SPSO Individual Decisions

Mr C complained about the dental treatment which his wife (Mrs A) received from her dentist. The dentist that examined Mrs A had said that there was decay in one of her teeth and that the existing crown should be removed; the decay treated; and a new crown fitted. An estimate was given for the potential costs of the treatment and/or crown, either on the NHS or as a private patient. Mrs A decided to take time to think about the matter and in the interim she increased her dental insurance cover should she have to pay a higher cost for the replacement crown. Mrs A then attended another dentist who said that there was no decay and that remedial work was not required. Mr C felt that the dentist was wrong to state that the tooth had decay and needed treatment, and as a result Mrs A had incurred extra costs. We took independent advice from a dentist. We found that the dental treatment Mrs A received was reasonable and in line with accepted practice. Dental radiographs confirmed that there was decay in the tooth and that the existing crown did require to be removed to allow the decay to be treated. A new crown would then be required. We did not uphold the complaint. Related reading View Decision Report 201810422 as a PDF (23.9 KB) Updated: August 21, 2019

Mr and Mrs C complained on behalf of their daughter (Ms A) about the orthodontic treatment (a speciality field of dentistry that deals with malpositioned teeth and the jaws) she received. Ms A underwent orthodontic treatment to treat mild crowding of her teeth (when there is not enough space for all teeth to fit normally within the jaws). Four of her teeth were removed, and braces were fitted. After the braces were removed Mr and Mrs C were concerned that the treatment had changed Ms A's facial profile and affected her lip support. They believed that there had been other methods of treatment available, which they felt that the orthodontist had failed to discuss with Ms A. We took independent advice from a dental and orthodontic adviser. We found that Ms A's overcrowding was treated appropriately and that a good result was achieved. We did not uphold the complaint about the treatment provided. Mr and Mrs C also complained that the orthodontist failed to obtain Ms A's informed consent before proceeding with the treatment. We found that there was no evidence of a proper discussion of the problem that Ms A presented with or the expectations she had of any treatment. We also did not see any evidence of any information being given to Ms A about what treatment options were availale. We upheld this aspect of the complaint. Finally, Mr and Mrs C complained about their way that their complaint was handled by the orthodontist. We found that the complaint had been handled appropriately and in a timely manner. We did not uphold this aspect of the complaint.

Mr C complained that his dentist had failed to provide him with appropriate dental treatment. In particular Mr C felt that his dentist had taken a radiograph which was not required and that they had tried to promote the use of private dental treatment over NHS treatment. We took independent advice from an adviser in general dentistry and found that the dentist had acted in accordance with the national guidance for taking radiographs. The radiographs indicated that there was decay present in Mr C's teeth and that the dentist had suggested appropriate treatment to be carried out. The records also contained evidence of discussions between the dentist and Mr C where it was explained what treatment was available on either NHS dental treatment or private dental treatment. There was no evidence to suggest that the dentist had promoted private dental care. Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201704505 as a PDF (11.01 KB) Updated: December 2, 2018

Miss C complained about the treatment that she received from her dentist, after they removed one of her teeth. She explained that, following the removal, she felt that the wrong tooth had been removed. This led her to attend another dentist, who found a crack in the remaining tooth, meaning this also had to be removed. Miss C was also unhappy with the dentist's handling of her complaint, as it took almost a year to receive a response. In their response to Miss C's complaint, and in response to our enquiries, the dentist defended their decision to remove the tooth based on the symptoms Miss C presented with. They said that this tooth was loose and the area around it was badly infected, leading them to conclude that this was not saveable and the most likely source of Miss C's pain. We sought independent advice from a dental adviser, who reviewed the records and agreed with this assessment. For this reason, we did not uphold the first complaint. With regards to the complaints handling, we found that there had been a considerable delay caused by the dentist awaiting an independent expert report they had commissioned in order to respond to Miss C's complaint. During this time, the dentist failed to provide Miss C with regular updates, or to formally agree extensions to the deadline for response, which is not in line with the most recent model complaints handling procedure. For these reasons, we upheld the second part of the complaint. However, we considered that the eventual response was reasonable in its content and conclusions.

