A dental practice in the Fareham area

3. Mr X complains the Practice failed to diagnose a facial ingrown hair (folliculitis) and instead treated him for gum disease and a tooth infection between 24 April and 11 June 2024.

4. Mr X says he was also given unnecessary treatment consisting of three courses of antibiotics.

5.He tells us the misdiagnosis led to a tooth extraction and root canal treatment with a specialist dentist on 22 June 2024, which Mr X did not need and was required to pay for.

6.Mr X has told us how the six months of unnecessary treatment from antibiotics caused him poor health, stress and pain, and the scarring on his face is upsetting and affecting his confidence.

7. To resolve his complaint, Mr X would like acknowledgment of the failings and financial compensation of £3,000 to cover the cost for the unnecessary treatment he had at the specialist dental practice as a result of the failings.

8.On 10 March 2024 Mr X underwent a fracture filling in the upper right and lower right posterior teeth at the Practice.

9.On 24 April 2024 Mr X attended an emergency appointment at the Practice with a swelling of his right cheek. Mr X was prescribed antibiotics (Metronidazole 400mg for five days) and advised to see his own dentist.

10.On 2 May 2024 Mr X attended another emergency appointment at the Practice with worsening facial swelling. An X-ray was performed and the dentist diagnosed Mr X as having a tooth infection. They prescribed a further five-day course of antibiotics (Metronidazole 400mg and Amoxicillin 500mg).

11.On 11 June 2024 Mr X was still experiencing symptoms of facial swelling and pain and so attended another emergency appointment at the Practice. Staff prescribed a third course of the same antibiotics for a further ten days and referred him to an endodontic specialist at the specialist dental practice for further review and treatment.

12.Mr X was assessed at the specialist dental practice and treated with a tooth extraction and root canal. On 22 June 2024 Mr X visited the specialist dental practice again due to worsening of his symptoms and he was diagnosed with folliculitis of an internal hair follicle on the right cheek. He received treatment for this which eventually resolved his symptoms.

16.When we consider 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. We will explain the reasons for our decision in more detail below.

Diagnosis and treatment

17.Mr X complains the Practice misdiagnosed his folliculitis as a tooth infection. We have looked carefully at whether the Practice acted in line with applicable guidelines and standards in diagnosing Mr X and deciding how best to treat him.

18.We can see from our independent clinical advice that the dental X-ray taken on 2 May 2024 shows infection of the tooth, and that the tooth required treatment. This is because the X-ray clearly shows a deep filling on the UR6 tooth and infection at the tip of the root, a failed root canal on the UR5 tooth, an infection on the root and decay on the UR4 tooth. We understand from our adviser that any of these three teeth could have caused a facial swelling requiring antibiotics.

19.The NICE guidelines referenced in our ‘evidence’ section indicate that for Mr X’s symptoms, including facial swelling, pain and lymph node swelling, the Practice acted in line with applicable guidelines in providing him with antibiotics. We understand from our adviser that the Practice acted in line with the ‘Antimicrobial Prescribing in Dentistry: Good Practice Guidelines’ in providing Mr X with antibiotic treatment of Metronidazole 400mg and Amoxicillin 500mg. As such, we have not seen any indications of failings in the Practice’s decision to treat Mr X’s infection with antibiotics.

20.Having considered the Practice’s decisions about treatment of his teeth, we understand from our clinical adviser that the referral to a specialist dentist was appropriate and in line with the British Endodontic Society’s ‘A guide to Good Endodontic Practice’ section ‘The LEC Tool - Complexity levels for endodontic treatment’. This is because the treatment required was a root canal or extraction of UR6 tooth, extraction or re-root canal of UR5 tooth and a filling was needed on UR4 tooth, which the guidance indicates is best taken forward by a specialist.

21. We know that Mr X is very concerned that the Practice did not identify he had folliculitis. We can see from the GDC’s ‘Scope of Practice guidance’, which sets out the skills and abilities a dentist should have, that it is not in a dentist’s remit to diagnose a skin condition such as folliculitis of a facial hair follicle. Therefore, there is no indication the Practice failed to act in line with the GDC standards in not identifying or advising Mr X he had this condition.

22.This means we cannot give any view that the actions of the Practice led to Mr X having further dental treatment, which was unnecessary or avoidable, nor in incurring costs for that treatment. We understand from our clinical adviser that the further dental treatment was needed, and that it is likely due to the ingrown hair being in the same region as the affected teeth that the dental infection was detected and treated. We have not seen anything to indicate that the presence of the ingrown hair led to the dental condition, or that the dental condition led to the ingrown hair. The evidence available to us indicates Mr X had two separate conditions for which we are glad to see he received treatment.

23.In light of the above, we have not seen anything to indicate the Practice failed to act in line with applicable guidelines and standards, and so we will take no further action.

24.We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it, and we hope our independent view is reassuring to Mr X. We would like to thank Mr X for bringing his concerns to our attention.

1. Mr X complains about the misdiagnosis of a facial ingrown hair (folliculitis) which he says led to unnecessary and costly treatment at another specialist dental practice. We are sorry to hear about the difficult time Mr X experienced due to the ongoing symptoms of the infection caused by the ingrown hair, and we acknowledge the impact this has had on his well-being.

2.We have considered the evidence available to us carefully, including obtaining independent clinical advice, and we do not see any indication of failings by the Practice. Therefore, we have decided to take no further action. We explain further below.