A dental practice in the Lincolnshire area

6. Mr A complains about the Practice. Specifically, he complains in November 2023:

• the dentist incorrectly diagnosed him as needing a filling and did not take an X-ray • the dentist refused to treat him as a patient • attitude of the dental nurse.

7. Mr A also complains about the Practice’s handling of his complaint. He complains another person should have carried out an investigation into his complaint and not the dentist who his complaint is about.

8. Mr A says the actions of the dentist have left him extremely anxious and does not trust this dentist. He also says he is now left without an NHS dentist due to the dentist refusing to treat him as a patient. Mr A said the attitude of the dental nurse made him feel anxious and confused and he felt like he was being ganged up on.

9. Mr A wants an apology and financial remedy.

10. On 10 November 2023, Mr A reported occasional sensitivity on a tooth at the gumline. The dentist recommended an appointment for a periodontal deep clean treatment with a hygienist and to book another appointment for a filling.

11. On 29 November, Mr A attends the Practice for his filling treatment. He decides not to have the treatment.

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. We have done this and have not found any indications that something has gone wrong.

Diagnosis and X-ray

16. Mr A says the dentist incorrectly diagnosed him as needing a filling.

17. In his complaint Mr A says he went to a private dentist for a second opinion. He says this dentist took several X-rays and said there was nothing wrong with his tooth and no cavities the dentist could see visually.

18. In the Practice’s response it said the dentist suggested a filling could protect Mr A’s tooth from further damage. It also said while the issue with the tooth was very minor treating the tooth at this point would reduce the chance of Mr A needing further treatment.

19. GDC guidance says dentists must make and keep complete and accurate records, including up-to-date medical history, each time that you treat patients. It also says you should record as much detail as possible about the discussions you have with your patients, including evidence that valid consent has been obtained. You should also include details of any treatment needs where appropriate.

20. The dental records note decay was present in Mr A’s tooth. The dentist then discussed a treatment plan to deal with the issue, which was a filling. Our adviser says if a dentist identifies an issue, it is then appropriate for the dentist to offer advice on a proposed treatment plan.

21. Our adviser said the fact another dentist has arrived at a different diagnosis does not mean the dentist was wrong it is just a difference of clinical opinion. The reason for this is the diagnosis of decay at the early stages can be difficult and there may be genuine differences in opinion as to the stage and extent of decay.

22. We recognise what an anxious experience this was for Mr A. We consider it was appropriate for the Practice to recommend a treatment plan for an issue the dentist identified. This is in line with GDC guidance.

23. Mr A also complains the Practice did not take an X-ray.

24. CDG guidance says no person shall carry out a medical exposure unless it has been justified by the practitioner as showing sufficient benefit. The CDG guidance also says patients assessed for caries risk (lesions) are placed into high, moderate, and low caries risk groups. For patients with high caries risk, X-rays are indicated at six-monthly internals, moderate risk yearly, and low risk 12 to 18 months but this period extending if there is evidence of continuing low risk.

25. The dental records show Mr A had an X-ray in December 2022. Our adviser said this X-ray shows no evidence of decay. If decay was present a year later in Mr A’s tooth our adviser has said the chances, are it would be a small lesion and therefore Mr A would be considered low caries risk. Therefore, it would not be appropriate to take further X-rays exposing the patient to unnecessary radiation.

26. We understand Mr A says the Practice should have taken an X-ray. The dental records show Mr A had an X-ray 11 months earlier. We therefore consider the decision not to carry out an X-ray was appropriate. This is in line with CDG guidance.

Dentist refusing to treat

27. Mr A complains the dentist refused to treat him as a patient.

28. In Mr A’s complaint, he says he asked some questions of the dentist as to why he needed the filling and felt like the dentist started to act uneasy and did not seem willing to discuss it properly. Mr A said he decided not to have the filling as the tooth was not causing him any problems. He says on the way out the dentist said to pick up a referral form. Mr A confirmed in an email that he did not pick a referral form up.

