A dental practice in the Wakefield area

4. Miss O complains about the care and treatment she had at the Practice on 10 August 2023.

5. She says she went for two fillings and during the procedure she felt the equipment drilling and scraping the nerves of both teeth continuously which caused her a lot of pain, as both nerves were caught with the equipment.

6. She says when she reported the pain she was experiencing, she was only offered to be seen again by the same dentist or to be referred privately, which she did not want to do. She says she wanted to be seen by a different NHS dentist.

7. She says she is unable to eat on the left side of her mouth and even has a 'dull ache' when not using her mouth. She says she has been overusing the right side of her mouth and so keeps getting toothache on the right side.

8. She says she has experienced pain from her ear down to her jaw on the left side and developed an infection that needed antibiotics. She says she now has a fear of the dentist.

9. Miss O wants service improvements to make sure the same thing does not happen to anyone else.

10. On 10 August 2023 Miss O attended the Practice to have two fillings. The dentist told her it was a ‘deep filling’.

11. On 19 September Miss O attended the Practice again for an urgent appointment to remove the filling. The dentist diagnosed her tooth with irreversible pulpitis (an advanced stage of inflammation in the pulp of the tooth). The records show the dentist explained the diagnosis and explained the options going forward, with the risks and benefits of each. Miss O chose option three which was ‘extirpate and dress – rebook for Root Canal Treatment (RCT) in house or referral to specialist pvt [private treatment]’.

12. Miss O has not returned to the Practice for more treatment since this appointment.

16. Miss O complains that during her appointment both nerves of the teeth were caught with the equipment.

17. She says it was a ‘strange and uncomfortable sensation’ despite the local anaesthetic and something she has never experienced before. She says she broke the tooth during the COVID-19 pandemic and never had any issues leading up to this appointment.

18. Miss O says she managed the pain for six weeks after the procedure by not eating on the side of the mouth that was affected. But, it became worse and was waking her up at night. We are sorry to hear how this pain affected her.

19. She says she was reluctant to contact the Practice because she never had any problems before and the procedure seemed to make the issues so much worse.

20. She says she was also aware that only one NHS dentist works at the Practice (who did her procedure) and she was concerned about the same dentist carrying out work again.

21. Miss O contacted the Practice on 19 September to report the pain she was experiencing and it booked her in for later that afternoon. She says she saw the same dentist again and explained the issues and that she thought her nerves were caught during the procedure before.

22. She says the dentist asked her questions including where the pain was coming from and she explained most of the pain was coming from the top tooth. She explains the dentist removed the filling, applied some medicine and refilled the hole.

23. Miss O explained the dentist gave her options to decide on and said she can either have a root canal (procedure to treat an infection at the centre of a tooth) or have the teeth removed. She says she chose root canal treatment.

24. She says the dentist said this could be done but they were limited on equipment. They said they could do a private referral and private dentists have more expertise and better equipment. They advised her to decide in a few weeks once the teeth had settled.

25. Miss O says the issues have not gone away, she still cannot eat on the left side of her mouth and has now developed occasional tooth ache to the right side of her mouth.

26. The Practice replied to Miss O’s complaint on 18 October. It said after looking through her notes, X-rays and speaking to the dentist it can see she was advised on 10 August that both UL4 and LL7 (two teeth on the left side of her mouth) had extensive decay and fillings were done that were very deep and close to the nerve.

27. It said the dentist did tell Miss O about the risks including, ‘1) there may be possible sensitivity afterwards, to return if persists’ 2) the filling was close to pulp and may require Root Canal Treatment/extraction in the future’.

28. The Practice also explained Miss O attended again on 19 September to report the pain she was experiencing and after an assessment, it found one tooth was the source of pain. Miss O chose to have the first stage of root canal treatment because she did not want to lose the tooth.

29. The Practice added the dentist gave her options including removing the tooth or root canal treatment at the Practice on the NHS (with the same dentist) or to have it done privately with ‘increased success rates’.

30. The Practice added it is ‘more than happy for you to book an appointment so this matter can be discussed together, and we can get the treatment completed for you at our [Practice] … or with a Private Endodontist [dental specialist]’.

31. Miss O was unhappy with the response, so the dentist who did the procedure sent a final response. They confirmed they felt the treatment was appropriate and they were sorry to hear about the complaint.

32. They said during the 10 August appointment they told Miss O the filling was deep and close to the nerves so she may experience sensitivity. They said they told her if this continues, to get back in touch for more treatment (root canal treatment or extraction).

33. They said, ‘I removed the decay tooth tissue as appropriate and placed a lining material under the filling. I hope this will reassure you that I did not drill the nerves of your teeth during your treatment with me’. The dentist added they were sorry Miss O returned with pain, which was when she decided to have the first stage of root canal treatment.

34. They added they understand her frustration due to the pain, dental pain can be linked with several causes and it would not have been appropriate to leave the broken tooth untreated. Overall, they confirmed the treatment provided was appropriate.

