A dental practice in the Bolton area

3. Mrs A complains her dentist missed a tooth fracture caused by an accident. The tooth was replaced with a denture, which looked uneven.

4. Mrs A says she had a relapse of depression and anxiety as a result, and because the denture was uneven it sometimes caught her lip.

5. Mrs A wants compensation for the temporary denture charge and to know her treatment was completed correctly.

6. Mrs A visited the Practice on 2 September 2021, after a fall that caused cuts to her face and tooth damage. Due to her injuries, the Practice could not take an X-ray until 8 September. The X-ray did not find a tooth fracture. The dentist told Mrs A her pain would settle in time.

7. On 14 January 2022, Mrs A went back to the Practice because she still had tooth pain and saw a different dentist. They did an X-ray and told her she had a tooth fracture. They planned to take out the tooth on 9 February 2022 and give her a temporary denture.

Missed tooth fracture and misaligned denture fitting

11. Before we decide if we should do 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.

12. Mrs A complains a fracture to her tooth was missed on 8 September 2021, and when her temporary denture was fitted it did not fit correctly. She says this affected her mental health due to the stress she experienced.

13. The Practice detailed what happened at each appointment, that it was normal for a tooth that had experienced a blow to be loose when tapped, and how the first X-ray had not shown a fracture to her tooth.

14. When the Practice found the tooth fracture in January 2022 it refunded Mrs A for the last two appointments and arranged to remove the tooth. It said fractures can be microscopic and can be undetected until they get larger.

15. The Practice said they discussed treatment options and Mrs A chose for the fractured tooth to be removed and an immediate denture (a temporary one) to be fitted. Once Mrs A’s jaw and bone had shrunk due to healing, a permanent denture would be fitted. The NHS would not fund this because she chose a sectional flexi denture.

16. Our advisor told us the Dental Trauma Guidelines Revised 2012 are the relevant guidelines on fractures. These state when identifying a tooth fracture, it may be tender to percussion (touch). An X-ray should be taken of the tooth, suitable treatment provided, and reviews of the tooth condition should happen at regular intervals.

17. Our advisor explained that teeth that have suffered a blow can be loose and painful without there being a fracture. They can heal and become fixed again over time. As the X-ray did not show a fracture, guidance says reviews to check should happen later, at intervals.

18. Evidence confirms the Practice did an X-ray in line with the guidelines. The X-ray did not show a root at the wrong angle. The records say the dentist told Mrs A to monitor the tooth since she chose not to have it filled.

19. The Practice did not offer any fixed appointments to Mrs A to review her in line with the guidelines. But we can see she was told to make an appointment if the pain did not settle, which suggests it was discussed with her.

20. We can see from her emails to the surgery that Mrs A refers to a conversation about returning in around 8 weeks’ time if she was still in pain. She made an appointment for review on 22 November but did not have this because she transferred it to her husband. This also suggests she was aware of the advice to return for review if needed.

21. While this was not in line with the guidelines as it was not a fixed review, it does not affect the complaint about her tooth fracture being missed. We have not seen any signs of failings in the dentist’s assessment of the tooth after the accident.

22. We also considered whether the dentist fitted the temporary denture following standards about its fit and look. The NHS UK website says ‘The NHS will provide all treatment that your dentist feels is clinically necessary to keep your teeth, gums and mouth healthy’.

23. Mrs A’s records say she chose to have her tooth removed and to wait three months before having a sectional flexi denture fitted. The records say Mrs A was happy with the appearance and fit of the temporary denture on 9 February, although Mrs A tells us she immediately told the dentist it looked misaligned. The dentist told Mrs A about changes to her gum as she healed and the likelihood of shrinking, which could cause a change to how the denture fitted.

24. Mrs A returned to the Practice on 24 February because a gap was beginning to develop between her gum and the denture. She told the dentist this sometimes caught her lip. The dentist found the denture fitted well, but a gap was developing due to her gum healing, which the dentist says they told Mrs A could happen on 9 February.

25. The notes say the dentist offered to realign the denture, which Mrs A declined as she said she would wait for her new denture to be fitted before she went on her holiday in June. In her email to the Practice dated 28 February she acknowledges a discussion was had about three months, but says it was mentioned as being only if she ‘couldn’t get on with the denture’. This suggests a discussion had been held about the dentures being temporary, and the potential for shrinking and the denture fit changing being the reason.

26. Based on the evidence we have seen, we are satisfied the Practice carried out Mrs A’s tooth care satisfactorily. There is nothing we have seen that suggests NHS guidelines were not followed in fitting the denture.

27. The dentist gave advice and treatment to Mrs A in line with guidelines and discussed the possibility of the shrinking of her gums and the need for a new denture as a result. The gap which developed was part of the natural healing process.

29. We are sorry that the fracture and the appearance of her dentures has caused Mrs A significant distress. We hope that our decision reassures her about the treatment she received.

1. We have carefully considered Mrs A’s complaint about her treatment from a dental practice in the Bolton area (the Practice). We recognise how anxious Mrs A has felt and we are sorry to hear how she has been affected by what happened.

2. We have decided not to consider the complaint further. This is because we have seen no signs anything went wrong with the treatment the Practice gave to Mrs A.