A dental practice in the City of Portsmouth area

7. Mr O complains between 2 and 30 November 2024 the Practice did not accurately assess his tooth and then it carried out unnecessary treatment.

8. He says there were complications with the treatment, and he had to make two emergency appointments at the Practice. Ultimately the Practice told Mr O the only option was to remove his tooth.

9. Mr O says he has had excruciating pain during this period. He says he incurred excess costs for the NHS treatment and then had to seek private treatment to save his tooth. He says this was all avoidable.

10. As an outcome, Mr O is seeking acknowledgement of failings from the Practice and an apology. He is also seeking financial remedy and reimbursement of his total treatment costs.

11. Mr O says during an appointment on 2 November 2024, the Practice did not listen to his concerns with his wisdom tooth. Mr O says the Practice did not fully explain what it would be doing. He told us it explained his options regarding treatment were 'decay and extraction' or ' filling and salvation'.

12. Mr O says the Practice then planned and completed a filling on his tooth when it should not have. He says this caused further issues and resulted in Mr O having to have a root canal (treatment removes an infection from inside of your tooth) and a crown fitted.

13. Mr O says following the filling he sought an emergency appointment and raised his concerns about being in unbearable pain with the Practice. Mr O says the Practice dismissed him, and it did not check on Mr O to ensure everything was correct.

14. Mr O says following the emergency appointment he had a follow up appointment where the Practice admitted to failing to clear the decay from his tooth during the procedure.

15. Mr O says at this point he was told he had two options, the Practice could extract under NHS care, but if he wanted to save the tooth, he was told he needed to go to endodontist (dentists who specialise in tooth pain, disease, and infection).

16. Mr Says he felt he had no option but seek private care at his own expense.

Assessment of his tooth

20. The records show that on 2 November 2024 the Practice carried out a routine examination. Mr O did not report any specific concerns at that appointment.

21. During the examination, the Practice identified a lesion (a deterioration or damage to the structure of a tooth) at the back of the upper right second molar (UR7). The Trust took a bitewing X-ray. This is an X-ray of the tooth used to help detect hidden decay.

22. The X-ray showed an area of shadowing near or slightly below the gumline. Our adviser explained shadowing indicates reduced tissue density. They explained dental decay commonly causes this appearance.

23. Our advisor explained clinicians cannot diagnose decay from X-rays alone. However, clinicians must interpret radiographic findings alongside clinical examination. In this case, the radiographic appearance, location of the lesion and clinical findings supported a diagnosis of decay.

24. The Practice also carried out percussion and sensitivity tests. These tests did not indicate pulp involvement (this is where nerves and blood vessels are affected by the decay) at that time. Our adviser explained on this basis the decision to provide a filling rather than root canal treatment was therefore clinically reasonable and consistent with accepted practice.

25. We considered GDC standards, which requires dental professionals to practise within their competence and provide quality care.

26. Based on the evidence within in the records and provided by our adviser we are satisfied the assessment Mr O required fell within general dental practice. We have seen no evidence there was a clinical indication at that stage for referral to another practitioner.

27. Mr O says the tooth had a mark for many years and had not caused problems. We appreciate why Mr O was so upset the treatment failed, when he felt it was not needed.,

28. Our adviser explained the absence of symptoms does not mean decay was not present. The later need for root canal does not, on its own, indicate that the original assessment was incorrect. Our advisor explained teeth with deep decay close to the nerve can deteriorate over time, even after appropriate initial treatment.

29. Taking account of the clinical records, the independent advice we received and the relevant professional standards, it is our view the Practice assessed Mr O’s tooth appropriately and acted in line with accepted guidance.

30. We have not seen anything went seriously wrong in the assessment or initial management of the tooth. For this reason, we will not be looking into this part of the complaint any further.

Providing unnecessary treatment

31. Mr O’s record show that the Practice planned to remove the existing filling and decay from tooth UR7 before restoring it. The Practice removed the filling and some of the underlying decay, but later X-rays showed that some decay remained in the tooth.

32. Our advisor explained that where decay is deep and close to the nerve, even complete removal does not guarantee that symptoms will settle. Inflammation of the nerve can continue and lead to pain, root canal treatment, or extraction. This means the outcome Mr O experienced was a recognised risk of treating this type of decay.

33. We considered the GDC standards, which requires clinicians to provide good quality care based on current evidence and authoritative guidance.

34. Our adviser explained providing appropriate care in this situation included removing decay adequately before restoring a tooth. In this case, the clinician did not complete that aspect of treatment to the expected standard. There is an indication of a failing.

35. Mr O says he would not have needed further treatment if the Practice had done the right thing. He says this was costly distressing and avoidable.

36. Our advisor explained that even where a clinician removes decay appropriately, inflammation in the nerve can still develop. A tooth that has deep decay close to the nerve can require root canal treatment despite appropriate initial care.

37. Taking account of the evidence, we cannot conclude that the need for root canal treatment arose solely because the Practice did not fully removal all decay. We do however recognise the possibility Mr O may not had needed further treatment had all the decay been removed during the first treatment.

38. NHS Complaints Standards which say organisations should offer fair remedies to put things right.

39. Mr O told us he is seeking acknowledgement of failings, an apology, financial compensation and reimbursement of his total treatment costs.

40. The Practice has acknowledged its shortcoming and offered Mr O a full refund for the NHS treatment.

41. We are satisfied the acknowledgement is in keeping with the indications of failings we have seen as set out above. As we are unable to say further treatment would have been needed regardless of the failings, this means we cannot link Mr O’s private costs to the failing.

42. Principles for remedy explain where it is not possible to return a complainant to their original position you should consider compensating them appropriately.

43. We cannot say the failings solely led to Mr O’s pain and further treatment, as this may have happened anyway. However, we recognise had the treatment been completed correctly, further treatment and expense may have been avoided, and Mr O is left not knowing if this would have been the case.

44. Our financial remedy guidance says an injustice of this nature would normally warrant a small financial remedy. We recognise the Trust has offered to refund Mr O’s treatment costs, we consider this to be in keeping with the amount we would expect it to compensate him.

45. We are satisfied the remedies appropriately recognises the failing. We cannot conclude that the later root canal treatment would have been avoided, we do not consider further action necessary. Therefore, we will not be looking at this part of the complaint any further.

46. We do not underestimate how painful Mr O’s condition was and it clearly caused him distress and discomfort. We hope our consideration reassures him about the actions taken by the Practice.

1. We are sorry to learn of Mr O’s dissatisfaction following his experience at the Practice. We acknowledge the difficult circumstances around this complaint, and the impact this had on Mr O.

2. We have carefully considered Mr O’s complaint about the Practice. Having done so, we have decided we will not investigate this complaint further.

3. This is because we have not seen any signs anything went seriously wrong with the Practice’s assessment of Mr O’s tooth nor in its treatment plan.

4. We did see signs the treatment was not completed correctly. We could not link this to Mr O’s private treatment and on that basis, we are satisfied the Practice has taken appropriate steps to put the impact of its actions right.

5. We understand this was and continues to be an upsetting time for Mr O. Our decision is not made without recognition of the upsetting experiences he had with his treatment and its outcome.

6. We have explained the reasons for our decision below and we hope this provide Mr O with some reassurance about the care he received.