SPSO Individual Decisions

C complained about the dental care and treatment that they received. C underwent root canal treatment (RCT) on their lower right tooth. C said that this was not performed appropriately and that they should have been referred earlier to an endodontist (a dentist with special training to treat problems affecting the inside of the tooth). C was also concerned that the dentist had caused injury to the inferior alveolar nerve (a nerve that runs through the lower jaw, providing sensation to the lower teeth, gum, lip and chin), left a gap in their tooth and caused a dent to another tooth. We took independent advice from a dentist. We did not find conclusive evidence that the dentist caused injury to the inferior alveolar nerve or a dent to C's tooth. We noted that the dentist did refer C to the endodontist but we did not find conclusive evidence that this should have happened sooner. However, we concluded that the dentist did not follow current guidance on endodontic practice. There was no evidence of the use of special tests or periapical radiographs (an x-ray that shows the entire tooth, from the crown to the root tip and surrounding bone) taken before the RCT was performed. As such, it was not possible to determine the case complexity. The dentist also used incorrect solution to irrigate the tooth canal and used an old method for assessing the quality of the radiograph imaging taken. Therefore, we upheld C's complaint.

Ms C complained to us that a dentist had failed to provide reasonable care and treatment to her. She said that the dentist inappropriately removed an inlay despite the fact that this had not caused her any problems. We took independent advice from a dental adviser. We found that it had been reasonable for the dentist to remove the inlay, as there was evidence of decay, and to carry out drilling on the tooth to do so. We also found that it was reasonable for the dentist to refer Ms C to a specialist for root canal treatment. There were no failings by the dentist that led Ms C to develop an infection. The presence of decay meant that there was a risk of infection for Ms C, with or without treatment, and this risk would increase through time, given that the decay would most likely spread further. However, we found that there was insufficient evidence that the dentist gave Ms C adequate information about the likelihood of infection. Therefore, we upheld the complaint for this specific reason.

Miss C complained about the treatment she received from her dentist. She said that she had presented with a small chip on a tooth and that the dentist had put on a small filling which repeatedly fell off. Miss C said that at the time of the filling the dentist ground the tooth down with an implement. Miss C said that when the filling fell out she was left with an unsightly tooth and she continually had to pay for the filling to be replaced. We took independent advice from a dentist. We found that there was no evidence that the treatment provided was inappropriate or that it was the cause of the filling repeatedly falling out. The records indicated that the dentist had listened to Miss C's concerns about the tooth and explained the potential treatment options. We considered that the problems Miss C reported to the dentist were likely to have been caused by natural wear and tear and that it was appropriate to have offered her the different treatment options. We did not uphold the complaint. Related reading View Decision Report 201805548 as a PDF (23.76 KB) Updated: May 22, 2019

Mr C attended his dentist over a period of months for treatment for severe tooth pain. The dentist extracted one tooth and referred Mr C to the dental hospital to have a second tooth extracted. When Mr C attended the hospital, they identified a number of issues regarding his teeth. Mr C complained that his dentist had failed to provide the appropriate dental treatment and that, as a result, he had suffered with severe pain over a prolonged period of time. We took independent dental advice. The adviser noted that the dentist did not keep adequate clinical notes in accordance with the guidance published by the General Dental Council. The dentist also did not appear to carry out some of the more basic investigations available for determining the cause of dental pain, and he did not report the findings of an x-ray he took of his Mr C's teeth, which is a requirement of the Ionising Radiation (Medical Exposure) Regulations (2000). We upheld Mr C's complaint and made recommendations.

