A dental practice in the Plymouth area

4. Mr A complains about the treatment he received from the Practice in April and June 2019, to treat a broken filling.

5. Mr A complains the Practice did not properly repair his filling during his appointment on 25 April 2019. Mr A also complains the Practice did not see him as an emergency on 26 and 27 June 2019.

6. Mr A complains this left him in a lot of unnecessary pain and it was difficult for him to eat.

7. Mr A wants the Practice to make systemic improvements and offer him financial compensation.

8. This is a summary of the events leading to Mr A’s complaint. We have not included all the details as those involved are already aware of this information. However, we have included this background to put the complaint in context.

9. On 25 April 2019, Mr A was seen at the Practice because his filling was broken, he was in pain, and was struggling to eat. His tooth was filled with glass ionomer cement (GIC).

10. On 17 June 2019, Mr A’s filling fell out and he attended the Practice again. He was in pain, his mouth had swollen, and he could not eat. The Practice replaced his filling.

11. On 26 June 2019, Mr A contacted the Practice to arrange an urgent appointment as the same tooth was causing him pain. The Practice could not see him that day. Mr A contacted the Practice again on 27 June and was seen on 28 June 2019. During this appointment, the dentist gave Mr A a GIC filling, and he agreed to root canal treatment.

12. The Practice completed Mr A’s root canal treatment in April 2021.

Mr A’s appointment on 25 April 2019

16. Mr A complains the dentist did not correctly repair his filling when he attended the Practice on 25 April 2019. Mr A feels the dentist should have removed his entire broken filling before replacing it with a new filling. He says he was in unnecessary pain and found it difficult to eat because of the poor treatment he received.

17. We can see during Mr A’s appointment, on 25 April 2019, the dentist suspected he had decay underneath the broken filling. This is recorded in the dental records as ‘??caries detected with probe under existing amalgam’. We can also see the dentist treated Mr A’s broken filling by refilling it with glass ionomer cement. We cannot see any evidence the dentist treated Mr A’s suspected decay.

18. We have found the Practice should have done more once the dentist suspected decay under Mr A’s broken filling. We appreciate this appointment was arranged on an urgent basis and was time restricted. FGDP’s guidance on dental emergencies says a treatment plan should be agreed which will generally be limited to resolving the emergency issue. It also says the dentist should arrange to complete the treatment, arrange any follow up treatment, or arrange another examination if needed.

19. We have found the Practice did not follow this guidance when its dentist repaired Mr A’s filling without treating, or arranging follow up treatment for, his suspected decay.

20. The Practice confirmed Mr A had an X-ray before the dentist assessed him on 25 April 2019. We cannot see this in Mr A’s records, but we have seen a copy of the X-ray. Our adviser said the image shows widening of the periodontal ligament at the root of the tooth. The British Dental Journal’s (BDJ) ‘Endodontics: part 3 treatment of endodontic emergencies’ says the widening of the periodontal ligament is evidence of irreversible pulpitis which should be treated with root canal treatment. However, our adviser said it is unlikely root canal treatment could have been carried out during an emergency appointment. The Practice should have arranged follow up treatment, in line with FGDP’s guidance.

21. There is no evidence in the records that the dentist arranged any follow up treatment after the X-ray showing widening of the periodontal ligament.

22. In summary, there was a clear opportunity for the Practice to treat Mr A’s tooth further than applying a temporary GIC filling. The dentist suspected decay in Mr A’s tooth. The periodontal ligament of the tooth had widened, which is evidence further treatment was needed. Unfortunately, the dentist did not recognise this. We have found a failing.

The impact of the failings on 25 April 2019

23. Mr A says the Practice’s failings meant he was in unnecessary pain and found it very difficult to eat. If the Practice had arranged root canal treatment on 25 April 2019, as it should have, this would have limited the amount of time Mr A was in pain and struggling to eat.

24. The Practice did not discuss root canal treatment with Mr A until 28 June 2019. We have found it should have had this discussion with him over two months earlier, on 25 April 2019.

25. We understand Mr A’s pain would not have been entirely relieved until he had his root canal treatment. The treatment did take a long time to complete. The Practice told us Mr A had his final treatment in April 2021. We understand the Practice did not have a full team of dentists in 2019, and then faced the challenges caused by the COVID-19 pandemic in 2020. However, if the Practice started arranging root canal treatment two months earlier than it did, Mr A would have been able to complete his treatment nine weeks earlier. This delay meant he was in pain and finding it difficult to eat for nine weeks longer than he should have been.

The Practice’s triage of Mr A’s symptoms on 26 and 27 June 2019

26. Mr A complains the Practice should have seen him on the same day when he contacted it on 26 and 27 June 2019. There is evidence Mr A contacted the Practice with swelling and pain he could not manage with pain relief. The Practice did not see Mr A until 28 June 2019 where it treated him and made arrangement for further root canal treatment.

27. The Practice should have seen Mr A within 24 hours of him first contacting it on 26 June 2019. Dental practices in England use the Scottish Dental Clinical Effectiveness Programme ‘prioritising dental emergencies’ for guidance when triaging possible dental emergencies. This guidance says a patient with severe dental pain, and with swelling that cannot be controlled at home, should be seen within 24 hours.

28. Mr A reported symptoms the guidance says should be triaged as an ‘urgent’ appointment and the Practice should have followed the guidance and seen Mr A within 24 hours. The Practice did not see Mr A until 48 hours after reporting his symptoms. We have found a failing.

The impact of the failings on 26 and 27 June 2019

29. Mr A complains he was in unnecessary pain and found it difficult to eat on 26 and 27 June 2019.

30. We have found the Practice did leave Mr A in pain, and with difficulty eating, for longer than necessary. If the Practice acted in lined with the guidance, it should have seen him on 27 June 2019, at the latest. Unfortunately, it did not see him until the following day. It then repaired his filling, which resolved the immediate acute pain and discomfort. It also arranged further treatment for 19 July 2019. This meant Mr A was in acute pain and discomfort for a day longer than he should have been.

1. We have found a dental practice in the Plymouth area (the Practice) did not treat Mr A correctly when he needed his filling repaired on 25 April 2019. We have also found the Practice should have seen Mr A within 24 hours when he contacted it for an appointment on 26 June 2019. Based on what we have found, and the impact it has had on Mr A, we uphold his complaint.

2. These failings caused Mr A unnecessary pain and made it difficult for him to eat. The Practice has not acknowledged its failings so we have recommended actions it should take to remedy this for Mr A.

3. We recommend the Practice acknowledges its mistakes and the impact these had on Mr A, makes service improvements, and pays him £500.