, these did not show that Mrs C had been fully informed of the risks of having her bridgework replaced. On this basis we upheld the complaint as we found that Mrs C had not been able to give fully informed consent to the procedure. Mrs C also complained that the bridge was inadequate. It fractured, fell out on several occasions and Mrs C developed abscesses. We found that the practice had replaced the old single-unit bridge with a bridge in two parts, which was not in the original approved treatment plan. After taking advice from our dental adviser, we found some aspects of the work unsatisfactory, in particular that Mrs C's bite was not properly assessed at the fitting stage, the bridge had to be re-fixed a number of times and the porcelain had fractured. We also upheld this complaint. Finally, although we recognised that the practice had refunded Mrs C the cost of the bridge and referred her for specialist treatment, we found that they had failed to correct the work, as Mrs C has continued to experience numerous difficulties.

Mrs C had root canal treatment from her dentist. She complained that the dentist did not tell her that there was a risk that, if the root canal treatment failed, Mrs C could lose the tooth and ultimately need a crown. Mrs C did lose her tooth and felt that the treatment was unnecessary and that the tooth could have been saved had another form of treatment been given. She also complained that other possible treatment options were not discussed with her and the response to her complaint was unreasonably delayed and contained inaccurate information. Dentists have a duty to explain any commonly encountered or serious risks and any risks of particular concern to the patient. We found that there was no evidence to show that the dentist had done so in Mrs C's case. Nor was it clear whether the dentist discussed other treatment options (in this case, extraction of the tooth) with Mrs C. We upheld this complaint. We did not uphold the complaint that root canal treatment was inappropriate. Although the results of such treatment can be uncertain, our dental adviser said that it was the only long term treatment with any possibility of success for the symptoms Mrs C was experiencing. Finally, we upheld the complaint about the dentist's complaints handling. We found that ten weeks was an unreasonable length of time for Mrs C to wait for a response to her complaint, that she had not been proactively updated on its progress by the dentist and that the letter contained inaccuracies.