Mr C complained about treatment that was proposed at an appointment with the dentist. He was also concerned that there was a failure to properly communicate with him about his ongoing treatment. Mr C was advised by the dentist that his tooth was in poor condition and might require further treatment at another appointment, referral to a specialist or extraction. Mr C was unhappy with the information provided by the dentist and did not proceed with any treatment. After taking independent advice on this case from a dental adviser, we did not uphold either of Mr C's complaints. The adviser considered that the dentist's assessment of the tooth in question was reasonable and highlighted no concerns about communication with Mr C regarding his treatment. Related reading View Decision Report 201506141 as a PDF (10.96 KB) Updated: March 13, 2018

Mr C complained about the treatment he received from his dentist at an examination. He was also concerned that the dentist had not advised him that the practice was about to be sold and that a different dentist would be continuing his treatment at a subsequent appointment. After taking independent advice on this case from a dental adviser, we did not uphold Mr C's complaint about treatment. The adviser considered that the examination was appropriate and that while further investigations could potentially have been carried out at the same time, overall, the care and treatment provided at the appointment in question was reasonable. We did, however, uphold Mr C's complaint regarding communication about the change of dentist. We found a lack of evidence that Mr C had been advised of the changes at the practice and received advice that General Dental Council Standards state that patients should be told who will be involved in their care. Related reading View Decision Report 201506140 as a PDF (11.07 KB) Updated: March 13, 2018

Mr C complained about how his new dentist communicated with him after taking over his care. He was also concerned that the dentist had failed to provide appropriate dental treatment to him over a number of appointments. The new dentist took over Mr C's care after his dental practice was sold to a new owner. Mr C advised he had not been told about the changes and felt uncomfortable. After taking independent advice on this case from a dental adviser, we upheld Mr C's complaint regarding communication. The adviser explained that in order to obtain valid consent, patients must be given all options including the risks and benefits of each. We found that there was insufficient evidence that this had been done, particularly with regard to the option of extracting the tooth in question. The adviser also considered that there was a lack of evidence that the changes to staff providing Mr C's care had been properly explained to him, particularly after his treatment became problematic and required referral to a more experienced dentist at the practice. We made two recommendations to address the issues highlighted during the investigation. The adviser found no issues with the actual treatment that had been provided to Mr C by the dentist and so we did not uphold this element of his complaint.

Miss C said she attended the practice for a check-up with the dentist and he removed a tooth which had been causing her pain for some time. She said she suffered extreme pain after the extraction and attended the practice again for an emergency appointment with the dentist. Miss C complained that the dentist unreasonably dismissed the pain she was feeling in her gum and unreasonably failed to notice and treat a hole in her gum. She also complained that the practice manager unreasonably failed to answer her questions about her treatment by the dentist in the practice's written response to her complaint. We obtained independent dental advice on Miss C's complaint from a senior dental practitioner. Our adviser said Miss C's dentist reasonably diagnosed that Miss C had a dry socket (a well-recognised complication of tooth extraction, characterised by increasingly severe pain in and around the extraction site, usually starting 24 to 48 hours post-operatively) and treated it in line with the guidelines and established good practice – suggesting that the pain in her gum was not dismissed. As we were not present at Miss C's appointment, it was not possible for us to say if there was a hole in her gum which the dentist then failed to treat. Given this and our adviser's view that the dentist's treatment of Miss C's condition was reasonable, we did not conclude that the dentist unreasonably failed to notice or treat a hole in Miss C's gum. However, in terms of the complaints handling, we considered that on balance the practice manager's response did not address all the points Miss C made and was not a full response to her complaint. We were also concerned that the practice manager deemed Miss C's letter of complaint to be for information only and initially failed to issue a response, when the letter's contents indicated that a written response was required.

Mr C attended his dentist for a routine check-up. During this check-up the dentist intended to scale and polish Mr C's teeth (a procedure where tartar build-up is removed from the gumline). Mr C refused, as a previous treatment had caused sensitivity to his teeth. The dentist advised Mr C that if he was unable to perform the treatment necessary then he could no longer provide treatment to Mr C and would remove him from his patient list. Mr C complained that the dentist had not followed the correct procedures in de-registering him and the reason for de-registering him was unreasonable. We sought independent advice from a dental adviser. The adviser explained the procedure for de-registering a patient, which involves contacting the local health board. The dentist was unable to provide evidence the correct procedure was followed and we upheld this complaint and made recommendations. The adviser said that it was an individual clinical decision for the dentist to make about whether the relationship had broken down to the point where they could no longer treat the patient. Therefore, we did not uphold Mr C's second complaint.

