A dental practice in the Lincolnshire area

3. Mrs U complains about the treatment provided by the Practice in 2021. Specifically, Mrs U complains:

· the dentist did not complete agreed dental work to an upper tooth on the front left side of her mouth in August 2021

· the dentist gave her two excessively large injections of local anaesthetic, one to either side of her mouth, leaving her jaw sore and painful for four hours

· the Practice removed her from its patient list in September 2021 due to a breakdown in its relationship with her.

4. In July 2021 Mrs U attended an examination appointment at the Practice. Mrs U says she discussed, and agreed, with the dental surgeon the treatment for her two front teeth, and another upper tooth on the left side of her mouth. Mrs U made her next appointment for August 2021.

5. Mrs U attended her appointment in August 2021 to have the dental work completed. She says she was given two excessively large injections, one to either side of her mouth. She says the injections took four hours to wear off, leaving her jaw sore and painful. Mrs U says no dental work was completed on one of her upper left teeth.

6. Mrs U complained to the Practice two days later. The Practice told her that dental work has been completed, as per the dental treatment plan. Mrs U disagrees and is adamant the dental work has not been done. Mrs U was removed from the Practice’s patient list in September 2021.

10. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and, we have not found any indications that something has gone wrong.

Whether the dentist provided agreed dental treatment

11. Mrs U complains the dentist did not complete agreed dental work to an upper tooth on the left side of her mouth.

12. The GDC standards (1.4.2) say: ‘You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation. You may need to balance their oral health needs with their desired outcomes. If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits, and likely outcomes to help them to make a decision.’

13. Section 1.7.2 of the GDC standards says: ‘If you work in a practice that provides both NHS (or equivalent health service) and private treatment (a mixed practice), you must make clear to your patients which treatments can be provided under the NHS (or equivalent health service) and which can only be provided on a private basis.’

14. The Practice has provided Mrs U’s dental records, treatment plan and X-rays. The treatment plan, which is dated July 2021, sets out the planned treatment of four fillings to Mrs U’s upper teeth, two on the left side and two on the right side of her mouth. Our Dental Adviser confirmed that the records show fillings were placed in Mrs U’s upper right and upper left teeth as planned during the initial assessment appointment in July 2021. They confirmed that all clinically necessary restorative dental work had been completed to the left side of Mrs U’s mouth.

15. It is documented in Mrs U’s dental records that she asked for some dental work which was not clinically necessary. The dental records say that all clinically restorative work has been completed. The dentist has documented in the records that other work has not been completed and that ‘full cosmetics cannot be achieved’. The records say Mrs U had been informed of this and advised to speak to another clinician regarding cosmetic work.

16. We note that the treatment plan which Mrs U has signed says: ‘The NHS provides all the treatment necessary to secure and maintain your oral health. There are some treatments (mainly cosmetic) that are not normally available under the NHS, and you may choose to have these privately.’ Based on this, we consider that the Practice provided the agreed treatment which was clinically necessary in line with GDC standards.

Local Anaesthetic

17. Mrs U complains the dentist gave her two excessively large injections of local anaesthetic, one to either side of her mouth.

18. Section 1.2.4 of the GDC standards say dentists should manage patient’s dental pain appropriately.

19. Our Dental Adviser says the dental records show the dentist administered 2.2ml of local anaesthetic (1.1ml per cartridge) during Mrs U’s appointment. Our Dental Adviser confirms this was a suitable amount of local anaesthetic to provide the correct level of analgesia to complete the agreed dental work. There is no evidence to suggest that relevant GDC guidelines were not followed when administering local anaesthetic.

20. Mrs U says the side effects of local anaesthetic lasted for four hours and left her jaw sore and painful.

21. Information on local anaesthesia on the NHS website says it can take a few hours for the effects of a local anaesthetic to wear off. It also says that patients may experience soreness at the injection site. Based on this, the side effects Mrs U complains about look to be usual side effects of dental local analgesia. We are sorry that the soreness and the length of time the anaesthetic lasted caused concern to Mrs U. We hope she is reassured that there is nothing to suggest she experienced anything untoward as a result of the anaesthetic.

22. As the Practice look to have acted in line with the GDC standards here, there are no indications of failings.

The Practice’s deregistration of Mrs U

23. Mrs U complains that the Practice removed her from its patient list in September 2021 due to a breakdown in its relationship with her.

24. The NHS (General Dental Services Contracts) Regulations 2005 state that where there is a breakdown in the dentist-patient relationship, the dentist may decide to no longer provide treatment to that patient. They must inform the patient and NHS England of this decision.

25. Section 1.7.8 of the GDC standards say the trust between a dentist and a patient may break down, and that the dentist may find it necessary to end the professional relationship. The dentist must be satisfied their decision is fair and must be able to justify their decision. A letter should be sent to the patient notifying them of their decision and the reasons for it.

26. The Practice’s deregistration policy reflects this. It states patients are only removed from the Practice list under exceptional circumstances. These may include a breakdown of trust between the dentist and patient, abusive or violent behaviour towards staff, and non-payment of fees. The deregistration letter will include information on how to find a new practice.

27. The policy also states the dentist responsible for the patient’s care will be responsible for writing the letter to the patient, to make them aware of the reason for their removal.

28. We have looked at the responses provided by the Practice and can see it informed Mrs U of the reason for its deregistration decision. The Practice wrote to Mrs U in September 2021 to tell her that, following discussion with members of the dental team, it could no longer provide dental appointments due to unacceptable behaviour demonstrated on numerous occasions causing stress and anxiety to staff.

29. The Practice said there was an irreversible breakdown in the dentist and patient relationship, which is based on trust.

30. Mrs U’s dental records refer to occasions when practice staff felt her behaviour was unacceptable. On one occasion, Mrs U’s behaviour is described as confrontational and agitated. The records indicate that from 2019 to 2021, Mrs U was often unhappy with what the Practice did or wanted dental work which the dentist did not think was clinically necessary, achievable or in her best interests.

31. Based on the evidence we have seen we consider the Practice was right to consider there had been a complete breakdown in its relationship with Mrs U. On this basis the Practice acted in line with the NHS Regulations and GDC standards by deciding it could no longer treat her. The Practice has also followed its own policy in the deregistration process and has provided information to Mrs U to help her find an alternative NHS dentist.

32. As the Practice acted in line with the relevant standards and its deregistration policy, there are no indications of failings.

33. This concludes our consideration of Mrs U’s complaint. We thank her for bringing her concerns to our attention and we hope she is able to register with a new dentist very soon.

1. We have carefully considered Mrs U’s complaint about a Dental Practice in the Lincolnshire area (the Practice). We are very sorry to hear about the circumstances that led Mrs U to approach us. We recognise the stress and upset she has experienced due to the matters she has complained about.

2. To reach our decision, we reviewed information provided by the Practice, together with information Mrs U provided in writing and by telephone. We also took advice from one of one of our Dental Advisers. Based on the evidence available, we have seen no indication that anything went seriously wrong.