A dental practice in the St. Helens area

3. Mr R complains about the following aspects of the care and treatment he received from the Practice.

4.Mr R complains that in his appointment at the Practice on 2 February 2022, the dentist did not adequately scale his teeth. He says the dentist caused trauma to his gum through negligent use of a scaling device and left vast amounts of plaque on his teeth.

5. Mr R says that on 7 February the dentist gave him a different explanation about his gum trauma than what they recorded in his notes. He says the dentist recorded that they advised extraction when this was in a previous appointment.

6.Mr R disputes that the dentist scaled his teeth on 7 February 2022, 3 March 2022 and 5 January 2023.

7.Mr R says as a result of the poor care and damage to his teeth and gums, he has experienced stress and loss of sleep. He says he now does not want to make another dental appointment because of the trauma.

8.Mr R would like the Practice to offer him a financial remedy.

9.Mr R attended the Practice on 5 January 2023 for a routine examination. The dentist diagnosed decay on the lower left canine and lower left incisor. They advised filling these teeth. The dental notes say the dentist scaled and polished Mr R’s teeth in this appointment.

10.The dentist filled Mr R’s teeth on 2 February. He says he started to experience pain in the evening where the dentist had filled his teeth. The Practice scheduled another appointment for 7 February.

11.On 7 February Mr R told the dentist he could feel a ledge on the lower left incisor. The dentist diagnosed gum recession as the cause of this.

15.Before we decide if we should conduct a detailed investigation of 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. If we think the organisation got things wrong, we look at the impact the mistakes had and what the organisation has done to put things right.

Treatment on 2 February 2023

16.We have looked at what the Practice did alongside what it should have done, and we do not think the dentist did anything wrong with the treatment they provided on 2 February that could have caused the problems Mr R noted with his teeth.

17.Mr R attended the Practice on 2 February for fillings in his lower left canine and lower left incisor. The dentist also scaled Mr R’s teeth in this appointment. Mr R says later in the evening when the anaesthetic had worn off, he realised he was in considerable pain. He thinks the dentist used the scaling tool wrong and damaged his gums, and failed to remove all the plaque from his teeth.

18.In its complaint response dated 15 January 2024, the Practice said the dentist filled and scaled Mr R’s teeth on this date and the procedure was uneventful. It says in his next appointment on 7 February, Mr R said he could feel a ledge on the lower left incisor. It says the dentist noticed there was gum recession and told Mr R this was the ledge he was likely feeling. It says this was not caused by the scale on 2 February.

19.The General Dental Council’s ‘Standards for the Dental Team’ has relevant guidance for what patients can expect from their dental team. It says a dentist should provide good quality care based on current evidence and authoritative guidance.

20.Our adviser looked at Mr R’s clinical notes and said they indicate an uneventful scaling procedure. There is nothing in the notes to suggest the care the dentist provided was not in line with the General Dental Council’s standard. Based on the evidence we have, it is not possible or us to know exactly how the dentist performed the procedure. But there is evidence that shows us it was unlikely to be the cause of the issues Mr R noted with his teeth.

21.Our adviser looked at the images Mr R provided to us. They said the images are clear that he had gum recession and is most marked around the lower left teeth.

22.Our adviser explained that recession is a result of risk factors combining over many years to damage the hard and soft tissue in the area. They said one of these factors is that plaque accumulation leads to inflammation which leads to loss of the gum tissue and underlying bone. The difficult anatomy in the area that Mr R complains about makes plaque control difficult and long term inflammation would contribute to the recession.

23.The Handbook for Cleaning/Decontamination of Surfaces explains that dental plaque is a substance that builds up on the teeth and gums. It says if oral hygiene is neglected, plaque growth reaches its maximum extent within 4 days.

24.The photos from the day after the scaling on 3 February show fresh accumulation of plaque, especially around the area of gum recession on his lower teeth. Our adviser explained the appearance indicates this plaque is very recent and could be due inefficient oral hygiene in the area. So, even if the dentist had not removed all of the plaque, we could not say this was why Mr R had a lot of plaque the next day, nor that it was the reason for his ongoing issue with plaque. A scale can only help the issue and Mr R would need to control it with his oral hygiene.