Ms C complained that her dentist failed to give her appropriate treatment. In particular, she complained that the dentist may have fractured the root of her tooth during root canal treatment. During our investigation we took independent advice from a dental surgeon. The adviser said that a root canal was the appropriate treatment for Ms C's tooth, and found that the root canal had been carried out appropriately, with Ms C's root fracture happening over a year later. We, therefore, did not uphold the complaint. Related reading View Decision Report 201606479 as a PDF (10.8 KB) Updated: March 13, 2018

Ms C complained that a dentist failed to carry out reasonable investigations to find the cause of her dental pain over the course of a year. She also complained that the dentist broke the root of her tooth and left it in her gum during the extraction of her tooth. We took independent advice from a dental surgeon and found that the dentist took reasonable steps to identify the cause of Ms C's dental pain, and that the delay was due to the time she had to wait for an appointment with a specialist. We did not uphold this aspect of the complaint. Whilst the adviser considered the tooth extraction was carried out properly, they felt that Ms C should have been advised that the likelihood of her tooth fracturing during the extraction was high, and offered a referral to a specialist to carry it out. We upheld this aspect of the complaint.

Miss C attended her dentist and reported mild discomfort in an upper tooth. Following an examination including x-rays, Miss C was advised that she required either extraction or root canal treatment of the tooth. Miss C chose to proceed with the root canal treatment which was carried out a few weeks later. Afterwards, Miss C experienced pain and swelling that resulted in her attending at the local out-of-hours service, where she received antibiotics for an abscess. Miss C returned to the dentist and was unhappy with the follow-up service. After taking independent dental advice we did not uphold Miss C's complaint. We found no failings in the care and treatment that Miss C was provided with. The advice we received was that the treatment provided was appropriate and that the risk of the abscess had been covered in the risks and benefits information provided to her. Related reading View Decision Report 201507822 as a PDF (11.02 KB) Updated: March 13, 2018

Miss C complained that her dentist failed to provide her with appropriate dental treatment. Miss C was advised by her dentist that she needed a crown on one of her teeth. She subsequently suffered problems with her tooth and had to receive further treatment. She questioned the advice to place the crown. Miss C also complained about subsequent treatment and the management of her pain during this time as well as the dentist's handling of her complaint. After receiving independent advice from a dentist, we upheld Miss C's complaints. We found that the dentist failed to provide Miss C with appropriate options, including risks and benefits, and therefore failed to get informed consent. We also found that placing the crown was not the best option, given Miss C's periodontal (gum) disease. Finally, we found that the dentist failed to respond to Miss C's formal complaint in line with the NHS complaints procedure.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended two appointments with the dentist to undertake a crown preparation and the fitting of a temporary crown. We took independent advice from a dental adviser who said there was no evidence to suggest the treatment which the dentist provided was of an unreasonable standard and the evidence was that the crown had been fitted satisfactorily. We accepted that advice and did not uphold Mrs C's complaint. However, the adviser identified issues in relation to record-keeping concerning the dentist's discussions with Mrs C concerning her teeth and the suggested likely treatment options. There was no evidence in Mrs C's dental records of these discussions. The adviser said this was not in accordance with the standards contained in the General Dental Council's 'Standards for the Dental Team'. The adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended two appointments with a dentist in the practice to re-cement a temporary crown and then to fit a new crown. We took independent advice from a dental adviser who said that the dentist had noted that the crown did not fit well due to an overgrowth of the gum around the tooth, which the adviser explained was a common occurrence when a tooth has been without a crown or temporary crown for some time. The adviser said that the dentist had quite correctly, and in Mrs C's best interests, decided that this was not acceptable and took remedial action to deal with the problem by excising the excess gum tissue under local anaesthetic and taking impressions for the crown to be remade. The adviser said that the treatment provided by the dentist was reasonable. We accepted that advice and did not uphold Mrs C's complaint. However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended for a review appointment, where she complained of tenderness above an incisor tooth when she pressed on the gum. No treatment was provided by the dentist and Mrs C was advised to book a further review appointment at a later date. We took independent advice from a dental adviser who said Mrs C's symptoms were suggestive of an infection. The adviser said the dentist should have carried out some form of investigation, as a minimum an x-ray, in order to determine the cause and confirm a diagnosis. There was no evidence that they did so. The adviser said that remedial treatment may then have been appropriate or arranging a further review appointment if it was considered that the problem would resolve without further treatment. The adviser considered that the dentist had not provided Mrs C with appropriate treatment. We accepted that advice and upheld Mrs C's complaint. The adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended an appointment with a dentist in the practice as the post and crown on a canine tooth had fallen out. The dentist had rinsed out the tooth using an antiseptic and re-cemented the post and crown, using a crown and bridge cement. The dentist had also advised Mrs C that a new post and crown should be constructed. We took independent advice from a dental adviser who said that there was no evidence that the treatment provided by the dentist was inadequate and both the treatment and advice they had provided to Mrs C was reasonable. We accepted that advice and did not uphold Mrs C's complaint. However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended four appointments with the dentist for the fitting of a new crown and as she was suffering discomfort from a bridge which had previously been fitted. We took independent advice from a dental adviser who said that there was no evidence that the treatment provided by the dentist was of an unreasonable standard or that it was inadequate. The adviser also said that they did not find any failures in the clinical treatment provided by the dentist. We accepted that advice and did not uphold Mrs C's complaint. However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended an emergency appointment with the dentist complaining of tenderness and food trapping in the upper right quadrant of her mouth. The dentist said that Mrs C had an established problem with an upper right crown and provided Mrs C with temporary treatment and advice regarding her upper anterior teeth. The dentist placed a temporary filling in the palatal deficiency (the roof of the mouth) to prevent food trapping. The dentist also prescribed Mrs C antibiotics for an infection in an upper right tooth. We took independent dental advice who said there was evidence the treatment the dentist provided was of an unreasonable standard. The adviser said that the symptoms experienced by Mrs C were suggestive of an infection. Therefore, the dentist should have carried out some form of investigation to determine its cause, specifically, they should have taken an x-ray of the tooth, in order to make an accurate diagnosis. The adviser also said that the prescription for antibiotics had been issued without a clear diagnosis being established or recorded in Mrs C's dental records. We accepted that advice and upheld Mrs C's complaint. The adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment.

