SPSO Individual Decisions

Mrs C complained that the dental treatment she received was unreasonable. Mrs  C had been a patient of the dentist for 20 years but received a second opinion from another dentist and was told that she had extensive gum disease. Mrs C was concerned that she was never informed of this and that the treatment she had received was inappropriate. Mrs C also complained that the dentist unreasonably communicated with her about the health of her mouth and that they provided an unreasonable response to her complaint. We took independent dental advice. We found that the patient notes recorded were very limited, with little information about the ongoing overall health of Mrs C's mouth or the investigations or treatments that occurred over the 20 year period. We also found no record of a Basic Periodontal Examination (BPE - a check on gum health that is required to take place at every six month exam). In relation to the dentist's communication with Mrs C, we found that there was little evidence in the dental records that the dentist adequately informed Mrs C about the health of her mouth over the 20 year period. We also found that the response to Mrs C's complaint included inaccuracies and comments that were not supported by the dental record and failed to signpost Mrs C to us at the end of the complaints process. We upheld all of Mrs C's complaints.

Miss C complained about the treatment a dentist provided to her over a number of years. We took independent advice from a dental adviser. We found that there was a failure by the dentist to observe decay in three teeth, and possibly other teeth. Consequently, the dentist failed to plan for the management and treatment of the affected teeth. This meant that Miss C's decay profile was wrong, and she did not receive the level of observation and intervention needed, which led to an increase in the risk of decay and a significant impact on the health of her gums. We also found that fillings placed by the dentist were of a poor standard. We concluded that the treatment provided to Miss C was below a reasonable standard and we upheld her complaint.

Miss C attended the dentist to receive restoration treatment which included having a filling replaced, and previous fillings smoothed over as they still had overhangs of amalgam (mixture used to fill the teeth). The dentist who provided the treatment was undergoing vocational training, and was supervised by another dentist. Miss C complained that the treatment she received was below a reasonable standard. We took independent advice from a dentist and found that overhangs of amalgam were still partially present, despite having been smoothed, and a significant gap was created between two teeth. Both the remnant amalgam and the gap were risks to Miss C's dental health, in particular as she had an underlying risk of tooth decay. We found that the treatment provided to Miss C was below a reasonable standard and, therefore, we upheld the complaint.

Mr C complained about the care and treatment provided to him by his dentist. Mr C attended his dentist after experiencing pain in his teeth. After taking x-rays and performing an examination, the dentist considered there was an abscess around the roots of a tooth supporting the bridge in Mr C's mouth. When Mr C re-attended to discuss this, the dentist documented offering options including an extraction. Some weeks later, the extraction was performed. Mr C said he was persuaded to have the extraction and questioned whether this was appropriate treatment. He also said the dentures he was provided with were uncomfortable and ill-fitting. He said he told the dentist that he ground his teeth, and that the dentist offered a bite shield, which was not provided. After obtaining independent advice from a dentist, we did not uphold Mr C's complaints. We found that there was evidence of options being discussed in the dental records, and consent to treatment. We found the treatment option of an extraction was reasonable in the circumstances. We considered the dentist provided appropriate advice about the dentures and the need to have them re-fitted. We noted that a bite shield would not usually be provided until the condition of a patient's teeth was stable. Related reading View Decision Report 201604467 as a PDF (11.19 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs A about care provided by a dentist. Mrs A attended with a painful front tooth and it was decided that root canal treatment was needed to save it. Mrs A had this treatment over two appointments. However, the tooth later broke while she was eating. Mrs A saw the dentist and emergency treatment was provided. Mrs A experienced pain and swelling following this and saw the dentist about this a few days later. At this meeting, there was a breakdown in the dentist/patient relationship. The dentist completed the treatment and Mrs A later registered with a new dentist. Ms C complained that Mrs A had not been offered options for treatment and that the risks had not been properly explained. She also raised concerns about the dentist's attitude towards Mrs A, and that the dentist had not followed the proper process as they had threatened to deregister Mrs A. Ms C's final complaint was that the handling of Mrs A's concerns had not been reasonable. We took independent dental advice. The advice we received was that the treatment provided was appropriate and was the only option to save the tooth. However, the adviser highlighted that there was no evidence that the risks of the treatment had been properly explained to Mrs A. There was also a lack of records for one of her consultations. We therefore upheld Ms C's complaint. The adviser noted that there was no evidence that steps had been taken to deregister Mrs A and we therefore did not uphold this aspect of Ms C's complaint. We found that the dentist had not included all appropriate information in the response to the complaint and that there were inconsistencies between the complaints handling procedure and the associated staff guidance document. We therefore upheld Ms C's complaint in relation to this.

