A dental practice in the Havant area

6. Miss H complains about the treatment provided to her by the Practice when it placed a filling on her tooth on 11 February 2025.

7. Miss H says that the Practice filled the tooth too high meaning that it was uncomfortable, painful, and she could not close her mouth. Miss H returned to the Practice on three occasions to have the height of the filling reduced. Miss H also complains that the Practice damaged her tooth when removing the tooth next to it.

8. Following this Miss H was still experiencing pain and decided to continue with her treatment at another Practice where it was discovered that the filling had been placed close to her nerve, and this is why she was experiencing so much pain.

9. Miss H says that she still has pain in her tooth now.

10. Miss H would like service improvements and a financial remedy.

11. On 11 February 2025 Miss H attended the Practice to have a filling placed in her tooth. Miss H said that after the procedure she told the dentist that she felt that the filling was too high, and she couldn’t close her mouth properly.

12. On 18 February 2025 Miss H had an appointment at the Practice as she still felt that her filling was too high. The Practice reduced the height of Miss H’s filling at this appointment.

13. On 19 February 2025 Miss H attended the Practice for some other dental treatment. In this appointment the Practice took an X-ray of her tooth. She explained that she was experiencing pain on biting.

14. On 4 March 2025 Miss H had another appointment at the Practice as she was still experiencing pain when she was biting. The Practice reduced the height of the filling again at this appointment.

15. On 11 March 2025 Miss H attended the Practice again to have another tooth removed. Miss H explained that the neighbouring tooth was damaged in this process and the porcelain of the crown on it was knocked off.

16. Miss H explained that throughout this period she was still having ongoing pain in the tooth that had been filled. She booked an appointment at the Practice for 4 April 2024 to discuss this.

17. Miss H said that on 3 April 2025 she had a call from the Practice in which it said that it had cancelled her appointment as the dentist had looked at her records and did not feel that anything more could be done for her.

The damage to Miss H’s crown

21. Miss H complains that the Practice damaged the crown on one of her teeth when removing the tooth next to it. We understand that this will have been disappointing for Miss H. She feels that the Practice should pay for her to have the crown repaired.

22. 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 have not found any indications that something has gone wrong.

23. On 11 March 2025 Miss H attended the Practice to have a tooth removed. Miss H said that in this process, the Practice chipped part of the porcelain of crown off the tooth next to it. Miss H told us that you can now see a small piece of the metal underneath the crown on her tooth.

24. In its complaint response the Practice acknowledged that it had chipped a piece of the crown off. However it said the crown is still well cemented, and the chip does not affect the integrity or strength of the crown. It told Miss H that if she was unhappy with the aesthetics of the chipped porcelain it could be replaced for cosmetic reasons. The Practice did not offer to pay for Miss H to have this cosmetic replacement.

25. Miss H’s records show that she signed a consent form when she had her tooth removed that explained that there was a risk of damage to the neighbouring teeth. The records also explain that the integrity of Miss H’s crown was not affected, and that the damage caused was purely cosmetic. The Practice also recemented Miss H’s crown and smoothed the porcelain where the chip had come out from.

26. Our adviser explained that as teeth are very close to one another it is common that during extractions accidental damage can occur to adjacent teeth. They said that this is outlined as a risk in the consent form that Miss H signed.

27. The GDC standards state that ‘you must obtain valid consent before treatment, explaining all the relevant options and the possible costs.’ We consider that in line with this guidance, the Practice explained the risk of damage to her neighbouring teeth to Miss H, and she consented to this.

28. We asked our adviser if the Practice should have offered to repair Miss H’s crown even though they did not damage the integrity of it. Our adviser explained that as Miss H had consented to this risk, the Practice did enough by ensuring that the damage to Miss H’s crown was rectified, by recementing it, and smoothing out the porcelain.

29. They explained that the metal that is underneath the porcelain is the crown, and the porcelain is layered on top for cosmetic purposes, meaning that the metal being visible will not affect the functionality of the crown.

30. Therefore, whilst we can see that the Practice did damage the crown when it removed her tooth, we do not consider this is an indication of a failing. Unfortunately, this is a known risk, and this was explained to Miss H before the extraction.

31. We appreciate that the chip in her crown will be frustrating and upsetting for Miss H. We consider that the Practice acted in line with the GDC standards by ensuring that Miss H was aware of and consented to the risks of having a tooth removed. The Practice also appropriately ensured that the damage to Miss H’s tooth was rectified.

Miss H’s filling being placed too close to the nerve

32. Miss H told us that following her having a filling done at the Practice on 11 February 2025 she was experiencing pain when she was biting her teeth together.

33. The records show that Miss H attended the Practice on three further occasions to discuss this pain with it. At these appointments the Practice reduced the height of her filling and took an X-ray of it.

