A dental practice in the Wyre area

3. Mr T complains about a Practice (the Practice) and a Clinic (the Clinic) in East Sussex. Mr T complains about the Practice who referred his tooth for extraction, and the Clinic who took the tooth out. He complains:

• the Practice did not do enough diagnostic tests and scans to identify the correct tooth for extraction before referring him for surgery, • the Practice did not properly communicate which tooth was being extracted or get Mr T’s consent • the Practice receptionist wrongly advised Mr T not to go to the Practice when his filling fell out, missing an opportunity to confirm the correct tooth for extraction, • and the Clinic did not do a final check with Mr T that the right tooth was being extracted, and it removed the wrong tooth.

4. Mr T explained the failings in his care meant:

• he was still in a lot of pain after his tooth was taken out, • he had difficulty eating on the right side of his mouth which meant he kept using the left side causing it damage, • a healthy tooth was taken out, • he felt his jawline changed, • Mr T had to take time off work, • and, it has been emotionally difficult, and he has felt depressed.

5. Mr T wants an apology and financial remedy for the prolonged pain he was in.

6. Mr T went to the Practice with pain in the upper right-hand side of his mouth from September 2023 to March 2024. Different options were discussed with Mr T including tooth extraction. On 1 March 2024 the Practice referred Mr T to the Clinic to have tooth UR7 removed.

7. This Clinic removed tooth UR7 on 6 March 2024. Mr T went back to the Practice on 8 March 2024 and said he thought tooth UR6 was the cause of his pain. Mr T said he thought the wrong tooth had been removed.

The Practice did not do enough diagnostic tests and scans to identify the correct tooth for extraction before referring Mr T for surgery

11. 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 we have not found any indications that something has gone wrong.

12. Mr T said the Practice did tests on his teeth to find the cause of his pain. He thinks there should have been more investigations including a CT scan. Mr T believes the wrong tooth was diagnosed because he was still in pain after the extraction of tooth UR7.

13. We have considered evidence from the Practice records to find out what happened. On 7 September 2023 Mr T had a radiographic scan of his upper right teeth. On this date the Practice also tested the sensitivity of his upper right teeth to air and water. After these tests, Mr T was diagnosed with tooth decay in the UR7 tooth.

14. On 13 February 2024 the Practice completed further tests. The Practice notes show tooth UR7 had tenderness to percussion. This is when the patient experiences pain when the tooth is tapped. The Practice also recorded tooth UR7 had hypersensitivity to 3in1 which is a tool used by dentist to spray air, water and mist at a tooth. After the results of these diagnostic tests, the Practice diagnosed UR7 with pulp necrosis. This is when the soft tissue in a tooth decays and dies.

15. The records show the Practice discussed different treatment options with Mr T on 13 February 2024. The Practice told Mr T treating tooth UR7 would be difficult because the root of the tooth was curved. The Practice recommended referring him to have tooth UR7 extracted. Mr T opted to leave tooth UR7 and monitor it. On 1 March, Mr T asked the Dentist to refer him for the extraction of tooth UR7.

16. We got clinical advice from a dentist with over 40 years of experience, our adviser. They were able to tell us what should have happened in Mr T’s care.

17. We have referred to CGD guidance, 2016. We have used this guidance for transparency, as the 2016 version is available freely online. Our adviser confirmed the content of this guidance was in place during Mr T’s care in 2023 and 2024. Section six of the CGD guidance says a range of diagnostic tests should be carried out to find the cause of dental pain. The guidance is clear not all tests need to be completed.

18. Our adviser explained relevant tests include putting hot or cold air on the tooth, putting pressure on the tooth and scanning the tooth. Our adviser said if Mr T experienced pain in tooth UR7 after these tests, it would have been appropriate for the Practice to diagnose UR7 as the cause of the pain. They said radiographic scans should show tooth decay. Our adviser looked at Mr T’s radiographic scan and saw tooth UR7 was damaged and decayed.

19. Our adviser referred to GDC guidance Section 6.3 which advises dentists to refer patients if they tooth cannot treat a tooth. The guidance states referrals must contain good evidence from diagnostic tests.

20. We acknowledge Mr T thinks more tests should have been done. We can see the Practice did three types of tests; a pressure test, an air test, and a scan. This was a good range of diagnostic tests to meet the appropriate guidelines. The findings of these tests were conclusive that tooth UR7 was the cause of Mr T pain. There was no need for the CT scan Mr T requested. We consider the Practice acted in line with guidance when it diagnosed tooth UR7.

21. We have considered Mr T said he was still in pain after the extraction. Our adviser explained it is likely Mr T was still in pain because of a fracture in tooth UR6. They told us, on radiographs, fracture lines can look like natural tooth lines, which makes diagnosis difficult. Tooth fractures are only clear when the tooth splits open. Mr T’s records show the fracture only became clear after extraction on 15 March 2024.