25.We have looked at the evidence. The notes indicate no problems with the scaling treatment. We accept we cannot know with any certainty whether the dentist adequately scaled Mr R’s teeth in the appointment. But the evidence indicates the scaling procedure is not the reason Mr R’s gum receded or for his ongoing accumulation of plaque.

26.We understand Mr R was in pain and this was a distressing experience for him. When we have looked at all of the evidence we cannot say the Practice did anything wrong that caused his gum and plaque problems.

Explanation of diagnoses recorded in Mr R’s dental notes

27.Mr R says in his appointment on 7 February, the dentist told him his gum had torn ligaments and wear and tear. He says the dentist wrote in the notes that the gum had pulled over time and the gum recession was already in existence.

28.In its complaint response dated 15 January 2024, the Practice explained about gum recession. It apologised for any misunderstanding from its explanation of the diagnosis and that it had not explained in as much detail as Mr R would have liked at the time. It said it understood Mr R’s frustration and acknowledged how distressing the situation had been for him.

29.The dental notes say the dentist advised Mr R that his lip had pulled on the gum over time causing recession. They say Mr R thought the recession was due to the scaling and was not happy with the explanation.

30.We have weighed up the evidence. We do not know if the explanation that the dentist gave to Mr R was different to what the dentist noted in the records. We can see that Mr R was upset and frustrated by the explanation and the Practice has apologised for this. It has now clarified what had caused him gum recession.

31.Our Principles of Good Administration say public bodies should acknowledge and apologise for mistakes. So if it did made any mistakes in what it told him, then we are satisfied it has done enough to put things right. There is nothing more we need to ask it to do.

Mr R disputes that the dentist scaled and polished his teeth on 7 February 2022, 3 March 2022 and 5 January 2023.

32.Mr R asked the Practice for a copy of his dental notes and got these on 17 August 2023. He says these state the dentist gave him with a scale and polish of his teeth on 7 February 2022, 3 March 2022 and 5 January 2023. He says the Practice did not provide these treatments.

33.Mr R asked the Practice to provide him with evidence that he had consented to this treatment. In its complaint response dated 29 February 2024, the Practice explained that written consent is only usually required when patients are undertaking either sedation or general anaesthetic. It is also only required for treatment that are a band two charge or above. A scale and polish is usually under band one and would be documented in dental records that a patient would have given verbal consent.

34.We have looked at all of the evidence. The dental notes clearly state the dentist did a scale and polish on these three dates. On 7 February and 3 March 2022, this was alongside fillings and crown preparation. On 5 January 2023 this was as part of a check up. Two of the records set out periodontal advice given to Mr R at the time. There is no indication these notes were not made at the time. We note that Mr R was looking at his records more than seven months after the last occasion and more than 18 months after the first.

35.When we weigh up the available evidence, it does suggest the dentist did a scale and polish on these occasions. However, we accept we cannot know for certain. We have thought about whether we could establish anything more by investigating this further. In the absence of any more evidence, unfortunately we do not think we can. We also note Mr R has not suggested there was any specific impact of this part of his complaint. As we set out above, plaque control is not something the dentist can manager – it is the individual’s responsibility to do this via good oral hygiene.

36.Our decision does not take away from how difficult Mr R has found this experience. We hope this letter clearly sets out the reasons why we will not be investigating the complaint further.

1. We have carefully considered Mr R’s complaint about a dental practice in the St Helens area (the Practice). We were sorry to hear about how the experience has affected Mr R. We understand this has been a difficult time for him.

2. We have carefully weighed up all of the evidence. We do not think the treatment the dentist provided caused trauma to Mr R’s gum or was the reason he continued to have plaque build up. We think the Practice has done enough to put right the confusion its explanations about his gum problem caused him. And we do not think we could ever conclude with any certainty that the dentist provided the scale and polish treatment documented in his medical notes.