A dental practice in the Swale area

4. Mrs M complains about the following aspects of care and treatment received at the Clinic from 13 November 2024 to 9 January 2025 following her wisdom tooth removal. Mrs M says: • the dentist incorrectly told her she had stitches from a wisdom tooth removal, which led the Clinic to perform multiple dry socket treatments she believes were unnecessary • the Clinic performed the final dry socket treatment without her consent • the Clinic refused to prescribe her antibiotics and pain medication on multiple occasions • the Clinic repeatedly dismissed her concerns about bleeding gums and painful lumps • the Clinic charged her for an emergency and a review appointment

5. Mrs M tells us the impact of the Clinic’s actions is: • she is traumatised from multiple invasive dry socket treatments and fears going to the dentist now • she is upset she was forced to return multiple times to request antibiotics and pain medication • her condition worsened and she developed bleeding gums and painful lumps in her mouth • she suffered needless pain that could have she could have avoided early on, without it causing issues with her everyday activities, like eating • she had to pay for multiple repeated appointments when the Clinic could have resolved it if her concerns were listened to and they had prescribed antibiotics rather than attempting numerous dry socket treatments.

6. By bringing this complaint to us, Mrs M is seeking: • financial remedy for all the pain and stress caused to her • specific refund of two appointments at £26.80 each, that she repeated due to the Clinic not listening to her concerns, only for them to later do what she requested earlier.

7. Mrs M underwent a wisdom tooth extraction at an oral surgery centre on 12 November 2024. The following day, she attended an emergency appointment at the Clinic. The Clinic diagnosed dry socket. This is when the blood clot at the extraction site fails to form or dislodges. This causes pain as it exposes the bone and nerves. The dentist performed a dry socket treatment which involved cleaning the socket and placing medicated dressings to relieve pain and promote healing.

8. On 15 November, Mrs M contacted the Clinic again due to ongoing pain. The Clinic carried out a second dry socket treatment during this visit and prescribed antibiotics. Mrs M returned on 18 November with persistent pain, and the Clinic advised her to continue with the course of antibiotics and take painkillers. On 21 November Mrs M reattended the Clinic due to bleeding gums and the Clinic performed a dry socket treatment.

9. On 2 December, Mrs M had a routine appointment at the Clinic. The dentist noted she was healing well from the wisdom tooth extraction. Mrs M returned for an emergency appointment on 12 December due to painful swelling around the wisdom tooth extraction site, and had a foul taste in her mouth. The dentist prescribed a polyp and prescribed antibiotics.

Mrs M attended two further follow-up appointments on 18 and 30 December 2024. On 18 December the dentist noted the polyp had reduced in size and appeared to be healing. On 30 December the dentist decided to prescribe a further course of antibiotics as the polyp was still present. Mrs M returned on 9 January 2025, and the dentist then offered to refer her to a specialist as the polyp was still present.

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.

12. When we see indications something has gone wrong, we consider the impact this had and the actions the organisation has taken to put things right. If we are satisfied the organisation has already done enough to put things right, we will not take further action.

13. For most of Mrs M’s complaint we have not seen any indications that things went wrong. This is because the Clinic’s actions appears to be in line with the relevant policies. There is one part of Mrs M’s complaint where we think the Clinic has done enough to put right the impact of what happened.

Dry Socket Treatments

14. Mrs M complains that the Clinic failed to provide appropriate treatment for her pain after she had a wisdom tooth removed. She says the issue began on 13 November 2024 when she visited the Clinic and the dentist performed a dry socket treatment. She says the dentist explained they could not go very deep with the treatment because stitches remained in her mouth following the extraction. She says this was incorrect and she did not have stitches.

15. The Clinic’s record show that following the extraction Mrs M’s socket was still bleeding and she had a bad taste in her mouth. She also said she was shivery and restricted in how far she could open her mouth. The dentist diagnosed an infected socket and performed the treatment to clean the socket and agitate it to promote bleeding.