Ms C complained to us that her dentist did not refer her to specialists in oral surgery to have her wisdom tooth extracted. She had attended a routine appointment with her dentist and explained that she had toothache in her bottom right wisdom tooth. An x-ray was taken but the dentist decided that, as there was no evidence of disease, the wisdom tooth did not need to be extracted. He therefore did not refer Ms C for dental surgery. We took independent advice from a dental adviser. We found that the dentist had acted in line with the relevant guidelines, which state that impacted wisdom teeth that are free from disease should not be operated on. We did not uphold this aspect of her complaint. Ms C also complained that the dentist did not tell her she would not be referred to have the wisdom tooth extracted. In response to our enquiries, the dentist told us that he had asked Ms C to wait in the waiting area for the results of the x-ray of her wisdom tooth. However, by the time he went to tell her the results, Ms C had already left the practice. The dentist left a note in her records that this was to be discussed with Ms C at her next visit. However, Ms C did not return to the dental practice. We found that the dentist had acted reasonably in relation to this matter and we did not uphold the complaint. Related reading View Decision Report 201507687 as a PDF (11.19 KB) Updated: March 13, 2018

Mrs C sustained nerve damage following dental treatment she received in 2014. She also complained that the dentist failed to respond to the Edinburgh Dental Institute (EDI)'s request for further information after she was referred there for further review. We sought independent advice from a general dental practitioner. We considered that the symptoms Mrs C experienced in October 2014 were consistent with accidental injection of sodium hypochlorite (a solution used to clean out the root canal) through the end of the root of her tooth. This is a rare but recognised complication of the treatment and is not in itself evidence of unreasonable care. We also considered that prior to 2015, it was a risk which would not normally have been discussed with patients before treatment. We did, however, identify the likelihood that the dentist had not used a rubber dam (a device used to isolate the root canal and protect a patient's airway) and concluded that this was unreasonable practice even though it would not have prevented the nerve damage caused. We upheld this part of Mrs C's complaint. We found no evidence to demonstrate that the dentist had not responded to any requests for information from the EDI and we did not uphold this part of Mrs C's complaint.

