A dental practice in the Leicester area

5. Mrs L complains about the care and treatment she received from the Practice on 16 April 2021 after visiting it with tooth pain and throbbing. Mrs L says the Practice incorrectly fitted a temporary filling.

6. As a result of the claimed failings, Mrs L says she has been left with no tooth, which is visible when she smiles. She says she experienced severe pain and swelling due to the dental treatment and had to have time off work as a result.

7. She will now have to pay for a false tooth and is anxious to visit any dentist.

8. As an outcome of her complaint, Mrs L would like compensation.

9. On 16 April 2021 Mrs L attended the Practice and was diagnosed with an abscess. The Practice fitted a temporary filling and gave her antibiotics.

10. The next day, Mrs L was experiencing more pain and had significant swelling around her cheek, which then spread towards her eye.

11. On 18 April 2021 she attended her local hospital due to the swelling and pain. She saw the maxillofacial doctors (doctors who specialise in treating the mouth, jaws, face and neck), who said, due to a filling being put over the abscess, the pus could not drain itself.

12. Due to this, doctors had to cut her gum to release the pus, extract her tooth and prescribe her further antibiotics.

16. Mrs L complains about the care and treatment she received from the Practice. She says during her appointment on 16 April 2021, the Practice fitted a temporary filling over her dental abscess and gave her antibiotics.

17. She was advised to book an appointment to have a permanent filling later. She says the Practice told her the tooth would not need removal.

18. Mrs L says her pain increased, and the swelling got worse. She then went to A&E and was advised a filling should not have been placed on the tooth. As a result, doctors cut her gum, removed the tooth and gave her further antibiotics. We understand this must have been very distressing.

19. She says she was left with no tooth, which impacted her confidence. She had to have time off work due to the pain and swelling. She has had to pay for a false tooth and is now apprehensive about visiting a dentist.

20. In the Practice’s response letter, it apologised if Mrs L was unhappy with the care it gave. It explained it gave the advice and treatment with Mrs L’s best interests in mind.

21. It says while Mrs L was very accepting of the tooth needing an extraction, Mrs L expressed she would like to save the tooth. The dentist tried to help her achieve that while providing all the treatment options.

22. As part of our investigation, we have reviewed Mrs L’s dental notes from her appointment with the Practice. They state swelling had appeared overnight, the tooth was painful and it was affecting Mrs L’s sleep. They also say Mrs L would like the filling to be replaced, as the previous one had fallen out.

23. The notes state Mrs L’s diagnosis was an abscess due to a lost filling. They say treatment options were discussed with Mrs L, which were tooth extraction, root canal treatment (a dental procedure used to treat infection at the centre of a tooth) or pulp extirpation (removal of the nerve and central part of the tooth structure).

24. It is recorded Mrs L opted for a temporary filling to be placed on the tooth, which could later be replaced with a private composite (tooth coloured) filling, and the patient declined all other treatment options. We acknowledge Mrs L does not recall being made aware of the treatment options.

25. We have viewed the hospital notes from when Mrs L attended A&E on 18 April 2022 and saw the maxillofacial doctors. The notes confirm Mrs L had a great deal of swelling and pain.

26. Mrs L’s tooth was extracted without any complications, and she was then discharged with antibiotics. From viewing the notes, there are no records that suggest Mrs L should not have had a temporary filling placed on the tooth.

27. Our adviser says it is recommended to seal the tooth with a temporary filling, as if the tooth is left open, more microbial cells, species, bacterial products are allowed to gain access to the root canal through the pulp and the peri-radicular tissues (area surrounding the apex of the root).

28. We refer to ‘Microbial causes of endodontic flare-ups’ (International Endodontic Journal, 20 June 2003), which states:

‘The practice of leaving the pulp or canal of teeth open and unsealed with temporary filling for the purpose of drainage is non-scientific and contrary to the accepted surgical practice, is unnecessary and is, in consequence, a bad practice. This practice is incoherent and detracts from sound biological principles of endodontic therapy.

To leave the tooth open is the most direct way to permit the reinfection of the root canal system in addition to overcome any previous attempts to eradicate microorganisms within the root canal system.’

29. Our adviser says the practice of leaving the tooth open for the purpose of drainage is no longer recommended as it can lead to further complications (like a flare-up of swelling) and reduce the success rate if root canal treatment is given.

30. As documented in the GDC’s ‘Standards for the Dental Team’, principle three:

31. ‘You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs’. From viewing the available evidence, there is nothing to suggest all the treatment options were not explained to Mrs L.

32. From viewing the dental notes, we can see no evidence to suggest the Practice did not obtain consent from Mrs L in relation to the treatment, but we do appreciate Mrs L does not recall this.

Conclusion

33. As a result of our investigation, it is our decision to not uphold Mrs L’s complaint.

34. We consider the Practice acted in line with the relevant guidelines when it placed a temporary filling on Mrs L’s tooth.

35. This does not detract from Mrs L’s experience and the understandable pain she went through.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs L’s complaint about a dental practice in the Leicester area (the Practice). It is clear Mrs L had a distressing experience. We understand she would like answers as to whether the Practice was correct in the treatment it gave her.

2. The evidence available to us shows the Practice placing a temporary filling over Mrs L’s abscess was in line with clinical guidelines. As such, we have found no failings.

3. We will explain our reasons for our decision in this report.

4. Complaints give us valuable insight into the organisations we investigate, so we thank Mrs L for allowing us to investigate the complaint. It is also important to acknowledge that even though we have found no failings in relation to her complaint, this does not detract from the upset and distress Mrs L experienced.