SPSO Individual Decisions

Mr C complained about a dentist's failed attempts to restore his broken tooth with a white composite filling. The filling fell out a week later and was replaced but unfortunately it failed again and fell out two days later. The option of fitting a crown was discussed but Mr C did not consider that he should have to contribute to the cost of this. He subsequently changed dentist and requested that the cost of subsequent treatment under the new dentist was reimbursed. We took independent advice from a dentist. We found that the treatment provided in attempting to restore Mr C's broken tooth was reasonable and in line with standard clinical practice. The dentist had no obligation to contribute to the cost of any treatment Mr C received from his new dentist. Therefore, we did not uphold the complaint. Mr C also complained about concurrent root canal treatment he was undergoing on a different tooth. This was carried out over several visits and, at the second visit, the dentist temporarily restored the tooth and booked Mr C a further appointment. However, Mr C reported that the tooth broke around four hours later when he was eating soft food. We found that the treatment provided was reasonable and in line with normal clinical practice. There was no evidence to support Mr C's concerns that failings in his treatment contributed to the tooth breaking a few hours later, and did not consider that the quality of this treatment should be associated with the subsequent extraction of the tooth by the new dentist. We did not uphold the complaint. Related reading View Decision Report 201803462 as a PDF (24.44 KB) Updated: March 18, 2020

Miss C complained about the treatment which she received from a dentist. She said that she had attended the dentist over a five month period complaining of a sore tooth and that the dentist told her she required eight fillings. Miss C said that following the treatment she still suffered sensitivity and discomfort from the treated teeth and that when she attended another dentist she was told that the fillings were not required. We took independent advice on Miss C's complaint from a dentist. We found that there was evidence from Miss C's x-rays that decay was present in her teeth and that treatment was required. Although Miss C had not reported problems with some teeth, it did not mean that there was no decay present and that, if the decay was not too deep, it is not uncommon for dentists not to record the depth of the decay. There was no evidence to substantiate the complaint that the dentist failed to provide Miss C with a reasonable standard of treatment. We did not uphold the complaint. Related reading View Decision Report 201903208 as a PDF (24.17 KB) Updated: March 18, 2020

Ms C complained about the treatment she received from her dentist, particularly in relation to the fitting of a crown which fractured multiple times and required repairs, and areas of untreated decay. We took independent advice from a dental adviser. We found that the treatment Ms C received from the dentist was unreasonable and we therefore upheld the complaint. The repair carried out to the crown was unreasonable, as was the failure to investigate the cause of the fracture. There were failings in the dentist's record-keeping, and we found that Ms C was incorrectly charged for the repair. There were also failings around the untreated decay, though the dentist had already acknowledged and reflected on this. We noted that the dentist had already apologised for some failings. They had also already taken steps to improve their practice and ensure these issues did not arise again, including carrying out an audit on clinical record-keeping, and undertaking some further training. We asked for evidence of these actions and we also made some further recommendations.

Mr C complained that staff at the dental practice had failed to deal appropriately with his concerns that his gums continued to bleed after having four teeth extracted. He was on warfarin medication (a medication to prevent blood clots) which meant that he was at high risk of bleeding. He reported this to the dentist, who said that it would be alright and he could leave the practice. When Mr C got home, the bleeding continued and he contacted the practice again and was asked to attend. He saw a second dentist who also said that he was not to worry and that the bleeding would stop. However, the bleeding continued that evening and Mr C had to attend hospital, where the bleeding eventually stopped and he was sent home. We took independent advice from an adviser in general dentistry and concluded that the second dentist was aware that Mr C was on warfarin medication and that they had repeated the advice given earlier by the first dentist about what Mr C should do in the event of bleeding from his gums. We considered this to be reasonable and we did not uphold the complaint. Related reading View Decision Report 201702748 as a PDF (11.11 KB) Updated: March 13, 2018

Mr C complained that dental staff at the practice had failed to deal appropriately with his concerns that his gums continued to bleed after having four teeth extracted. He was on warfarin medication (a medication to prevent blood clots) which meant that he was at high risk of bleeding. He reported this to a dentist, who said that it would be alright and he could leave the practice. When Mr C got home, the bleeding continued and he contacted the practice again and was asked to attend. He saw a different dentist, who also said that he was not to worry and the bleeding would stop. However, the bleeding continued that evening and Mr C had to attend hospital where the bleeding eventually stopped and he was sent home. We took independent advice from an adviser in general dentistry and concluded that the first dentist was aware that Mr C was on warfarin medication, that they had checked his clotting status prior to the extractions and that they had stitched and packed the tooth sockets following the extractions. The first dentist had also provided Mr C with a detailed post-operative instruction sheet, which provided advice on action which should be taken regarding any bleeding. We did not uphold the complaint. Related reading View Decision Report 201702492 as a PDF (11.19 KB) Updated: March 13, 2018

Ms C complained about the dental care and treatment she received during a course of treatment for a root canal. She complained that at one appointment, the local anaesthetic injection had resulted in her lower lip becoming tingly for several months, and that it then went completely numb. She also complained that she had not been told of the potential risks of local anaesthetic injections. During our investigation, we took independent advice from a dental practitioner. We found that whilst altered sensation is a rare complication of a local anaesthetic injection, it does not suggest any failing on the part of the dentist. We also found that there is no requirement for dental practitioners to discuss potential risks of local anaesthetic injections with patients. Therefore, we did not uphold Ms C's complaints. Related reading View Decision Report 201603804 as a PDF (10.97 KB) Updated: March 13, 2018