29. The Practice response supports what Mr A has said. It mentions Mr A queried the need for a filling and said the reason was to protect the tooth from further damage. In this response the Practice said it was clear that Mr A lacked trust in the dentist’s clinical judgement. It said where there is a breakdown of trust it is often sensible to seek treatment with another dentist, and in Mr A’s case he opted to attend a different practice. The Practice said it would be happy to facilitate the transfer of Mr A’s care to a different dentist at the Practice had he wished to. It apologised if there was a misunderstanding in this respect and acknowledged that should have been clearer.

30. GDC guidance says ‘patients can withdraw their consent at any time, refuse treatment or ask for it to be stopped after it has started. You must acknowledge their right to do this and follow their wishes. You should explain the consequences or risks of not continuing the treatment and ensure that the patient knows that they are responsible for any future problems which arise as a result of not completing the treatment. You must record all this in the patient’s notes.

31. The dental records say patient queries if filling needed as he has no pain and wants to avoid root canal treatment. The dental records also say the dentist advised if he leaves it, it is most likely to progress to a root canal and that it is better to treat the superficial decay at this stage to reduce the likelihood of root treatment. The dental records show Mr A opted to not have the treatment.

32. NHS contracts states that where there is an irrevocable 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. The contract says a dentist cannot include purely the fact the patient has made a complaint as a reason to refuse to treat.

33. The dental records say the dentist discussed patient dentist relationship based on mutual trust and felt it might be more appropriate to book in with another dentist. There is no information recorded about a referral form.

34. The Practice has confirmed Mr A is currently registered with them as an NHS patient and has sent him two recall due notices via email and SMS and a recall overdue notice via SMS. The Practice said it has not informed NHS England as it has not removed the patient from its current list.

35. We understand the distress this has caused Mr A and recognise he says he is now left without an NHS dentist. Having carefully considered all the evidence we consider the Practice acted appropriately in line with GDC guidance. We consider communication about the transfer of dentist could have been clearer and why this caused Mr A to feel he has been left without an NHS dentist. The Practice has acknowledged and apologised for this. It has also confirmed Mr A is still registered with it. We therefore consider no further action is needed on this part of the complaint.

Attitude of dental nurse

36. Mr A says the dental nurse was rude and confrontational for him asking questions about his treatment. In his complaint to the Practice, he says the dental nurse started repeating what the dentist had said about getting a referral form.

37. From the dental records, it shows Mr A did question the dentist about the filling and there is evidence of a breakdown in relationship between the dentist and Mr A. There are no records to indicate any issue with the dental nurse or the mentioning of a referral form.

38. We have considered whether we would be able to reach a decision regarding this issue. We have not found any clear evidence to support Mr A’s account about the attitude of the dental nurse.

39. We have carefully considered what Mr A says and what the dental records state. Having done so, even on balance, we cannot reach a view on whether the dental nurse was rude and confrontational. This is because we have no way to determine whether Mr A’s account is correct.

40. Therefore, we are unable to reach a conclusion about what happened, and we will be taking no further action with this issue.

Complaint handling

41. Mr a complains another person should have carried out the investigation into his complaint and not the dentist who his complaint is about.

42. The Practice complaints policy says the person responsible for investigating complaints sits with the clinician or clinicians responsible for the patient’s care.

43. On 19 January 2024, Mr A received a full response to his complaint from the clinician involved in his care.

44. We understand why Mr A would have wanted another person to investigate his complaint. We consider it was appropriate for the clinician responsible for his care to respond to his complaint. This is in line with the Practice’s complaints policy.

45. We thank Mr A for bringing his complaint to us for consideration. We appreciate how difficult it must be for him to go through the details of his complaint again.

1. We have carefully considered Mr A’s complaint about a practice in the Lincolnshire area (the Practice). We are sorry to hear of Mr A’s experience and the distress this has caused him.

2. We have looked at the evidence provided by Mr A and the Practice and having thought about the issues carefully, we consider it was appropriate for the dentist to recommend Mr A for a filling and the Practice did not need to take an X-ray. We consider communication about the dentist refusing to treat Mr A as a patient could have been clearer. We can see the Practice acknowledged and apologised for this and confirmed Mr A is still a registered NHS patient at the Practice.

3. We have decided we would likely not be able to reach a decision about attitude of dental nurse.

4. We consider it was appropriate for the dentist to respond to Mr A’s complaint.

5. We understand our decision may be disappointing to Mr A. We are sorry we cannot help him further. We have explained our decision in more detail below.