22. We consider tooth UR7 and tooth UR6 had separate issues which led to them both failing at different times. At the point of referral on 1 March 2024, the Practice diagnosed tooth UR7 in line with guidance and appropriately referred it for extraction. We have seen no indication the Practice did anything wrong in this case. For this reason, we will be taking no further action on this part of Mr T’s complaint.

The Practice did not properly communicate which tooth was being extracted or to get Mr T’s consent

23. We have considered Mr T’s evidence. Mr T went to the Practice on 27 February 2024 with swelling around his UR6 tooth. Mr T told us he thought this was the tooth to be extracted. Mr T said he did not feel he was correctly informed which tooth was being extracted. He also said he was not given the final opportunity to consent to extraction.

24. We have considered evidence from the Practice by looking at Mr T’s records.

25. On 13 February 2024, the Practice conducted tests and diagnosed Mr T’s UR7 tooth. It provided Mr T with treatment options, saying he could leave and monitor tooth UR7 and risk further decay and pain. The Practice also said Mr T could have tooth UR7 extracted. After discussing the options, Mr T asked to leave the tooth in place.

26. On 27 February 2024 Mr T attended the Practice for an appointment. The records align with Mr T’s account of events. It states Mr T reported pain and swelling around tooth UR6. The Practice gave Mr T antibiotics for this. The records show tooth UR6 was not discussed for extraction in this appointment.

27. On 1 March 2024 Mr T contacted the Practice. The notes say Mr T asked to be referred for extraction of tooth UR7.

28. Our adviser told us GDC guidance is relevant in this case. The guidance states there is no requirement to get written consent from a patient. The guidance is clear that consent comes from discussions with the patient.

29. Our adviser said the Practice should have had a conversation with Mr T where they explained which tooth was the cause of his pain and the options for treatment. The guidance says the patient should have a reasonable amount of time to make a decision.

30. The notes from the appointment on 13 February 2024 are extremely clear that the cause of Mr T’s pain was tooth UR7. The records show this was communicated to Mr T. The records also show they discussed different treatment options. We consider these discussions met the consent guidelines.

31. The records show Mr T prompted the extraction referral himself by contacting the Practice. This shows he was given reasonable time to make the decision which meets the guidelines.

32. We consider the Practice correctly communicated tooth UR7 was the one for extraction and the appropriate consent guidelines were followed. There are no indications of failings. For this reason, we will not be taking any further action on this part of the complaint.

The Practice receptionist wrongly advised Mr T not to go to the Practice when his filling fell out, missing an opportunity to confirm the correct tooth for extraction

33. Mr T explained he thinks a dentist should have seen him at the Practice on 27 February 2024. Mr T explained the filling fell from tooth UR6, and the phone conversation solidified in his mind tooth UR6 was being extracted. Mr T explained this was a missed opportunity to clarify tooth UR7 was the one for extraction.

34. The records show Mr T had an appointment at the Practice on 27 February. In the appointment he complained of pain and swelling around tooth UR6. Later the same day, Mr T called the Practice to say a filling had fallen out of his tooth.

35. The receptionist spoke to a dentist who advised if Mr T was not in pain, he could monitor the tooth or ask for a referral for extraction. Mr T said he would monitor his tooth and call later if he wanted a referral for extraction.

36. Mr T had his tooth extracted on 6 March 2024. Mr T had an appointment on 8 March 2024 where he told the Practice he thought the wrong tooth had been removed. The records show Mr T pointed to tooth UR6. The records state MR T had a lost filling from tooth UR6.

37. We asked our adviser what should have happened when Mr T called the Practice on 27 February 2024. Our adviser explained we would expect receptionists to consult with dentists on clinical matters.

38. Our adviser said the dentist should have considered CGD guidance. Section 4.1 says once a patient has had an examination and diagnosis of pain, they are free to choose which treatment they want.

39. Section 6 in CGD guidance says emergency appointments may be necessary when a tooth crown falls out. The appointment should take place if the patient reports pain.

40. We can see it was appropriate for the receptionist to pass on the dentist’s advice on the phone after speaking to them. The Practice’s decision to not see Mr T was appropriate because Mr T was not experiencing pain. This was in line with CGD guidance section 6.

41. We can see the filling fell from tooth UR6. We appreciate this may have contributed to Mr T’s confusion as he thought tooth UR6 was being extracted. As described in paragraphs 29-30, Mr T was appropriately informed tooth UR7 was diagnosed as the cause of his pain.