16. Mrs M returned on 15 November as she was still in pain and struggling to eat. The dentist diagnosed the dry socket was still present. They did a further dry socket treatment and prescribed a five-day course of antibiotics.

17. Mrs M returned on 18 November as she was still in pain. The dentist noted the socket was healing and there were no signs of infection or inflammation. They advised her to continue the course of antibiotics, take painkillers, rinse with saltwater and use a warm pack.

18. The national standards for dentists say dentists must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation. The national guidance on antibiotics in dentistry say that dry socket treatments consist of rinsing affected areas using sterile solution to remove pieces and to place a suitable dressing in the socket to relieve symptoms.

19. The Clinic’s records show the dentists carried out dry socket treatments to clean the socket and encourage healing, not because of a belief that stitches were present. We have also seen no evidence the depth of the initial treatment was because of a belief that stitches were present.

20. We recognise it was distressing and traumatic for Mrs M to have to have three dry socket treatments. Our clinical advisor confirmed the treatments were appropriate and in line with national standards. Our adviser told us dry socket is a risk of any tooth extraction and is common in lower wisdom teeth. Our adviser said the symptoms of dry socket can last for over two weeks. Our adviser also explained that dry socket can sometimes heal and then return for no obvious reason.

21. It is unfortunate that Mrs M had a difficult recovery from wisdom tooth removal and had to visit the Clinic several times. We hope she is reassured the Clinic provided clinically justified dry socket treatments to try and relieve her symptoms.

Dry socket treatment without consent

22. Mrs M complains that the Clinic did the final dry socket treatment on 21 November against her wishes and without her consent.

23. The Clinic’s records show Mrs M said her socket had been healing well but started bleeding again after sneezing. At that appointment, the dentist performed a dry socket treatment to remove food debris and aid healing. Mrs M told us she did not want this treatment and said no to the dentist, but they did the treatment anyway. This must have been very distressing for Mrs M to have treatment she did not want.

24. National standards for dentists say dentists must obtain valid consent before starting any treatment and ensure the consent remains valid at each stage of the investigation or treatment. We reviewed the Clinic’s documentation dated 21 November, which includes Mrs M’s signed consent form authorising examination and necessary treatment under the NHS. This is a generic consent form which does not detail what treatment is required. The dentist’s record of the consultation does not record the dentist obtained verbal consent to the dry socket treatment. The Clinic’s responses to the complaint did not address this matter either.

25. In cases of conflicting accounts, we must balance our decisions on reliable evidence. As the records did not give us clarity on this matter, we asked the Clinic to address this issue.

26. The dentist told us that even though there is no specific recording regarding obtaining consent from Mrs M, the treatment could not have taken place without her consent to proceed.

27. We note from Mrs M’s clinical records, the dentist who did this treatment also treated her on 13 and 15 November. The notes of these earlier appointments also do not document that the dentist obtained Mrs M’s consent to treatment. We note that Mrs M has not complained about treatment being provided without consent on those dates. This points to there being a wider issue with the dentist’s record keeping. We note the other dentists Mrs M saw regularly documented obtaining her verbal consent to treatment.

28. This lack of documentation about consent means we will never know exactly what the dentist and Mrs M said, and how it came to be that she stayed in the chair for treatment she did not want on 21 November. We understand Mrs M will be disappointed we cannot make an evidence based decision on whether the dentist provided treatment without her consent.

29. In the letter to us, the dentist acknowledged their documentation was inadequate. They have assured us that moving forward they will record verbal consent from the patient before starting treatment. For these reasons, we feel it has already done enough to put things right and we do not need to take further action.

Mrs M’s complaint about the Clinic’s refusal of antibiotics and pain medication:

30. Mrs M states the clinic denied her antibiotics and pain medication for her gum problems. She explains that she had to attend several appointments and repeatedly request prescriptions, which she believes were unnecessary and caused her additional expense, stress, and pain.