Ms C was a new patient at a dental practice where she presented with a chipped tooth. She saw a dentist who examined her mouth and did an x-ray which revealed some decay. She attended the dentist six times within two months and during this time, root canal treatment was commenced, she had one extraction and four fillings. Ms C complained about the care and treatment she received. She said that it had been unnecessary and left her with damaged teeth and in pain. However, the dentist said that she had presented with extensively damaged teeth which required attention and that although Ms C had had a difficult time, this was as a consequence of extensive decay. Despite her best efforts, the dentist said that she had been unable to save one of Ms C's teeth. We took independent dental advice, and found that Ms C's notes were poorly recorded and that while decay was present in some of Ms C's teeth for which treatment was necessary, it appeared that one of Ms C's teeth had been treated in error while a damaged tooth received no treatment. We also found that some of the decay was minimal, not requiring the extensive drilling that was undertaken. While the dentist recorded that she had had to give Ms C extensive treatment, the condition of Ms C's mouth as recorded in her notes suggested that she only required oral hygiene advice. We upheld Ms C's complaint.

Miss C attended an emergency dental appointment, as she was concerned about a large lump in her mouth that had become extremely painful and caused her face to swell. The swelling had been developing for a week, and had worsened despite receiving antibiotics and starting root canal treatment with her regular dentist. The dentist at the emergency appointment immediately referred Miss C to hospital, and gave her a letter of referral to take with her. Miss C asked where exactly she should go, and the dentist told her to go to A&E, as they would transfer her to the right unit. However, when she got to A&E, staff told Miss C she was given the wrong advice and the dentist should have phoned the maxillofacial unit (a unit specialising in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) and sent her there directly. At the unit, Miss C had an infected tooth removed and the abscess in her mouth was drained. While she was there, hospital staff called the practice to advise them of the correct referral process for that unit. Miss C complained about the care and treatment she had received. In particular, Miss C was concerned that the dentist had not taken an x-ray, or tried to drain the abscess or remove the tooth themselves. She said that staff at the hospital told her this was a simple procedure, and the dentist could have phoned the hospital and received advice over the phone about this. The dentist explained that in Miss C's condition he thought it was appropriate to refer her for hospital treatment immediately. He apologised for not knowing the correct referral process for the unit, and explained that dentists at the practice had now been made aware of this. Miss C was not satisfied with the dentist's response, and brought her complaint to our office. After taking independent dental advice, we did not uphold Miss C's complaint. We found that the dentist had acted correctly in referring her immediately to hospital, and it would not

Miss C was concerned about a large lump in her mouth, and arranged an emergency dental appointment, where she was given antibiotics and advised to see her regular dentist. By the time Miss C saw her regular dentist a few days later her face was quite swollen. Miss C was advised by her regular dentist to have root canal treatment (RCT) on the infected tooth, noting that Miss C had started this treatment a year earlier but had cancelled the appointment to complete the treatment and not made another. The dentist administered an anaesthetic to start the treatment, but this did not take effect, so asked Miss C to return the next day. When Miss C returned, the dentist administered the anaesthetic and started RCT. However, by the next day Miss C's face was extremely swollen and she was in considerable pain. She attended another emergency appointment and was immediately referred to hospital, where the tooth was removed and the abscess drained. Miss C complained to us about the care and treatment she received. In particular, Miss C was concerned that the dentist did not take an x-ray, or attempt to remove the tooth or drain the abscess in her mouth. After taking independent dental advice, we upheld Miss C's complaints. We found that the dentist should have attempted to drain the abscess, or referred Miss C on if she was not comfortable attempting this. We also found that the dentist should have taken an x-ray before starting RCT. Finally, we found that the dentist's record-keeping was not of a reasonable standard, as there was no proper description of the diagnosis or treatment plan.

Miss C was concerned about a large lump in her mouth, and made an emergency appointment at a dental practice. The dentist who carried out the emergency appointment examined Miss C, prescribed antibiotics and advised her to see her regular dentist. Following further visits to different dentists, Miss C was diagnosed with an abscess in her mouth, and a few days later she was referred to hospital, where the tooth was removed and the abscess drained. Miss C complained to us about the care and treatment she received. In particular, Miss C was concerned that the dentist who she saw during the emergency appointment did not take an x-ray, or attempt to remove the tooth or drain the abscess in her mouth. In response to our enquiries the dentist said that Miss C had been undergoing root canal treatment to her tooth about a year previously, but had cancelled the appointment to complete the treatment and not made another. The dentist explained that, at the time of her appointment, it was not clear whether this tooth was the cause of the problem, as Miss C had multiple treatment needs. After taking independent dental advice, we upheld Miss C's complaint. We found that, while the abscess was probably not swollen enough at that stage to drain it, the dentist should have taken an x-ray to establish which tooth was the source of the infection.