Ms C complained on behalf of her son (Mr A) about the treatment he had received from his dentist. Mr A had x-rays taken of his teeth and an area of decay was identified in a tooth. The dentist considered that this required a filling and carried out the treatment at a later appointment. Mr A experienced some pain following the filling and returned to have this assessed on two occasions. He then continued his treatment at a different dental practice. Ms C complained to the dentist about the size and shape of the filling. She also questioned why no attempt had been made to protect the nerve before proceeding with the filling, and commented on attempts to treat Mr A's pain with the use of toothpaste for sensitive teeth. In the response from the practice, the dentist advised that the tooth had been lined before it was filled and that at no time had the nerve been exposed. The dentist considered the size and shape of the filling to be reasonable and in proportion to the decay. As a goodwill gesture, a refund was offered for the cost of the NHS treatment Mr A had received. After taking independent advice on this case from a dental adviser, we did not uphold Ms C's complaint. We found that the treatment that had been provided to Mr A represented reasonable practice. Our adviser agreed that the filling was of a reasonable size and shape. They also considered that steps had been taken to protect the nerve and that while toothpaste for sensitive teeth may have had minimal effect, it would not have worsened the situation. Related reading View Decision Report 201402414 as a PDF (11.34 KB) Updated: March 13, 2018

Mrs C complained that part of her dental work was provided on a private basis without her prior knowledge or consent. She said that she was not given a written treatment plan or cost comparison before the treatment was carried out. The dentist said that Mrs C was given a verbal explanation of the treatment options available to her, together with details of the costs, and that fee information was also clearly displayed in the practice reception and on the practice's website. He indicated that Mrs C had provided consent, having been told that part of the treatment was not available on the NHS, and a written treatment plan was not provided as Mrs C had not yet made a firm decision on all the treatment to be carried out. We took independent advice on this complaint from one of our advisers, who is a general dental surgeon. He said that it was not sufficient for patients to receive information relating to treatment costs verbally and through notices displayed in the practice and online. The relevant regulations and guidance require that a written treatment plan, including an estimate of costs, is provided to the patient before treatment starts, and it can be revised later if the treatment plan changes. As Mrs C was not provided with a written treatment plan, we upheld her complaint and made some recommendations. We also found some failings in the dentist's handling of Mrs C's complaint. We were critical that he suggested to Mrs C that no further treatment would be provided until her complaint was resolved or withdrawn. Complaints handling guidance and regulations require that a practitioner's first responsibility is to ensure that the patient's immediate health care needs are being met, if relevant at the time the complaint is made. We did not consider that the dentist's actions were in keeping with the spirit of this requirement. We also identified other areas where the dental practice's complaints procedure was not compliant with regulations and guidance, par

Mr C complained that a dentist had failed to fit a crown properly. He said that the crown was too big and that he could not close his teeth together. He also said that it eventually fractured because it had been too big. We took independent advice on this complaint from our dental adviser. The crown had initially been too big, and Mr C had gone back to the dental practice the day after it was fitted to have it adjusted. The adviser said that minor adjustments are often required to a crown to fit the biting surface correctly, and that this was not unreasonable. The dental notes indicated that Mr C had accepted the adjustment that was made. There was no evidence in the dental records that he later complained about the size of the crown before it broke over two years later. We found no evidence that the care and treatment the dentist provided to Mr C was unreasonable. Related reading View Decision Report 201304163 as a PDF (11 KB) Updated: March 13, 2018