42. The Practice made their decision based on the diagnosis of tooth UR7. The Practice gave two options for treatment when Mr T’s filling fell out. We consider Mr T was able to make an informed decision to monitor the tooth himself. This was in line with CGD guidance 4.1.

43. We consider the Practice’s decision to not see Mr T was in line with guidance. We have seen no evidence of failings.

The Clinic did not do a final check with Mr T that the right tooth was being extracted and removed the wrong tooth.

44. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason the person could not bring the complaint to us sooner.

45. We have considered when Mr T had a reason to complain about the Clinic. We have also considered how long the Clinic’s complaint process took.

46. On 1 March 2024 the Practice referred Mr T to the Clinic for extraction of his UR7 tooth. On 6 March 2024, Mr T went to the Clinic and had this tooth extracted. The evidence shows on 8 March 2024 Mr T went back to the Practice and said he thought the wrong tooth had been removed.

47. Mr T complained to the Practice on 4 April 2024. This was four weeks after the event being complained about. In Mr T’s complaint to the Practice, he also complained about the Clinic. Mr T was unhappy about the Clinic’s pre-operative appointment. Mr T complained the Clinic did not explain which tooth was being extracted or give details of the procedure.

48. We can say Mr T knew he had reason to complain about the Clinic on 4 April 2024. To be within our time limit, Mr T needed to complain to us by 4 April 2025. He complained to us about the Clinic in August 2025, four months outside our time limit.

49. Mr T complained to the clinic on 21 March 2025, 11 months and two weeks after he became aware of the need to complain. We asked Mr T the reasons for the delay. Mr T said he first contacted the Clinic in November 2024 and asked how he could complain. Mr T said the Clinic’s opening times were not convenient for him. Mr T said he was more focused on his complaint about the Dentist and sorting out the pain in his tooth. This meant it took him longer to find out about the formal complaint process.

50. We have considered Mr T’s reasons. We can see he had pain in his tooth at this time. We consider Mr T was able to complain about the Practice and come to PHSO while still enquiring about his pain at the Practice. It is reasonable to say Mr T could have complained to both organisations at the same, earlier opportunity stage.

51. We have considered Mr T’s reason that the Clinic’s opening times were inconvenient. We can see Mr T’s complaints were made in writing. We consider Mr T did not rely on the Clinic being open to make his complaint.

52. We can also see Mr T was able to find out about the Practice’s formal complaint process promptly. We consider Mr T had the capability to do this for the Clinic.

53. We have not seen sufficient reason to put this 11-month two week delay aside.

54. We considered how long the Clinic’s complaint process took. When Mr T formally complained to the Clinic on 21 March 2025 it responded to him three and a half weeks later, on 15 April 2025. As this time was outside of Mr T’s control and it is a legal requirement complainants complain to the organisation before coming to PHSO, we have put this time aside.

55. Mr T brought his complaint us in August 2025, approximately four months after he received the Clinic’s final response. Mr T told us he was unsure whether to bring his complaint about the Clinic to us. He was also dealing with the medical problems surrounding tooth UR6.

56. We considered if it was reasonable Mr T delayed coming to PHSO because he was deciding whether to bring this complaint to us. Mr T complained to the Clinic on 21 March 2025. It is reasonable to say at this stage, he knew he was unhappy with the Clinic. The complaint response did not resolve the issue for Mr T. It is reasonable to say he should have known to bring this complaint to us when he received the Clinic’s complaint response.

57. Mr T brought his complaint about the Practice to us in June 2024. We consider Mr T should have known to do the same thing with his complaint about the Clinic.

58. We considered if it was reasonable Mr T delayed coming to PHSO because of remaining tooth pain. Mr T told us he had tooth UR6 removed in January or February 2025. We can see any further tooth pain was resolved when he received the Clinic’s final response in April 2025. We can see this was not a barrier to him bringing his complaint to us.

59. We consider this complaint is out of time. This is because of the 11 month and two-week delay between Mr T’s date of knowledge and the day he raised his complaint with the Clinic. This is also because of the four-month delay from the Clinic’s response and coming to PHSO. We have not seen sufficient reason to put the time limit aside.

Conclusion

60. We appreciate Mr T was still in pain after his tooth was removed which impacted his daily life. Mr T then became concerned the wrong tooth was taken out and a healthy tooth was removed.

61. We hope our findings have reassured Mr T that UR7 was not a healthy tooth. The diagnostic tests identified damage in this tooth, and it was correct to refer this tooth for extraction in March 2024.

1. We have carefully considered Mr T’s complaint about the Practice and the Clinic.

2. We have not found any indications of failings in Mr T’s complaint about the Practice. Mr T’s complaint about the Clinic falls outside of our time limit. We have discussed Mr T’s reasons for not bringing these issues to us sooner. We have not seen sufficient reason to put our time limit aside.