Ms C was a new patient at a dental practice, and had seen a dentist there who started her treatment. However, Ms C complained that when she attended another dentist (the dentist) in the practice as an emergency, she was not cared for or treated properly. She said that the dentist was reluctant to treat her and that when she did, she gave Ms C an injection that caused bruising and facial swelling. Ms C also said that the dentist drilled her tooth too deeply and then left her without finishing the treatment, saying that she did not have the necessary equipment. Ms C believed that her treatment was not carried out properly, and said that it caused her extreme pain and discomfort. We took independent dental advice and found that after examining Ms C's mouth, the dentist gave Ms C appropriate advice and treatment, but did not take an x-ray to review the existing fillings to ensure that she was fully informed. We found that the dentist should also have continued Ms C's treatment, as it was possible to do so without the equipment to which she referred. Alternatively, if she felt she was unable to do this, she should have referred Ms C to a more experienced practitioner. Because of these failings, on balance we upheld the complaint. Our adviser noted, however, that although Ms C suffered discomfort and bruising because of an injection, this was a well-recognised complication and not a reflection on the ability of the dentist.

Mr C complained that a dentist had failed to provide him with an acceptable level of treatment, including root canal treatment, which meant he had to have a significant amount of additional treatment. In considering Mr C's complaint, we took independent advice from one of our advisers, who is a dentist. Although a drill had broken whilst inside Mr C's tooth during root canal treatment, our adviser said that this is a well-recognised complication of the treatment and is a fairly common occurrence. Mr C was concerned that part of the drill remained in his tooth, but there was no evidence of this in an x-ray taken after the treatment. Mr C had also been sprayed with water during the treatment, but the practice had already written to him to apologise for this. We found that it was reasonable for the dentist to try to repair a fractured filling rather than removing and replacing the whole filling, and that it was reasonable to prescribe Mr C with an antibiotic. In addition, we found that there was no requirement for the practice to offer Mr C an emergency appointment when a temporary filling fell out. Overall, we found that that the dental treatment provided to Mr C was reasonable. Related reading View Decision Report 201400117 as a PDF (11.19 KB) Updated: March 13, 2018

Ms C said that when she attended for her six-monthly check up at the dental practice, she reported a problem with a tooth where she had previously had root canal treatment. The dentist said that she had a slight infection and that she needed more work on the tooth. Ms C then complained that the treatment was not carried out in a reasonable way, and that the dentist had not had a proper x-ray done before starting the work. When Ms C raised these matters with the dentist, she said he behaved inappropriately and removed her from his list. After obtaining independent advice from one of our dental advisers, we did not uphold Ms C's complaints. The adviser said that the records showed that an x-ray was taken to establish the working length of the tooth and the length of the filling required. This x-ray did not need to be ready on the day it was taken, but on the day the filling was to be done, and was the x-ray that Ms C (incorrectly) thought had not worked. Ms C also got an infection in the tooth, which was not uncommon, and the dentist had treated it appropriately with antibiotics. Ms C had disputed her care with the dentist and did not accept his explanations about it. The dentist then decided that in his view, as the trust between them had broken down, it would be more appropriate for Ms C to change dentist. Our investigation confirmed that, given the circumstances, he was entitled to do this. Related reading View Decision Report 201303059 as a PDF (11.32 KB) Updated: March 13, 2018

Ms C complained that the care and treatment she received from her dentist on two occasions was unreasonable, both when a temporary filling was inserted into a tooth in her lower jaw, and when she attended a week later for a permanent filling. Ms C said that from the time the temporary filling was applied she felt sick and had a bad taste in her mouth. She also said that part of it broke off, and she swallowed it, after which she also experienced stomach problems. When she went for the permanent filling, she said the dentist injected a local anaesthetic but then did not wait long enough before starting to work on her tooth. When she complained of pain, the dentist injected her again, leaving her face temporarily paralysed on one side, so that she could not close her eye. Our investigation included taking independent advice from one of our dental advisers, who said that the material (Cavit G) was widely used for temporary fillings, and was approved by the relevant regulatory authorities as being safe for use. The adviser said that it was reasonable and appropriate for the dentist to use this in Ms C's case, but that, very rarely, a few patients report similar side effects to those Ms C experienced. The adviser was unable to say whether Cavit G was the direct cause of these in Ms C's case, and noted that the dentist had provided Ms C with a list of its ingredients to take to her GP if the symptoms continued. In terms of what happened with the permanent filling, the adviser explained that local anaesthetic in the lower jaw has to be placed close to the facial nerve and usually takes between two and four minutes to work. However, as the dentist cannot see the facial nerve, and each patient's physiology is different, the placing of the injection can only be an educated guess. This can sometimes mean that a second injection is needed in a slightly different place, which can have the effect of temporarily paralysing the facial nerve. The adviser found no evidence t

