A dental practice in the Manchester area

5. Mr C complains about aspects of the care and treatment provided by the Practice between February 2021 and October 2022.

6. Specifically, he says the Practice did not meet its duty of care in relation to his request for dental implants. He says the Practice did not appropriately follow the instructions set out in dental hospital clinic letters dated June 2021 and January 2022 which were needed for him to be eligible for dental implants.

7. He also says the Practice did not make a referral to the dental hospital for further implant consideration between June 2021 and October 2022.

8. Mr C says because of these delays, he has been left in pain, and this has had an ongoing impact on his mental health.

9. By bringing this complaint to us, Mr C us seeking our independent review of his care and for the Practice to take appropriate action to remedy any failings in his care.

10. Mr C previously had dental implants, which later broke. He was under the care of both a dental hospital and the Practice at the time.

11. Mr C wished to have further implants fitted. However, the dental hospital raised concerns about his suitability for implants due to his oral hygiene and provided instructions to the Practice regarding his ongoing care.

12. During this period, Mr C received several dental bridges and denture-based treatments. He says these were uncomfortable and caused him pain. Because of this, he was keen to be reassessed by the dental hospital and considered again for dental implants.

13. Mr C asked the Practice to refer him to the dental hospital for further consideration but was told a referral could not be made as he did not yet meet the criteria the hospital had put in place. Mr C disagreed with this decision and raised a formal complaint with the Practice.

Following the dental hospital’s instructions

17. Mr C says the Practice did not appropriately review or act upon the instructions contained in the dental hospital clinic letters dated June 2021 and January 2022 which were needed for him to be eligible for dental implants.

18. We considered the GDC’s standards for the dental team. This guidance explains that dental professionals should provide good quality care based on current evidence and authoritative guidance (standard 7.1), and work within their skills and knowledge, referring patients appropriately where treatment is outside their scope (standards 7.2 and 6.3).

19. The guidance also emphasises that referrals should be clinically appropriate and made where treatment is likely to be suitable and beneficial. In relation to implant treatment, suitability depends on factors such as oral hygiene, periodontal health, and overall prognosis. The guidance further highlights the importance of communicating clearly with patients about their care and treatment, including providing information they need to understand treatment pathways and any requirements for further treatment to be considered (standards 2.3 and 2.4).

20. The dental hospital’s correspondence dated June 2021 set out recommendations for Mr C’s ongoing care prior to any further consideration of dental implants. The hospital advised the focus of treatment should be on improving oral health and stabilising Mr C’s dentition. The hospital recommended the extraction of teeth with poor prognosis, together with scale and polish treatment and oral hygiene instructions. It also explained once this initial phase of care had been completed, the upper right canine tooth implant (UR3) should be reviewed to determine whether it could be restored or would require removal and replacement of a new implant.

21. In subsequent correspondence dated January 2022, the dental hospital amended the referral criteria, explaining that priority should be given to achieving dental stability with dentures, and that further implant consideration would only be possible if oral hygiene improved and there were ongoing difficulties adapting to dentures.

22. From the evidence we have considered, we can see the Practice provided the following care: professional cleaning, oral hygiene instruction, treatment of infection around an existing implant, extraction of a tooth with poor prognosis, and the provision of temporary and then more stable denture-based treatment.

23. Our adviser confirmed the care provided by the Practice was consistent with the dental hospital’s instructions and with relevant professional standards.

24. In conclusion, we are satisfied that the Practice followed the dental hospital’s instructions and acted in line with GDC Standards, as the Practice appropriately focused on stabilising Mr C’s oral health rather than progressing with a referral that did not meet the hospital’s criteria. Overall, we consider there is no indication of a failing in how the Practice responded to or implemented the hospital’s guidance.

Timing of referral for further implant consideration

25. Mr C says the Practice should have made a referral to the dental hospital for implant consideration between June 2021 and October 2022.

26. The records show that despite ongoing care, Mr C’s oral hygiene did not improve to the level required by the dental hospital for implant consideration.

27. Mr C did not attend the Practice for a period after March 2022 and returned in October 2022 raising concerns about his dentures. The final appointment in December 2022 was conducted by a different dentist. The notes from this appointment record the dentures were generally well fitting, with only minor issues, and that further appointments were offered for ongoing dental support.

28. Our adviser confirmed, based on the information available at the time, an earlier referral for implant assessment would not have been clinically appropriate because the referral criteria had not been met due to poor oral hygiene and ongoing efforts to achieve dental stability with dentures.

29. Our adviser further explained that the only referral which may have been required during this period was for removal of the implant which was damaged. In a letter from March 2022, the dental hospital advised it would remove implants Mr C was having problems with. In a consultation at the end of March 2022, we can see the dentist offered a referral for removal of the implant, but it is recorded that Mr C did not want to proceed with this.

30. By the time of the appointments in October and December 2022, we cannot see that this was reported as an ongoing issue which suggests further referral may not have been clinically indicated at that time.

31. With the above in mind, we are satisfied the Practice’s consideration of making a re-referral to the dental hospital was appropriate and in line with GDC Standards 7.1, 7.2 and 6.3. We have not identified any indications that the Practice unreasonably delayed a referral or failed to act on information available at the time.

Conclusion

32. We understand that Mr C experienced discomfort and frustration during this period and he continues to experience pain and ongoing dental difficulties, and this is not the outcome he was hoping for. We do not wish to diminish the significance of his experience or the impact it has had on him both physically and emotionally.

33. Having carefully reviewed the evidence and the independent clinical advice, we have not identified any indication of failings in the care and treatment provided by the Practice. The Practice acted in line with the dental hospital’s guidance, relevant GDC standards, and expected clinical practice. For these reasons we do not see indications to suggest further action is needed.

1. We have carefully considered Mr C’s complaint about the care and treatment he received from the Practice in relation to his request for dental implants.

2. We recognise that Mr C has experienced ongoing dental problems and discomfort, and that this situation has been frustrating and distressing for him. We want to reassure him that we have carefully considered his concerns, the impact these events have had on him, and the actions taken by the Practice.

3. Having carefully considered Mr C’s complaint, we have decided that there are no indications of failings in the care and treatment provided by the Practice.

4. We hope our explanation provides some reassurance to Mr C that his concerns have been carefully and independently considered.