Ms C complained that her dentist had failed to fit temporary crowns properly. As a result they had become detached shortly after fitting. Ms C said when she returned to the dental practice, she was made to wait for an hour, before being told to go home and come in later that day. When she attended again, she felt the dentist was unprofessional and unreasonable as she asked Ms C to leave the surgery and refused to provide her with the impressions that had been taken of her teeth. We took independent advice from one of our dental advisers on the treatment provided to Ms C. We found that the treatment provided was well documented and complied with the appropriate national guidance. Our investigation found there was no evidence that Ms C had received inappropriate or unreasonable dental care. Related reading View Decision Report 201405666 as a PDF (11 KB) Updated: March 13, 2018

Mr C complained that when he went to the practice for root canal treatment, the dentist fractured a crown and broke a portion of a front tooth. The dentist put in the existing crown, which lasted for two days. Mr C returned to the practice, but a further repair only lasted a day. Mr C obtained an emergency appointment with another dentist who inserted a temporary crown. On returning to the first dentist for further treatment Mr C explained he had been in a lot of pain and was unhappy that he had to pay for a new crown. The practice said that Mr C had agreed to save the tooth and in order to carry out root treatment it was necessary to drill through the inner surface of the tooth/crown. At that point it was not possible to ascertain how much tooth structure was present below the crown. The practice said that the first dentist explained this to Mr C and that a fractured crown is a recognised problem which occurs fairly commonly after root treatments. The practice went on to say that it was also relatively common for temporary crowns to fall out, as normally they are only used for two weeks until permanent restoration can take place. Mr C complained to us that the treatment options were not explained to him and he was not told the crown could be damaged. After taking independent advice from a dental adviser, we found that clinically the treatment which had been provided was appropriate. However, we upheld part of Mr C's complaint as we found no recorded evidence that the dentist had communicated the risks to him.

Mr C complained about the care and treatment provided by his dentist in 2010. He said that a denture and replacement filling were not completed properly, and that an existing cavity (area of decay) was not discovered and/or treated. We upheld Mr C's complaint, as our investigation found that the treatment was not of a reasonable standard. We took independent advice from our dental adviser, who commented that there was no record in Mr C's dental notes of the purpose of his first appointment with the dentist. Although the next three appointments followed what would be considered best practice, the adviser said that there appeared to be problems with the denture from the start. She also noted that subsequent adjustments appeared only to make matters worse. There was a lack of detail in the notes about a treatment plan or discussion of treatment options relating to the filling. The adviser was concerned that the filling was done after the construction and fitting of the new denture and said that normal practice would have been to do the filling first. On the matter of the undetected cavity, the adviser said that this was likely to have been present during the treatment but might not have been visible in the mouth. It should, however, have been detectable on an x-ray. She noted that the later removal of this tooth by Mr C's new dentist caused further problems with the denture. X-rays were taken in May 2010 but the records do not make it clear what type they were; on which teeth they were taken or the reason for taking them. The adviser said that Mr C had had considerable work done on his teeth since these x-rays and further x-rays should have been taken before making the denture, as these might have revealed the cavity. Overall, the dental adviser was concerned that the standard of the records did not conform to that expected by the General Dental Council or the Faculty of General Dental Practice (UK). As the practice waived the cost of treatment after Mr C com

Mr C complained about the care and treatment received from his dentist, including that: a root canal treatment was not completed properly; despite requesting a white filling the filling provided was grey; the dentist allowed bleach from a syringe to spill on to Mr C's suit and allowed the syringe to fall on to Mr C's thigh. We upheld Mr C's complaint. Our investigation, which included taking independent dental advice, found that the root canal treatment (a deep filling of the root of a tooth) was not completed properly. Our adviser said that the dentist should have used a rubber dam, which would have protected Mr C's gums from the hypochlorite (bleach) used during the treatment. The adviser was also of the opinion that, although the end result could be deemed acceptable, the root filling was slightly short of the tip of the root canal. She was also concerned at the lack of detail in the dental notes, including a failure to document the working lengths of the canals or what substance was used to wash them out. On the matter of the type of filling used, the adviser stated that it would be normal practice within the NHS to use an amalgam (grey or silver) filling. She said that white fillings can be provided but that this would be on a private basis. The adviser also commented that it is considered best practice to restore a root filled tooth with a crown (a metal and/or porcelain restoration made in a laboratory which covers the tooth) and that all the various options should have been discussed with Mr C. However, we found no evidence that this was done. Overall, the dental adviser was concerned that the standard of the records did not conform to that expected by the General Dental Council or the Faculty of General Dental Practice (UK). On the matter of the incident with the syringe, the dentist acknowledged that this had happened but he could not at the time of the investigation, some two years after the incident, recall exactly what had happened. He acknowle

Mrs C attended a NHS dentist for treatment. While there, she asked for some minor remedial work to a denture that was made at a private practice. Mrs C complained that the dentist had removed extensive material from the denture making it sharp, uneven, and unwearable. Mrs C also complained that the dentist failed to properly handle her complaint. We did not find anything lacking in the dentist's handling of Mrs C's complaint. The evidence showed that the dentist responded to the correspondence within a reasonable timescale, offered an appointment to discuss the complaint in more detail, fully explained her position, offered to discuss the matter with Mrs C's private dentist, and offered to arrange for another dentist in the practice to reline her denture. Related reading View Decision Report 201104613 as a PDF (16.52 KB) Updated: March 13, 2018