35. We have reviewed Miss O’s dental records and can see that before the procedure on 10 August, the dentist got valid consent in line with the GDC guidance principle three. This says, ‘obtain valid consent: Patients expect to be asked for their consent to treatment before it starts’.

36. We can see this because the records state ‘Procedure explained. Risks and benefits explained – made aware deep filling. Informed consent gained’.

37. We have seen evidence that Miss O consented to the treatment and the dentist explained the filling was deep.

38. The dental notes state that the dentist discussed that the caries [decay] was ‘extensive’ and ‘warned patient that it is a deep filling’. The risks were explained and the notes say, ‘1) there may be possible sensitivity afterwards, to return if persists. 2) the filling is close to pulp and may require Root Canal Treatment/XLA (Extraction under Local Anaesthetic) in the future’.

39. We consider the 10 August procedure was appropriate and in line with NHS guidance that explains treatment for tooth decay depends on how severe it is.

40. The guidance says, ‘you’ll probably need a filling if you have a hole (cavity in your tooth). If tooth decay has reached the soft tissue (pulp) in the middle of your tooth you may need root canal treatment. Sometimes the tooth may need to be removed (extraction)’. Our adviser confirmed this was the correct treatment considering Miss O’s symptoms.

41. NHS guidance recommends root canal treatment once tooth decay has reached the pulp. From the notes we can see the tooth decay was ‘close to the pulp’ and the dentist explained to Miss O that she may need this treatment in the future.

42. We have reviewed the dental notes and have not seen any clear evidence to suggest the nerves were caught during the procedure. Our adviser also explained it does not seem the nerves were caught or that there is any evidence to suggest the procedure was done incorrectly.

43. We cannot say the dentist caught Miss O’s nerves on 10 August. It is clear from the notes the filling was deep and this was more than likely the cause of the pain after the treatment. The dentist explained there may be sensitivity afterwards and if this continued she should return to the Practice.

44. We can see Miss O returned to the Practice on 19 September for an urgent appointment as the pain did continue. We have explained above what was found and discussed during this appointment.

45. The Practice explained the options were: ‘1) leave and monitor – not advised, symptoms may worsen. 2) removal of tooth 3) extirpate and dress – rebook for RCT in house or referral to private specialist’.

46. The notes show Miss O chose option three and would decide later whether she wanted a referral or not.

47. Our adviser explained the dentist acted in line with NHS guidance by offering to check their work and if there was anything more they could offer. Our adviser explained that as there was a breakdown in trust and only one NHS dentist worked at the Practice, it was right to suggest seeing a private dentist as an alternative.

48. We asked the Practice whether the notes were up to date as the latest appointment was from September.

49. The Practice replied:

‘When [Miss O] attended on the 19th September, you will see from her notes that she was given 3 options, [Miss O] mentioned she wanted a RCT [root canal treatment] but went away to decide whether or not to have RCT at the Practice or have a referral. In [Miss O's] original complaint she also states that she went away to let the tooth settle and make a decision. This was then followed by a complaint from [Miss O], [the dentist] was more than happy for [Miss O] to attend the practice and discuss the treatment and hopefully get the RCT completed (as stated in our reply) but [Miss O] refused to be seen again by [the dentist], so no further appointments could be booked.’

50. As per NHS guidance, the dentist offered to see Miss O again and also discussed options and the risks. NHS guidance says:

‘If you have restorative dental treatment on the NHS, and something goes wrong, requiring repair or retreatment, within 12 months of the original treatment, then your dentist should do the necessary work free of charge. Restorative dental treatment can include ‘fillings, root fillings, inlays, porcelain veneers and crowns’.

51. We can see that as Miss O was still experiencing pain almost a month after the fillings, the dentist offered to do more work and Miss O opted for root canal treatment and to decide later if she wanted a private referral.

52. Miss O says she does not want to pay for private treatment and does not want to see the same dentist again so she has not had more treatment and is continuing to experience pain in her tooth.

53. Our adviser explained the Practice has done all it can, in offering to do more work or to refer her privately.

54. We understand why Miss O is worried and does not want to see the same dentist again.

55. In summary, we have found no signs that anything went wrong in the care and treatment the Practice provided.

56. We are sorry to hear about the pain Miss O continues to experience. We hope this statement gives reassurance that the Practice’s treatment did not fall below expected standards.

1. We have carefully considered Miss O’s complaint about the care and treatment she had from a dental practice in the Wakefield area (the Practice) on 10 August 2023.

2. We are very sorry to hear about the circumstances that led Miss O to come to us. We recognise the distress she experienced both during the procedure and the pain she says she has experienced since. We are sorry to hear how this affected her.

3. We have not found any signs that the Practice did anything wrong during the appointment. We hope the statement below is clear and shows how we have reached our decision.