A dental practice in the Lancaster area

5. Miss H complains the Practice did not perform a root canal in June and July 2021 appropriately in line with standards and guidance.

6. Miss H explains as a result overtime her tooth filled with bacteria causing pain. She had to have a second root canal three years later. She says she no longer trusts dentists. She says due to the poor root canal she had to pay for private treatment which financially impacted her.

7. Miss H is seeking an apology and a financial remedy.

8. On 7 June 2021 Miss H started root canal treatment at the Practice. It was completed on 19 July 2021.

9. In June 2024 Miss H was informed her initial root canal had not been completed properly.

13. Miss H complains the Practice did not perform a root canal in June and July 2021 appropriately in line with standards and guidance. She explains the Practice did not completely fill in the tooth. She says this meant over time her tooth filled with bacteria causing pain. She had to have a second root canal three years later.

14. The Practice explained on 7 January 2025 it was unable to give comment on Miss H being informed her root canal would be a short obturation. Short obturation refers to root canal filling material that stops short of the natural apex of the tooth's root, meaning it is less than the full length of the root canal.

15. We have reviewed the records.

16. On 7 June Miss H attended the Practice for the first part of her root canal treatment. The notes say the tooth was irrigated (washed out) with Corsodyl. Two X-rays were taken on this date.

17. On 19 July 2021 Miss H attended the Practice for the final part of her root canal treatment. The notes indicate she was informed the obturation was slightly short. It is noted she was shown X-rays accordingly. An X-ray was taken at 10.51am on the same day.

18. The Practice acknowledged the root filling was slightly short in its clinical review. It has not provided an explanation for why it was short.

19. We have considered the Quality guidelines for endodontic treatment. It says:

‘Root canal treatment Irrigation • The objectives of irrigation are to: eliminate microorganisms, flush out debris, lubricate root canal instruments and dissolve organic debris. The irrigant solution should preferably have disinfectant and organic debris dissolving properties, whilst not irritating the periradicular tissues.

Filling of the root canal system • The prepared root canal should be filled completely unless space is needed for a post. The prepared and filled canal should contain the original canal. No space between canal filling and canal wall should be seen. There should be no canal space visible beyond the end-point of the root canal filling. The tooth should be adequately restored after root canal filling to prevent bacterial recontamination of the root canal system or fracture of the tooth.’

20. As noted above, the Practice has acknowledged the root filling was slight short. Leaving a gap in the root canal without reason is not in line with quality guidelines for endodontic treatment. Our advisor said the sealing points are over 2mm away from the tip of the root. They explain this is sometimes unavoidable if the canal is curved or blocked.

21. Our advisor told us the X-rays show instruments reaching the root tip, so in this case the treatment cannot be considered effective. There are visible gaps around the sealing points which would allow bacteria in.

22. Our advisor adds irrigation is ideally done with sodium hypochlorite. Another irrigant is suitable, 2% chlorhexidine. The Practice used Corsodyl. This is a 0.2% solution of chlorhexidine which is considered an insufficient concentration to achieve disinfection.

23. We understand how important it is to receive the right dental treatment to prevent future problems. In considering the records, guidance and clinical advice, we consider the Practice did not irrigate or complete the root canal appropriately and the actions were not in line with Quality guidelines for endodontic treatment. This is a failing.

Impact

24. Miss H says as a result of the underfilled tooth over time her tooth filled with bacteria causing pain. She explains in March 2024 she noticed pain around the area of her root canal.

25. This was three years after the initial treatment. She says due to the poor root canal she had to pay for private treatment which financially impacted her. She says as a result of the events she no longer trusts dentists.

26. Our adviser said the visible gaps around the sealing points and leaving a gap in the root canal which would allow bacteria in. It appears overtime this bacterium led to a problem with the tooth and caused Miss H pain and required her to have further treatment. Our advisor told us the failings in the root canal treatment would mean a higher risk of failure. We can link the failings in the initial root canal to the fact she required further treatment on the tooth three years later.

27. We consider the actions of the Practice would likely have caused Miss H distress when she learned her treatment was not carried out appropriately. This likely would lead her to lose trust in the actions of dentists and worry about receiving treatment moving forward.

28. Miss H says she had to pay privately for treatment because of the gap in her root canal. We have seen from the records Miss H attended the Practice on 25 June 2024 after she began to experience pain in the tooth. It was identified a further root canal was required. She acknowledges in her complaint she was referred for a new root canal on the NHS however the waiting list would be a few months. Miss H chose to seek private treatment rather than wait for NHS treatment. We cannot say Miss H had no other option than to seek private treatment for her root canal. The Practice did offer to provide the treatment on the NHS.

29. We go on to make recommendations below.

1. Miss H complains that a dental practice in Lancashire (the Practice) did not perform a root canal in June and July 2021 appropriately. We understand how challenging it is when treatment does not go as you would expect and how it can cause a loss of trust in a dentist.

2. Based on the evidence, including clinical advice, our decision is the root canal performed was not in line with standards and guidance. We consider this led to the need for a second root canal and a loss of trust in dentists.

3. We will uphold this complaint.

4. We recommend the Practice issue Miss H an apology and pay £120 in recognition of the distress caused.