31. The clinic notes indicate the dentist did not provide any advice about medication at Mrs M’s first appointment on 13 November 2024. At her second appointment on 15 November, the dentist prescribed metronidazole (an antibiotic). On 18 November the dentist advised her to continue her antibiotics and use over‑the‑counter painkillers. On 12 December the dentist prescribed amoxicillin (an antibiotic). Mrs M says this could have been avoided if the Clinic had addressed her concerns earlier. On 30 December the dentist prescribed metronidazole again. Throughout her care, the Clinic also advised saltwater rinses and warm packs as supportive pain management.

32. National guidance on antibiotics in dentistry say that dry sockets do not require antibiotic prescriptions. National guidance on pain relief says that for dental pain, pain relieving medication should be used as a temporary measure until the cause of pain has been dealt with. It says that most dental pain is relieved effectively by over-the-counter painkillers such as ibuprofen and paracetamol.

33. Our adviser confirmed general dentists do not routinely provide patients with pain medication. This is because over the counter medication is generally effective for dental pain. We can see in the patient notes the dentists gave Mrs M advice about pain relief when she reported pain. This was in line with national guidance.

34. Our adviser confirmed it is not clinically appropriate to prescribe antibiotics for dry socket without observable signs of more widespread infection. As there is no guidance to suggest antibiotics should be prescribed when the dentists diagnosed dry socket, the Clinic followed appropriate measures in not prescribing them initially.

35. The records confirm the Clinic prescribed antibiotics when there were signs of infection, such as during the emergency appointment on 15 November when Mrs M had not improved despite dry socket treatment. The Clinic also prescribed antibiotics on 12 December, where they observed discomfort from a polyp. The Clinic prescribed a different course of antibiotics on 30 December when Mrs M’s polyp persisted. Our adviser confirmed these were appropriate times to prescribe antibiotics.

36. We recognise Mrs M had a long and painful recovery from her wisdom tooth extraction. Our adviser said the recovery from wisdom tooth extraction can be unpredictable depending on the person’s biology which will determine how they heal and how they respond to pain.

37. The records consistently show that the Clinic advised over-the-counter pain relief and supportive measures, and prescribed antibiotics when clinically necessary. We have seen no indications the Clinic did anything wrong in respect of pain relief or antibiotics. Therefore, we will take no further action.

Mrs M’s complaint about the Clinic’s dismissal of concerns about bleeding gums and painful lumps:

38. Mrs M complains that the Clinic did not take her concerns about bleeding gums and painful lumps seriously, and that her issues worsened until she booked emergency appointments.

39. The records show the Clinic saw Mrs M on multiple occasions between 13 November and 9 January 2025. We can see she reported bleeding from the extraction site from the start of this period until 21 November. We can see Mrs M reported painful ulcers on 18 November, then swelling and lumps in her gums from 12 December.

40. National standards for dentists say dentists must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation.

41. The Clinic’s complaint responses to the complaint did not address this specific matter, so we asked the Clinic to explain its view on Mrs M’s concern. The dentist said they considered her concerns and provided the relevant advice and medication where necessary for appointments on 18 November 2024 till 9 January 2025.

42. On 13 November Mrs M reported the socket was still bleeding after the extraction the previous day. The dentist provided a dry socket treatment and our Adviser agreed this was an appropriate course of action to try and heal the socket.

43. On 15 November there is no reference to Mrs M having painful lumps or bleeding gums. On 18 November Mrs M told the dentist she had painful ulcers. The dentist advised her to continue the prescribed five-day antibiotic course prescribed on 15 November. Our adviser confirmed this was an appropriate course of action.

44. On 21 November Mrs M reported further bleeding and the dentist performed another dry socket treatment. Our adviser confirmed this was in line with relevant standards. We can see no reference to Mrs M having bleeding gums or lumps on 2 December 2024, where the dentist assured Mrs M the affected area was healing well.