Ms C, who is an advice worker, complained on behalf of her client (Mrs A) about a dentist. Ms C said the dentist failed to provide Mrs A with reasonable dental treatment when extracting three teeth. She said that he failed to remove a fragment of bone from Mrs A’s lower gum, resulting in infection, pain and discomfort, and that the follow-up treatment was not appropriate. We obtained independent advice from our dental adviser. The adviser explained that fragments of bone can occur during the extraction process. They are quite often not seen until several days after the extraction and can come out themselves without any clinical intervention. The adviser said the fact that a fragment of bone remained after the extraction was not caused by inappropriate treatment, and that the dentist could not unreasonably fail to remove a fragment that was not evident to him at the time. The adviser said it seemed unlikely that the dentist would have identified a fragment of bone in Mrs A’s gum and then knowingly left it in place. In terms of the follow-up treatment, the adviser said the records suggested that, on the whole, the treatment provided at two of the three follow-up appointments was reasonable. However, because of the dentist's poor record-keeping, it was not possible to say whether the treatment Mrs A received at the remaining appointment was reasonable. Because of this, although we did not uphold Ms C's complaint, we were critical of the dentist’s record-keeping.

Miss C complained about the care and treatment provided by her former dentist, together with the way in which her complaint was handled. During the course of our enquiries, the dentist acknowledged that there were failings in Miss C's follow-up treatment and the handling of her complaint. In order to address these issues, the dentist agreed to apologise to Miss C and reimburse her for the cost of her treatment. Miss C was satisfied with the proposed action and so we considered her complaints resolved. Related reading View Decision Report 201300081 as a PDF (10.8 KB) Updated: March 13, 2018

Mr C complained that a filling that had come loose from one of his front teeth had not been adequately restored, resulting in it having to be replaced several times. He also complained that during the attempts at restoration, healthy tooth tissue was drilled away. Our investigation, which included taking independent advice from a dental adviser, found no evidence of inadequate treatment or that healthy tooth tissue had been drilled away. The adviser said that there are two approaches to this type of restoration, either of which would be considered reasonable. The adviser commented that the position of the tooth and the nature of the restoration would have made this treatment challenging and problematic. The dentist chose one of the two accepted methods and there was no evidence that the treatment provided was not of a reasonable standard. Related reading View Decision Report 201203494 as a PDF (11 KB) Updated: March 13, 2018

Mr C complained about root canal treatment that he had received. He told us that after it he was left with periodic pain for two years, and that he had to pay for corrective work to be carried out by a new dentist. After taking independent advice from a dental adviser, we upheld Mr C's complaint. Our investigation found that the standard of treatment he received was inadequate. The adviser said that an x-ray taken after the treatment showed that the dentist had not completely filled the root canal, leaving space that could then act as a possible further source of infection, and that led to Mr C's problems. We also found that there was a lack of information in the dental records and no record of any discussion with Mr C of the options, risks or warnings given in advance of treatment. In addition, there was no evidence that x-rays taken had been graded or that any report on the x-rays was written.

Mrs C, an advocacy worker, complained on behalf of Ms A about the care and treatment she received at the dental practice when her upper right second molar was extracted. After the extraction, Ms A experienced extreme pain. Her face started to swell and she felt physically sick. She contacted NHS 24 and attended the dental hospital for treatment. Ms A said that the dentist had failed to explain the risk associated with the removal of the tooth and made an error when extracting the tooth. She also felt the dentist had not provided an adequate response to her complaint. We upheld two of Ms C's three complaints. Our investigation found that the dentist had failed to explain the risks involved, and we noted that x-rays were not taken, after difficulties with the extraction were recognised. We also found that there was not enough detail in the dental records and that, while the dentist provided accurate information in responding to Ms A, the response was incomplete because of the inadequate level of detail. However, we found no evidence that an error was made when extracting the tooth, and noted that the complications that occurred were a well recognised complication of the extraction of upper molars.