A dental practice in the Bournemouth area

4. Mrs A complains that the Practice has failed to diagnose and treat her for gum disease since 2017. She says that by the time she was diagnosed in 2023, she had already lost most of her upper teeth which could have been avoided had she been diagnosed and treated sooner. She says the loss of teeth has impacted her confidence and negatively affected her mental health, whilst also causing distress.

5. Mrs A complains that the Practice failed to contact her back when she reported experiencing pain after being prescribed antibiotics for an abscess in January 2023. She says that as a result, the infection continued and one of her teeth broke in half.

6. Mrs A wants the Practice to acknowledge its failings, improve its service and provide financial compensation.

7. On 23 January 2023, Mrs A attended an emergency appointment at the Practice as she was feeling pain on the left side of her face. Staff completed X-rays and found the pain was possibly coming from sensitivity on Mrs A’s upper left canine and two other teeth which were loose. Staff told Mrs A that she would need to start antibiotic treatment for her upper left canine. During this appointment, the dentist examined the area around Mrs A’s tooth and saw an indication of gum disease. No action was taken at that time, as Mrs A was being treated for an infection.

8. Mrs A attended another urgent appointment on 14 February as she was in pain. Staff found an upper left tooth was split in half and another one was loose. She was told both teeth needed to be extracted and added to a denture plate so a denture could be made. On 24 February, a denture was fitted.

9. In April, Mrs A attended the Practice and saw a different dentist. They completed a scoring system for gum disease and found that Mrs A did have it in a few areas of her mouth. Over the next few months, Mrs A was formally diagnosed and treated for gum disease in four of the six sections of her mouth.

13. The Practice diagnosed Mrs A with gum disease on 28 April 2023. She believes this should have happened sooner. The Practice did not acknowledge any failings in response to the complaint and says Mrs A was diagnosed correctly at the right time.

14. We asked our adviser whether or not the Practice should have diagnosed Mrs A with gum disease sooner than was the case. They explained that prior to 2023, there was no evidence in Mrs A’s medical records to suggest she had gum disease. Additionally, Mrs A did not attend the Practice between October 2018 and March 2021 which suggests there were no issues during this time.

15. During the appointment in January, the dentist noted indications that Mrs A may have gum disease in the section of her mouth they were treating for infection. However, this was not diagnosed or treated at the time.

16. Further, the gum disease was not diagnosed or treated in appointments in February. This did not happen until the appointment in April.

17. The Practice says it did not diagnose or treat the gum disease in earlier appointments because it was not the problem that Mrs A presented with. It said that appointments on 23 January and 14 February were emergency/urgent appointments where Mrs A was in pain and had issues with her teeth. The appointment on 24 February was a follow up so a denture could be fitted. The Practice says it was appropriate to focus on the urgent issues which were present at the time, and deal with the gum disease later.

18. The Regulations state that urgent treatment is one or more treatments that are provided to a person in circumstances where:

(a) - prompt care and treatment is provided because, in the opinion of the dental practitioner, that person’s oral health is likely to deteriorate significantly, or the person is in severe pain by reason of his oral condition; and

(b) - care and treatment is provided only to the extent that is necessary to prevent that significant deterioration or address that severe pain.

19. This means that urgent treatment is provided to address pain and only to the extent to prevent that pain or deterioration. The Regulations do not define gum disease as an urgent treatment.

20. As such, we consider that the Practice acted appropriately in the urgent/emergency appointments where it only focussed on the issues Mrs A presented with that were causing her pain, not gum disease. We note that the purpose of the appointment on 24 February was a follow up to an urgent appointment to allow a denture to be fitted. So again, we consider that it was appropriate for the Practice to focus on that.

21. The next time the Practice saw Mrs A was in April where it formally diagnosed her with gum disease. This seems to be the first real opportunity it had to do so given the nature of the appointments prior to this. The evidence suggests that the Practice acted in line with the Regulations when it focused on the most serious presenting complaints.

Callback

22. Mrs A complains that the Practice failed to contact her back when she reported experiencing pain after being prescribed antibiotics in January 2023. She says that as a result, the infection continued and one of her teeth broke in half.

23. Mrs A was prescribed antibiotics during the appointment in January to treat an infection in one of her teeth.

24. She called the Practice sometime later (the exact date is unclear as no records were kept). Mrs A says she told staff she was in pain and they told her a dentist would contact her about this.

25. The Practice says that according to staff’s recollection of the events, Mrs A reported pain and requested further antibiotics from reception staff. But they spoke to a dentist who said no further antibiotics were required. It is unclear if this was then communicated to Mrs A as none of the calls were documented in her medical records.

26. But in any event, it appears that Mrs A’s pain subsided as she did not contact the Practice again regarding this issue.

27. In relation to her concern that this led to another tooth breaking in half, it does not appear that this was the case.

28. The tooth that broke in half was not the one which required antibiotic treatment. So it seems the two issues were unrelated. We appreciate that it must have been distressing for Mrs A when her tooth broke. We do not think we can reasonably link it to the Practice not calling her back.

1. We found that the Practice diagnosed Mrs A with gum disease at the right time. Whilst there was an indication that Mrs A was developing gum disease in appointments she attended in early 2023, these were urgent/emergency appointments where the focus was on treating the presenting problem, rather than diagnosing and treating gum disease.

2. It is not clear if the Practice contacted Mrs A after she reported pain following a tooth extraction. But in any event, it does not seem that this resulted in a different tooth of Mrs A’s breaking.

3. Overall, our decision is to not uphold this complaint. We appreciate that Mrs A has had a difficult time with her dental health and were sorry to hear about this.