SPSO Individual Decisions

Ms C complained to us about the treatment she received from her dentist. She said that the dentist had damaged the cartilage in her jaw and it was causing her severe pain. When Ms C reported this to the dentist she was advised to stay on a soft diet and that she would be referred to dental consultants should the problem remain. We took independent advice from a dentist. We found that there was no evidence that the treatment the dentist had provided was inappropriate or that it was the cause of the jaw problems. We found that Ms C had reported problems with her jaw a number of years previously but that no remedial action was required at that time. We found that the advice given by the dentist was reasonable and appropriate. Therefore, we did not uphold the complaint. Related reading View Decision Report 201805288 as a PDF (23.69 KB) Updated: March 20, 2019

On attending his dentist, Mr C was noted to have dental decay in two of his teeth. It was agreed that this would be removed and his teeth would be filled. Despite this, Mr C remained in pain and he required root canal treatment. The treatment and known risks of such treatment were explained. Mr C experienced one of these risks in that a file broke during treatment and was required to be left in his root canal. Mr C's treatment was completed but he remained in pain. Mr C complained that he did not receive appropriate or reasonable treatment. We took independent dentistry advice. We found that while it was regrettable that the instrument broke, this was not indicative of poor treatment and was a known risk, as was the possibility of continuing pain. We therefore did not uphold Mr C's complaint. Related reading View Decision Report 201604307 as a PDF (10.97 KB) Updated: March 13, 2018

Mr C had treatment to extract two teeth. Immediately after the treatment, he complained about the treatment received and that the dentist had failed to take reasonable account of his hearing condition. He complained that his dentist took too long to carry out the extractions and that he did not appear able to carry out the extractions. He also said that he had advised his dentist of his need to lip read in order to fully understand what was being said to him. However, during the procedure, the dentist had continued to speak to him with a mask on. We took independent advice from our dental adviser, who said that the treatment Mr C received was reasonable and appropriate and that, while the extractions had taken some time, this was reasonable in this case. Our adviser explained that guidance issued by Health Protection Scotland requires dentists to wear full personal protection equipment (PPE), including a mask, during any operative procedure. As such, he considered that it would not have been reasonable to expect the dentist to repeatedly stop the procedure and remove his mask to speak to the patient. This would have required the dentist to remove his PPE, undertake hand hygiene and put on new PPE on each occasion that he stopped to speak to the patient. However, we were mindful of Fife NHS Board's advice that requires staff to respect disabilities. We considered that, in the circumstances, consideration should have been given to offering Mr C the services of an advocate/translator/interpreter or similar. This would have ensured that he fully understood what was being said to him during the procedure.

Mr C raised concerns about the care and treatment he received when he attended the practice in 2014. In particular, he complained that the practice had failed to take reasonable account of his hearing condition. He said the dental nurse had spoken to him while standing behind him and, as a result, he had been unable to lip read. In addition, she had roughly moved his head. He also complained about the handling of his complaint. During our investigation we found no evidence that the dental nurse had roughly moved Mr C's head or spoken to him while standing behind him. We were satisfied that, in line with the practice's policy, the dental nurse was required to wear a mask during the treatment. We were pleased that the dental nurse had re-read the relevant guidelines to try to prevent a similar situation occurring in the future. However, we considered that had a translator been present, as detailed in Fife NHS Board's policy, Mr C's communication needs would have been fully met. We were also critical of the handling of Mr C's complaint and we made a number of recommendations to improve how the practice communicates with patients, and how they deal with complaints.

Mr C visited his dentist because he had toothache. The dentist found an abscess that was discharging pus from the gumline of the third and fourth teeth on the lower right side of Mr C's mouth. As Mr C was already taking a course of antibiotics prescribed by his GP, the dentist said that he should let the inflammation settle before returning to have the teeth extracted. Mr C returned and his teeth were extracted but the pain and swelling continued. He went for an emergency appointment, and the abscess was found on the first lower right tooth. Mr C was referred to local maxillofacial surgeons (specialists in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) who provided intravenous antibiotics before removing all his lower teeth. Mr C complained that his dentist did not provide reasonable treatment during the first consultation. He said he was not already taking antibiotics and that these were prescribed when he found it necessary to visit his GP having been unable to secure an emergency appointment with his dentist. We found clear evidence that the antibiotics were prescribed before Mr C visited his dentist. Based on the information available at that time, we were satisfied that the dentist could not provide any immediate treatment, and we did not uphold this complaint. We were, however, critical that the dentist did not take additional x-rays to identify the true location of Mr C's abscess. The failure to do so delayed treatment by around two weeks and so we upheld the complaint that the care and treatment was unreasonable. However, we were satisfied that the two teeth that were extracted had to come out in any case. We found no evidence to suggest that emergency appointments were requested and refused and did not uphold that complaint.