Mr C complained that his dentist did not provide a reasonable standard of treatment. At Mr C's initial appointment, the dentist carried out a detailed examination. She noted that there was extensive decay in one of his lower wisdom teeth and that it might require extraction. When Mr C returned to start the treatment, the tooth was drilled to remove the decay, but this led to exposure of the nerve. The dentist covered the exposed nerve by dressing it with a paste to treat inflammation/infection, and a filling material. She told Mr C that the tooth would need to be extracted at a later appointment. Mr C attended the dentist again two days later as he had pain and swelling around the tooth. The dentist gave him an antibiotic and reduced the filling by cutting it back (this eases symptoms slightly by preventing the patient putting pressure on the tooth when biting). The next day, Mr C contacted NHS 24, as he was concerned about increasing swelling and pain around the tooth. He was referred to an emergency dentist who prescribed a different antibiotic. Mr C saw his dentist again several days later. She was unable to extract the tooth because of the swelling, although she thought that it had gone down slightly. Mr C was later admitted to hospital because the swelling had increased. It was found that he had an abscess and he had an operation to drain the abscess and to extract the tooth. Mr C complained about the dentist's failure to extract the tooth. As part of our investigation we took independent advice from our dental adviser. We found that the decision to delay the extraction of the tooth until such time as it could be fully assessed was reasonable because of the risks associated with extraction of a lower wisdom tooth. However, the dentist had used a substance called glass ionomer to fill the tooth when the nerve was exposed. Our adviser said that this was not an appropriate choice for an exposed nerve and the dentist should have chosen a more approp

Mr C visited a dentist several times in the summer of 2011 where he had seven teeth removed and two fillings. Around three months later, Mr C was admitted to hospital suffering from fever and was subsequently diagnosed with sub-acute bacterial endocarditis (a chronic bacterial infection of the valves of the heart) and underwent surgery. Mr C complained that the dentist failed to prescribe him antibiotics despite Mr C having told him that he felt feverish after the first three teeth were extracted. Mr C said that a hospital doctor had commented that patients undergoing any form of invasive dental treatment should be administered antibiotics. We noted that the dentist treated Mr C for infected sockets in June 2011 by washing them out with an antiseptic solution and packing them with a dressing. This form of treatment is in line with guidance issued by the Faculty of General Dental Practice. National guidance issued by the National Institute of Clinical Excellence recommended that antibiotics were only to be given routinely to a small minority of patients undergoing dental treatment who have a certain heart defect. As Mr C had no previous medical history, such as a heart condition, that would require administering antibiotics before or after the tooth extractions, we considered that the dentist acted appropriately and in line with the national guidelines. Mr C's dental records showed that he was given antibiotics in July 2011 but there was no reason given as to why these were prescribed. The dentist later explained that they were given because infection of the sockets had persisted, which we considered reasonable. Mr C's hospital records showed that the endocarditis was caused by Strep Viridans (a bacteria found in the mouth and throat of most people). The bacteria can enter the bloodstream following a dental extraction but is usually killed by the body's immune system in a healthy person. It is normally only a problem for those with a compromised immune system

Mrs C complained about the orthodontic treatment that her son (Mr A) received. (Orthodontics is the branch of dentistry dealing with the prevention and correction of irregular teeth.) Mr A attended an appointment with the orthodontist and Mrs C completed an NHS form so he could be considered for NHS treatment. The orthodontist found that Mr A's teeth were not misaligned enough to qualify for NHS funding but carried out work privately on his front teeth. Mrs C complained that she was not told that Mr A would be treated privately. She said that she did not agree to this and that she only became aware of the decision when she relocated to England and found that the orthodontist had withheld Mr A's clinical records because the bills were unpaid. We found that Mr A should not have been considered eligible for NHS treatment. However, the orthodontist should in that case have obtained written consent from Mrs C for private treatment to be carried out. The decision to provide the treatment was confirmed in writing to Mr A's dentist, and the orthodontist said that it was discussed with Mrs C during the appointment, along with the associated costs. However, we found no evidence in the records to show that this was discussed with Mrs C. Neither did we find evidence that consent was obtained, or that any payment was taken once treatment commenced. We also found that it was inappropriate for the orthodontist to withhold Mr A's clinical records. We made recommendations to address thse failings.