34. Miss H told us that as her pain was continuing, and the Practice had refused to see her, she decided to seek treatment at another dental practice. Miss H explained that this Practice told her that the filling had been placed too close to the nerve, and this is why she was having ongoing pain.

35. In its complaint response the Practice said that it could refer Miss H to have her painful tooth be assessed by an endodontist (a specialist dentist that looks at issues with the root of the tooth) as it was now outside their scope and required a specialist opinion.

36. Miss H’s records show that she explained to the Practice that she was having pain when she was biting her teeth together. The Practice X-rayed Miss H’s tooth on 19 February 2025. It explained to her that it could see no evident cause of her pain, and that the filling was not too close to her nerve. It then explained to Miss H on 3 April 2025 that there was nothing more it could do to help her with the pain she was experiencing.

37. We asked our adviser if the X-ray showed that Miss H’s filling was done too close to the nerve. Our adviser explained that the X-ray shows a filling that is somewhat shallow and is therefore not close to nerve space.

38. Our adviser said that a deep filling is not the only possible cause of dental pain, and that the Practice should have done more to investigate Miss H’s pain.

39. The toothache guidance explains that there are many different tests that can be carried out by dentists to attempt to diagnose a patient’s pain. These include discussing the type of pain that the patient is experiencing and when it occurs, performing a cold test, where the tooths responsiveness to cold stimuli is tested, or a EPT test, where the tooths responsiveness to electrical stimuli is tested.

40. Our adviser also explained that the Practice could have used a fracture finder or tooth sloth, a tool which is used to check for small fractures in a patient’s teeth. There is no evidence that the Practice did any of these further tests.

41. Although we cannot say that Miss H would have been diagnosed and received treatment had these further tests been carried out, we can say that Miss H lost the opportunity for a better clinical outcome in her case, where her pain could have been treated sooner.

42. We contacted the Practice to discuss the indication of failing we identified. We asked the Practice if it would provide Miss H with a financial remedy and to discuss Miss H’s case with its staff, to ensure that they understand the importance of carrying out the appropriate tests to investigate a patient’s pain.

43. Our NHS Complaint Standards say organisations should openly identify instances when things have gone wrong, or where services have had an unfair impact, and take responsibility for these. They should make sure staff can offer a range of ways to put things right for the individual.

44. Our ‘Guide to Financial Remedy’ sets out our ‘severity of injustice scale’ (our scale). This is a guide which helps us decide an appropriate amount of financial remedy, depending on the injustice the person has suffered. The scale has six bands ranging from levels one and two lower-level injustices of frustration and pain up to level six where often loss of life or profound effects on a person being able to live a normal life.

45. In this instance, we recognise the impact caused to Miss H to be at a level two on the scale. This is because, we cannot say that Miss H would have been able to receive a diagnosis and treatment that would have stopped the pain she was experiencing if the Practice had performed further tests to investigate her pain. However, we can say that the failure of the Practice to do these further investigations, meant that she lost the opportunity for a better clinical outcome in her case.

46. Our scale explains that cases where there is ‘loss of opportunity for a better clinical outcome in cases involving less serious illness or the outcomes of minor injuries’ we usually recommend a financial remedy of between £120 - £550.

47. We also conduct precedent checks to look for similar themes to help inform our thinking on remedy and checks on similar sorts of awards made to ensure consistency. As part of this process, we contacted the Practice to discuss our findings with it. The Practice agreed to pay Miss H a financial remedy of £200 and to discuss Miss H’s case with its staff.

48. Taking this into account, we are satisfied that the discussions that the Practice are undertaking with its staff about Miss H’s case, and the financial payment is in line with our NHS complaint standards and our severity of injustice scale and is enough to remedy the impact caused. As such we consider this issue is resolved, and we will not be considering this any further.

49. We would like to thank Miss H for taking the time to bring her complaint to us. We understand it will have been frustrating for her to be without a diagnosis or treatment for her pain. We hope that this report offers her some closure on this matter.

1. We have carefully considered Miss H’s complaint about a Dental Practice in the Hampshire area (the Practice).

2. We are sorry to hear about Miss H’s experiences at the Practice. We can understand that it will have been difficult for Miss H to be in pain for such a long period of time.

3. Miss H says that the Practice damaged a crown on one of her teeth when it was removing the tooth next to it. We can recognise that this will have been frustrating for Miss H. After consideration, we have not seen any indications of failings for this issue, as this is a common occurrence in dental treatment, and Miss H accepted this as a risk before the procedure.

4. Miss H also complains that the Practice filled her tooth too close to the nerve, and this caused her ongoing pain. Miss H’s records do not show that the tooth was filled too close to the nerve. However, we consider the Practice should have done more investigations into her ongoing pain. It did not do so and we consider this is an indication of a failing.

5. We have spoken to the Practice, and it has agreed to take steps to put right the impact caused from this. As we have achieved a resolution for this issue, we will not consider this further.