A dental practice in the North Tyneside area

4. When he sought care for toothache at the Practice on 5 July 2025, Mr T complains the dentist:

• performed a tooth extraction on an infected tooth with pus without running any dental scans prior to the procedure • did not prescribe him antibiotics before or after the tooth extraction.

5. As a result of the failings Mr T alleges, he says:

• he was in constant dental pain after his tooth extraction • he had to be urgently admitted to a specialist hospital five days after his tooth extraction as, at that stage, his local hospital recommended urgently seeing a maxillofacial specialist • he was urgently placed under an induced coma and had two tooth operations whilst in hospital for about a week as an inpatient • he is still unable to chew properly, has trouble ingesting food sometimes, has weak legs and still attending physiotherapy sessions post-coma • he and his family experienced worry and distress from these events.

6. By bringing his complaint to us, Mr T is seeking:

• a full investigation into his case • acknowledgment that the poor dental care he received in July 2025 was below standards • a written apology from his dentist • service improvements confirmed in writing so that future patients will not go through what he did • financial redress.

7. Mr T attended an emergency appointment at the Practice on 5 July 2025. He had toothache. The Practice’s dentist identified pus in the tooth he reported pain in. To address this, the dentist extracted the tooth.

8. Mr T sought help for his ongoing tooth pain on 9 July at his local pharmacy. The antiseptic spray pharmacists gave him did not resolve his pain. He saw his GP the following day and later attended an emergency care hospital (Hospital A).

9. Staff at Hospital A gave him antibiotics but advised he would need specialised, maxillofacial care. Maxillofacial staff treat conditions in the mouth, jaw, and face. Hospital A does not have this service. Staff at Hospital A directed Mr T to attend another hospital with this service (Hospital B).

10. Staff at Hospital B admitted him as an emergency. They had concerns about his breathing and heart rate. They intubated Mr T and placed him in the high dependency unit. They performed surgery to do another tooth removal. Two days later staff performed a further surgery. They later discharged him on 20 July.

13. 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 something has gone wrong.

14. In his complaint to us, Mr T told us the Practice’s dentist decided extraction of his tooth was the best course of action. He said the tooth had a significant filling from previous restoration treatments he had on it, as shown in previous X-rays. He said the dentist did not take new X-rays before extracting his tooth.

15. Critically, he added the dentist did not prescribe him antibiotics despite his medical history. He said his long-standing health conditions increased the risk of him having dental infections, and infections spreading and becoming life-threatening. Mr T cited his diabetes, that he was immunocompromised, and his obesity and general poor health.

16. In response to Mr T’s complaint, the Practice considered it acted in line with guidelines. It said Mr T experienced complications which resulted in his later hospital admission.

17. We saw the dentist acted in line with relevant clinical guidelines on these matters.

18. Regarding the need for X-rays, our dentist referred us to the Dental Radiography Guidance. We note section 8.3.1, Extraction of Teeth, says: ‘there is no convincing evidence to support the need for routine radiography prior to extractions in adults’. Where there are existing radiographs (X-rays), these should be referred to before extraction of teeth.

19. Mr T’s dental records show two previous periapical X-rays at the time of his tooth extraction, the most recent one taken in January 2023. Periapical refers to the tissues surrounding the root of a tooth. Periapical X-rays take images of these areas. Mr T had these X-rays taken prior to restoration work he had on the affected tooth in 2023, and again in 2024.

20. Although Mr T presented with a new development of pus/infection in the affected tooth in July 2025, our dentist explained the Practice were not required to take further Xrays of it given the previous ones he had of the tooth.

21. Even where there are existing X-rays, the Dental Radiography Guidance lists specific situations where it is ‘judicious’ to take an X-ray before a tooth extraction. These situations are:

• when a patient has a history of previous difficult extractions • the dentist has clinical suspicion of unusual anatomy • when the patient has a medical history placing them at special risk if complications are encountered • prior orthodontic extractions • extraction of teeth or roots that are impacted, buried or likely to have a close relationship to important anatomical structures.

22. The Practice’s dentist was satisfied Mr T’s diabetes was under control, so they did not consider him at high risk and did not take a further X-ray on 5th July 2025.

23. Our dentist said, as Mr T is diabetic, he is at increased risk of infection, delayed healing, and higher risk of post-operative complications (e.g. dry socket, poor wound healing). However, as his health conditions were being managed, the Practice’s dentist did not need to take new X-rays in addition to the ones already in his records.

24. Considering this evidence and advice, we cannot see Mr T’s medical history or conditions indicated special risk of complications the Practice should have identified. This means we cannot see staff had to do X rays before his tooth extraction because of his medical conditions at the time.

25. As we explained above, Mr T had previous tooth restorations not extractions. Our dentist did not identify other situations from the list above that applied in Mr T’s case.

26. All this means, as Mr T had previous X-rays, and he did not match criteria from the Dental Radiography Guidance when the dentist needed to do another one before his tooth extraction, we saw no failing in the dentist not doing an X-ray before his tooth extraction.

27. Regarding whether the dentist should have performed a tooth extraction, with or without prior X-rays, we saw this was the procedure they should have done.

28. The FGDP Guidance recommends what dentists should do to manage acute periapical infection. They should remove the source of infection. This means either extracting the tooth or draining any abscess and removing infected pulp.

29. Our dentist said the first treatment they would expect for Mr T’s condition was tooth extraction. Where pus is present, bacteria invade the tooth and, once inside, the infection spreads down through the root and into the jawbone.

30. In Mr T’s case, the Practice’s dentist decided, in the context of his emergency appointment, to remove the source of his infection as soon as possible. This means we consider the Practice acted in line with the FGDP Guidance in deciding to perform Mr T’s tooth extraction.

31. In terms of prescribing antibiotics, the Prescribing Guidance says antibiotics are not the first line of treatment. Our dentist said the first treatment of choice should always be extraction or incision/drainage of any abscess rather than antimicrobial prescribing.

32. The Prescribing Guidance says dentists consider antibiotics only if local measures have proved ineffective, or there is evidence of cellulitis, spreading infection or systemic involvement.

33. Our dentist said Mr T presented with swelling a few days after his tooth extraction, when he sought further care. At this point, his condition would justify the Practice prescribing him antibiotics. However, he did not report these problems and return to the Practice, so it had no chance to do this.

34. Considering this advice and evidence alongside the Prescribing Guidance, we do not see the Practice should have given Mr T antibiotics prior to or just after his tooth extraction. This guidance only indicated staff should have considered antibiotics a few days after his procedure, when his presentation matched the circumstances staff should consider prescribing them. This means we see no indication of a failing in the Practice not giving him antibiotics.

35. We recognise it must have been distressing and painful for Mr T to experience tooth extraction complications. For the reasons set out above, we cannot find indications of failings and we will not take this complaint any further. We hope we have clearly explained our findings and this helps reassure Mr T on the care he received from his dentist.

1. We are very sorry to read about Mr T’s experience at his dental practice and recognise the physical and psychological challenges he has faced. We acknowledge the importance of having his concerns about his tooth extraction on 5 July 2025 addressed and we have carefully considered all of them.

2. We have found Mr T’s dentist acted in line with guidelines when deciding to perform his tooth extraction. They were not required to do an X-ray or any other exams before performing this procedure. We did not see the dentist should have prescribed Mr T antibiotics prior to or after this procedure.

3. Therefore, we decided not to take any further action. We have explained our decision in detail below.