Mr C complained that the dentist carrying out work on his teeth over a number of appointments acted unreasonably by treating what Mr C considered to be a healthy tooth. We took independent advice from a dental surgeon. They noted that no unnecessary work had been carried out on Mr C's teeth and that his dental records confirmed that treatment had been carried out on teeth needing treatment. Mr C does not speak English as a first language and during the course of our investigation we found that an interpreter was not present at every appointment. Mr C may not have understood fully the treatment that was being carried out. We therefore made a recommendation to address this.

Ms C complained about the dental treatment she received on a tooth that was infected. The tooth had previously had root canal treatment and a crown. Ms C said the dentist had been clear that after two courses of antibiotics, they would take the tooth out and apply the antibiotic directly and replace the tooth temporarily to allow the infection to clear completely. Ms C understood that she would then be able to return in two months and that it would be refitted permanently. Ms C said that she was not made aware that the integrity of the tooth might be compromised or consented to the treatment that was carried out by the dentist. Subsequently, the dentist was unable to replace the root filling and later the tooth fell out. We took independent advice from a dental adviser. We found that the evidence from Ms C's dental records showed significant failings around the consent process and shortcomings in relation to the prescription of antibiotics and taking of x-rays. We also found that the dentist failed to offer and discuss alternative treatments with Ms C and so opportunities to save the tooth were missed. In view of the poor outlook of the tooth, we recommended that the dentist refund the cost of treatment available on the NHS to remedy the situation (a bridge), as well as the costs of the treatments Ms C received during this period.

Ms C said that after having two teeth filled, she began to experience progressively worsening pain. She said that this prevented her sleeping and caused her much distress. However, she said that her dental practice refused to provide her with further treatment on the basis that they considered the cause of her pain to be as a consequence of complex regional pain syndrome (a poorly understood condition where the person experiences persistent and debilitating pain) for which she had been diagnosed in 2008. Ms C then left the practice. She said that the next day she attended an emergency appointment with another dentist. They determined that she had some decay, a dying nerve and a bleeding root canal and she was given treatment which she said provided immediate relief. She then complained that the original dentist failed to treat her appropriately. We took independent advice from one of our dental advisers. The investigations showed that given Ms C's symptoms, the source of her pain had been difficult to establish and diagnose and that, in the circumstances, it had been reasonable to suggest that the cause was complex regional pain syndrome. We also established while an x-ray might have helped with a diagnosis, the dentist concerned had, nevertheless, provided Ms C with reasonable care and treatment. The complaint was not upheld. Related reading View Decision Report 201401744 as a PDF (11.29 KB) Updated: March 13, 2018

Mr C complained that his dental practice had failed to make a referral to the dental hospital within a reasonable timescale. Mr C had teeth which required extraction, and he said that it had taken a long time to get an appointment for this procedure to be carried out. Mr C had other health conditions which meant that once they had received his referral, the dental hospital had made contact with other health professionals involved in Mr C's care to ensure that his treatment could take place. Whilst we recognised that the delay was frustrating for Mr C, we did not find any evidence that any delay was caused by the practice. Mr C also complained that he had been asked to make a payment to secure an appointment with his dentist and was told this was because he had previously cancelled appointments. Mr C was unhappy with this as he said he had always had good reason to cancel and had given sufficient notice. We considered that the dentist had acted reasonably as Mr C had cancelled a number of appointments late or failed to attend. It was, therefore, not unreasonable for the dentist to apply the practice's policy of charges for failed appointments. Related reading View Decision Report 201406169 as a PDF (11.14 KB) Updated: March 13, 2018