A dental practice in the Newcastle area

3. Mrs U complains that when a dentist at the Practice fitted a temporary two-unit bridge in December 2019, they left a small gap between her gum and the unit. She says the Practice did not replace the temporary bridge with a permanent structure in a timely manner which allowed her gums to move.

4. She also says in June/July 2021 a gap appeared between the temporary bridge and the nearby permanent four-unit bridge structure. She says the permanent bridge structure fractured because of this.

5. Mrs U complains the temporary six-unit bridge fitted in November 2021 is too heavily modified, too short in length, not modified to specific moulds and is a different colour to the rest of her teeth. She says it has affected her facial structure, lips and smile.

6. Mrs U would like financial compensation.

7. On 5 December 2019, Mrs U attended the Practice. A dentist extracted an upper tooth and fitted a two-unit temporary bridge to the upper left of her mouth.

8. On 2 April 2020, the Practice postponed Mrs U’s appointment due to the COVID-19 pandemic. In June and July 2021, a dentist extracted two of Mrs U’s lower teeth.

9. On 2 September, Mrs U attended the Practice complaining the permanent four-unit bridge in her upper mouth had been loose for some weeks.

10. On 27 September, Mrs U complained to the Practice about the temporary two-unit bridge fitted in December 2019. On 30 September, the Practice offered to see Mrs U as soon as possible to resolve the issues.

11. On 20 October, a dentist fitted a temporary six-unit bridge to Mrs U’s mouth and took impressions for a new laboratory-made temporary bridge. The dental records note Mrs U understood the bridge work was temporary until her periodontitis (gum disease) settled. On 3 November, the Practice fitted the six-unit laboratory-made temporary bridge to Mrs U’s mouth.

12. On 4 November, Mrs U contacted the Practice to complain about the appearance of the six-unit temporary bridge.

13. The Practice referred Mrs U to the local dental hospital for a consultant’s opinion before any further work could be done.

14. On 19 December, Mrs U complained to us.

Delay in replacing the temporary bridge

18. Mrs U says there was a gap between the bridge and her gum, and the delay in replacing the temporary two-unit bridge with a permanent bridge allowed her gums to move. She says a gap began to appear between the temporary bridge and the permanent bridge next to it in June/July 2021. She says this caused the permanent four-unit bridge to fracture and become loose. We can see from Mrs U’s letter to the Practice she was aware of the need to allow the gum to harden after the extraction on 5 December 2019, before further work could be completed.

19. The Practice explained by letter the fracture to the upper left incisor (tooth) of the permanent bridge is not related to the temporary bridge work. The Practice advised that this was now being stabilised. The Practice explained temporary bridges are usually in place for six months to allow full healing. In this instance, the pandemic extended the timescale.

20. The BSRD guideline says the purpose of temporary restorations is to ‘restore, protect and maintain the position of prepared teeth between appointments and until the placement of the final restoration’.

21. Mrs U had the temporary two-unit bridge fitted in December 2019. Our adviser says a temporary bridge is made before the teeth are extracted for immediate insertion and it is very difficult to predict the exact level of the tissues after the tooth is removed. There is often a space left. This is helpful as the purpose of the temporary unit is to allow shrinkage of the tissues during the healing period. There is nothing to suggest the Practice did anything wrong when it left a gap between Mrs U’s temporary bridge and her gum.

22. In line with the BSRD guideline, the Practice needed to see her for further work to do the final restoration. Our adviser says a temporary bridge is usually in place for three to six months. The dental records say Mrs U was due to attend the Practice for a review of the bridge after three months. Unfortunately, the Practice cancelled Mrs U’s appointment on 2 April 2020 due to the pandemic. This was out of the Practice’s control as there was a national lockdown and there were strict rules on dental services at this time. Dental practices could restart face-to-face care with appropriate personal protective equipment in June 2020.

23. Mrs U did not return to the Practice until June 2021. We asked why she did not go back until then. She explained she was following government guidelines. She says the government considered people over 60, as she was, to be ‘clinically vulnerable’ and to be ‘especially careful’. Mrs U says she contacted the Practice for an appointment in April 2021.