Mr C complained that he had been inappropriately treated by his dentist. He was unhappy with the insertion of two crowns on teeth in his upper jaw and the removal of a crown from a tooth from his lower jaw. Mr C said that the upper crowns had not been fitted properly, and had left unsightly gaps between his teeth, which had never been there before. Mr C said that the dentist had then referred him to a dental hospital, because the dentist found him too difficult to deal with. Mr C also complained that when attempting to remove the crown from his lower jaw, the dentist had removed almost the entire tooth. He said he had not been warned that this was a possibility and, had he known this, he would not have agreed to the removal of the crown. We took independent advice on Mr C's complaint from our dental adviser. He said the decision to replace the two upper crowns was appropriate, and was supported by the x-rays of the teeth, and that the same applied to the removal of the crown from the lower tooth. He said that gaps between the teeth would have appeared as inflammation of the gums (caused by previous poorly fitting crowns) receded. It was appropriate for the dentist to have referred Mr C to the dental hospital, in line with General Dental Council guidelines, once it became clear he was still unhappy with the treatment he had received. The adviser said that the dental records for the removal of the crown from the lower tooth showed that the treatment options were explained to Mr C. He also pointed out that, had the tooth been left in place, it would have fractured. We did not uphold Mr C's complaints as our investigation found no evidence to support his claims of inadequate and unnecessary treatment. Related reading View Decision Report 201301837 as a PDF (11.38 KB) Updated: March 13, 2018

Miss C had root canal treatment on one of her front teeth in 2012. After the treatment, she experienced pain and swelling which did not improve with antibiotics that were prescribed by her dentist. Whilst on holiday, she visited another dentist (the second dentist) who removed the root canal filling and found that she had two perforations in the tooth. He provided a temporary filling so that Miss C could discuss further treatment with her own dentist when she got home. Miss C was later referred for specialist dental surgery so that she did not have to lose the tooth. She complained that her dentist did not carry out the root canal treatment to a reasonable standard and did not provide her with a reasonable level of aftercare. We found that the tooth had first been root canal treated in 2006, but that this work was not completed. In 2012 Miss C's dentist had removed the original root canal filling and re-filled the tooth. We took independent advice from our dental adviser, who said that Miss C's tooth was filled well and that x-rays taken after the treatment showed no sign of any perforations. The perforations were, however, visible on an x-ray taken by the second dentist, who had used a softer filling material to diagnose the problem. Our adviser explained that the perforations could have been caused either when the first dentist removed the original filling, or when the second dentist removed the first dentist’s filling. Although the infection that Miss C developed was suggestive of a perforation after the first dentist’s treatment, there was no evidence of this on the x-ray. We concluded that there was insufficient evidence to say that Miss C's dentist had caused the perforations. Furthermore, we were satisfied that he took all reasonable measures to establish whether the procedure had been successful, and that he provided appropriate medication and onward referral to a specialist when Miss C had problems following her treatment. Related reading View D

Miss C complained that during treatment a dentist handled her five-year-old daughter (Miss A) with excessive force, and shouted at her. While the dentist was attempting to fill one of Miss A's teeth, she became distressed and moved in the chair. In trying to adjust Miss A's position in the chair, Miss C complained that the dentist handled Miss A roughly, causing bruising to her arm. The dentist indicated that, as Miss A had slid down the chair, he lifted her under the arms to put her back in the correct position. He said he did not use any force and he could not understand the bruising allegation. He also said that he was required to raise his voice to give instructions to his nurse and be heard over Miss A's crying. He said he did not shout at Miss A. In investigating the complaint, we obtained a statement from the nurse which supported the dentist's position. In the absence of any evidence to support Miss C's version of events, we did not uphold the complaint. Related reading View Decision Report 201202549 as a PDF (11.16 KB) Updated: March 13, 2018