45. Mrs M reported painful swelling in her lower right gum when she went to an emergency appointment on 12 December. The dentist diagnosed a gingival polyp (enlargement of the gum, typically due to trauma, irritation, or inflammation) and prescribed her antibiotics. They took photographs of the area and advised her to return for a review in a week. Our adviser confirmed this was an appropriate course of action.

46. When Mrs M returned on 18 December, the dentist noted the swelling had reduced in size. They advised saltwater rinses and mouthwash, and to return in two weeks for a review. Our adviser confirmed this was appropriate as Mrs M’s problem seemed to be healing.

47. Mrs M attended again on 30 December and said she believed she had an abscess. The dentist noted the polyp was still present but the socket underneath was healthy. The dentist noted they were unsure of the cause of the polyp but would prescribe a different antibiotic to those prescribed on 12 December. Our adviser confirmed this was in line with relevant standards.

48. On her repeat visit on 9 January 2025 the dentist offered to refer Mrs M to a specialist as the polyp was still present. Our adviser said this was an appropriate course of action.

49. Our advisor stated that even though the area around the extraction site showed signs of swelling, inflammation and bleeding at times, it was likely due to the healing process. Our adviser said occasionally the healing process after an extraction can result in slow healing and prolonged post operative pain. We recognise this was very difficult for Mrs M

50. Our adviser confirmed at each visit, the Clinic reviewed Mrs M and managed her care in line with professional standards, with advice and treatment tailored to her condition. As we have seen no indications the Clinic did anything wrong, we will take no further action.

Charges for appointments

51. Mrs M attended multiple appointments from mid November 2024 until early January 2025, for which the Clinic charged her on five occasions. She explained her view that the emergency appointment on 12 December should not have incurred a fee, as she felt it was necessary only because antibiotics had not been prescribed at her previous visit. She also explained she should not have had to pay for the appointment at the end of December, which she attended after being advised to return if her symptoms persisted. We understand why Mrs M is dissatisfied she had to pay so many charges for the various appointment to treat the complications following her wisdom tooth extraction.

52. NHS dental charges are set by NHS England. The Clinic applies them based on the type of treatment provided. In November and December 2024, the charge for both urgent care and routine examinations was £26.80. NHS England guidance explains that the charge for urgent care covers a single course of emergency treatment, and any subsequent treatment or care is chargeable separately.

53. The Clinic booked the emergency appointment on 12 December 2024 because Mrs M was experiencing signs of infection. We cannot see any evidence this was because antibiotics should have been prescribed on 2 December, when the dentist noted the extraction site was healing well. The charge applied for the 12 December appointment falls within the urgent care category and is appropriate.

54. Similarly, the appointments on 18 and 30 December 2024 were routine reviews following earlier advice to return if symptoms continued. The Clinic correctly charged these separately, as the charge paid on 12 November covered a single course of emergency treatment.

55. It is regrettable that Mrs M had to attend so many appointments during this time, and we do not underestimate the impact the charges for these appointments had. The charges applied were consistent with NHS England’s dental charging structure and therefore we can see no indications of failings in the Clinic’s actions.

56. We recognise how upsetting it must have been for Mrs M during this time. We hope she is reassured that the Clinic acted in line with relevant guidance and her difficult recovery was not due to any failings on the Clinic’s part. We would like to thank her for her time and effort in bringing this complaint to our attention.

1. We have carefully considered Mrs M’s complaint about the actions of the dental clinic (the Clinic) she attended in 2024-2025 when she had problems after a wisdom tooth extraction.

2. We recognise how important this complaint is to Mrs M and acknowledge the difficulties she experienced while in pain. We are sorry to hear she feels the Clinic dismissed her concerns and denied her appropriate medication on several occasions. We also recognise the stress and worry this situation has caused her.

3. We have reviewed the evidence which shows the Clinic assessed and treated Mrs M’s painful lumps and bleeding gums after her wisdom tooth removal. The Clinic prescribed antibiotics when infection was present and consistently advised her on pain relief and supportive care. The Clinic followed national guidance, and we have seen no indications that it failed in managing her dental issues.