24. When Mrs U returned to the Practice in June 2021, there is no record of any issues relating to the temporary two-unit bridge or permanent four-unit bridge. Mrs U only attended the Practice about these issues in September 2021. She reported having noticed the movement in the permanent four-unit bridge ‘weeks earlier’.

25. It is unfortunate the Practice could not review the temporary bridge as planned in April 2020. The pandemic and pause on services at this time was beyond the Practice’s control. We appreciate Mrs U’s explanation for her delay in attending the Practice. She quite rightly wanted to protect herself and others and follow government guidance.

26. It is not clear that Mrs U had noticed the problems with the bridge when she did attend the Practice in June 2021. It is not mentioned in the notes. And when she attended in September, she said she had noticed the movement in her four-unit bridge weeks earlier, which could have been after her June 2021 appointment. When we weigh up the evidence, the delay in the Practice replacing the temporary bridge with a permanent bridge was because of the pandemic. There are no signs the Practice did something wrong.

27. We have not looked at whether the delay affected Mrs U’s permanent bridge work. This is because we could only hold the Practice responsible for this if it had done something wrong to cause the delay.

How the six-unit bridge looked

28. In October 2021, a dentist at the Practice explained the treatment options to Mrs U as the permanent four-unit bridge was damaged. The dentist explained partial dentures would be the most suitable option. Mrs U chose a six-unit bridge to replace the permanent four-unit and temporary two-unit bridges. Mrs U says this six-unit bridge structure is too heavily modified and is too short. She says the Practice did not modify it to specific moulds and it is a different colour to the rest of her teeth.

29. On 3 November 2021, a dentist fitted a six-unit laboratory-made bridge. The dental records say the dentist explained to Mrs U this was a temporary bridge until her periodontal disease improved and they could organise more treatment. In its 12 November 2021 complaint response, the Practice explains the priority was to replace the failing permanent and temporary bridges.

30. As we mentioned earlier, the BSRD guideline says the purpose of temporary restorations is to ‘restore, protect and maintain the position of prepared teeth between appointments and until the placement of the final restoration’. Our adviser said this must be the focus for the temporary bridge and there would be more focus on aesthetic considerations (how the bridge looked) in the final, permanent restoration.

31. After Mrs U complained about the appearance of the temporary six-unit bridge, the Practice referred her to the local dental hospital for a specialist consultant’s opinion. The Practice advised Mrs U in December 2021 it would not be able to carry out any more work until it had received the consultant’s opinion.

32. We have seen the specialist consultant’s 26 April 2022 clinic letter. They explained to Mrs U that a replacement bridge would be high risk with a significant potential for failure. They recommended partial dentures instead. Unfortunately, the relationship between the Practice and Mrs U broke down and the Practice is no longer treating her.

33. We understand Mrs U was not happy with how the temporary six-unit bridge looked. We appreciate her account about how this has affected her appearance. When we weigh up the evidence, it appears the Practice acted in line with BSRD guidance in how it provided the temporary bridge. Had things turned out differently, she would have returned to the Practice for final restoration work. This would have been dentures, rather than a bridge, but the Practice could have made sure she was happy with the result. We have seen no signs of failings with what the Practice did.

34. We understand how distressing the events have been for Mrs U. It is clear from her account how strongly she feels about the issues. We do not underestimate how this has affected her, and our decision does not take away from this.

1. We have carefully considered Mrs U’s complaint about a dental practice in the Newcastle area (the Practice). We have seen no signs that anything went seriously wrong with the treatment the Practice gave to Mrs U. We appreciate she has been through a difficult experience. We are grateful to her for bringing her complaint to us.

2. The delay in the Practice replacing the temporary bridge with a permanent bridge was a result of the COVID-19 pandemic. We understand Mrs U was unhappy with how the six-unit temporary bridge the Practice fitted looked. When we weigh up the evidence, we think the Practice acted in line with relevant guidance when fitting the temporary bridge.