A dental practice in the Eastleigh area

4. Ms A complains the Practice did not take sufficient action between January 2022 and November 2024 to treat damage to her son, T’s, tooth, and advised to take a ‘wait and see’ approach. She states the dentist refused to put a treatment plan in place. She also complains the dentist did not recognise the adjacent tooth came through in the wrong location.

5. She complains the complaint handling was poor and the person who they complained about was the same person who investigated the complaint, which is not independent.

6. Ms A states, as a result, a second opinion was required, and T has to have braces. She states him having braces has led to questions from friends, not being able to eat certain foods, and extra dental care. She complains there has been a financial impact as they have had to pay privately for her son’s treatment.

7. Ms A is seeking an acknowledgement that opportunities were missed to take action sooner which would have prevented the need for braces. She is also seeking financial compensation of £1200 to cover the cost of the braces.

8. T experienced trauma to his URA tooth when he was two years old, in 2018.

9. The UR1 tooth is the first permanent tooth in the upper right quadrant of the mouth. The URA refers to the baby tooth in the same position, which is in place until the UR1 erupts. UR2 is the tooth directly adjacent to UR1.

10. In January 2022, T attended the Practice with signs the URA was infected.

11. T attended the Practice again on 10 June 2022 and Ms A advised the dentists that no new swelling had appeared since the last visit.

12. T attended the Practice on 15 February 2023. At this time, it was observed that the URA was a grey shade and had a broken edge. It is noted at the time that this is asymptomatic (no noticeable signs or symptoms of concern).

13. T attended the Practice again on 6 October 2023. Again, the URA was described as grey in colour, but there were no problems recorded and this was asymptomatic.

14. On 12 April 2024 T attended the Practice and the URA was observed as being grey in colour due to past trauma. The URA was noted as being mobile and the records state this tooth will exfoliate (come out to make way for the adult tooth) soon.

15. On 6 June 2024 the URA was darker than the other teeth and it was mobile. The dentist reassured T and his father that the tooth would come out naturally soon and there were no problems.

16. On 8 November 2024 T went back to the Practice and the URA was still present and mobile. The adult UR1 tooth which would replace the URA was coming through at an angle. The records state there is a lack of space for the permanent tooth to come through. A referral was made to the dental therapist to extract the tooth using local anaesthetic.

17. T’s tooth was extracted on 11 November 2024.

Management of tooth and treatment plan 21. 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.

22. Ms A complains the dentist did not take sufficient action to treat the damage to her son’s tooth, and that they were advised to take a ‘wait and see’ approach on 11 January 2022 when he attended the Practice with signs of an infection. Ms A states the dentist refused to put a treatment plan in place.

23. The Practice say the ‘wait and see’ approach is the only thing it can do at an early age. T was five years old at the time of the appointment in 2022. The Practice say the teeth need to come through completely first before deciding if treatment is required. The Practice set out what was in the records and how antibiotics were prescribed to relieve the symptoms. It said then the tooth turned grey as it had lost its vitality. It also said there had not been any complaints of pain.

24. The records show T attended the dentist on 11 January 2022, and at this time there were signs of an infection in URA. The records show T had swelling on the gum surrounding the URA which was not painful, and there was URA buccal sinus draining (pus in this area).

25. The records from this appointment set out that the possibility of extracting the tooth was considered, and the pros and cons of waiting for the tooth to naturally come out or having the URA extracted was discussed. The records state Ms A was not keen on her son having a tooth extracted if this could be avoided. The dentist therefore advised Ms A to bring T back to the Practice if he complains of any pain.

26. Prevention and Management of Dental Caries in Children, ‘For primary teeth with associated pain (pulpitis with irreversible symptoms) or infection and when alternative management options have been excluded, an extraction should be considered.’

27. Our adviser said usually if there is trauma to a baby tooth, the correct approach is the ‘wait and see’ approach. It is not necessary to treat the tooth if there are no signs of infection.

28. We have seen when T attended the Practice in January with signs of infection, he was treated with antibiotics which was appropriate, and extraction was considered in line with the guidelines. Ms A stated she would prefer to avoid extraction if possible. We therefore have not identified any indications of failings at this appointment.

29. T attended an appointment on 10 June 2022. The records from this appointment state ‘patient complains of/ history of presenting complaint: Nil’. Ms A told the dentist there were no new lumps since the last visit and nothing present on the exam. It is therefore reasonable that a management plan was not put in place.

30. On 15 February and 6 October 2023 T presented for a regular exam with no concerns. As there were no further concerns a treatment plan was not necessary.

31. T had an appointment on 12 April 2024. On this date, the records state Ms A was worried about an adult tooth not coming through since a baby tooth came out. It is important to note this is not the URA. During this appointment the URA was noted as grey, but it was mobile and will exfoliate soon.

32. On 4 June 2024 a regular dental exam was completed.

33. On 6 June 2024, an appointment took place in which T’s father said he was concerned about the URA being darker than the other teeth. The URA was mobile during this appointment, and the dentist reassured T and his father the tooth would come out naturally and there were no problems.

34. Our adviser told us if both incisors (the sharp teeth at the front of the mouth) were mobile and near exfoliation (losing the baby tooth and the permanent teeth coming through), advising natural loss (‘wiggling’) can be reasonable. There are no specific guidelines which set this out, but this is accepted good practice.

35. The records show during this appointment, a treatment plan was confirmed with the patient.

36. We have seen in the appointments dated 12 April and 6 June 2024, the URA was mobile and appeared to be close to exfoliation. There were no signs of infection or other concerns with the teeth. It is therefore appropriate to advise waiting for natural loss rather than carrying out an extraction.

37. On 8 November 2024 T attended for a regular exam. Ms A was concerned about the lack of loose teeth. It was noted during this appointment that the UR1 was erupting with distal direction (at an angle). A referral was therefore made to have his URA extracted. T’s URA was extracted on 11 November 2024.

38. Managing the developing occlusion- a guide for dental practitioners, recognises ectopic eruption and abnormal eruption patterns as indications for orthodontic assessment/referral. It sets out:

‘Ectopic eruption and displacement of teeth may require interceptive treatment to prevent further malocclusion (misalignment of teeth).’

39. The first time it was noted that the UR1 was erupting at an angle was on 8 November 2024. The URA was extracted three days later on 11 November 2024. We consider this is appropriate management and in line with the Managing the developing occlusion - a guide for dental practitioners.

40. A ‘wait and see’ approach is appropriate when development is within normal limits and there are no functional or pathological concerns. During each appointment between June 2022 and March 2024, no pain or other concerns were noted. The URA was noted to be grey but appeared near to exfoliation during the appointments on 12 April and 6 June 2024. Extraction was prompted as soon as it was noted that the UR1 was coming through at an angle. We have found the appropriate action was taken at each of T’s appointments.

Adjacent tooth in wrong location 41. Ms A complains the tooth next to the UR1 came through in the wrong location.

42. The Practice said the UR1 and the URA were both present during the examination appointment on 8 November 2024. At this time, the URA was extracted, and the UR1 was erupting with a distal inclination (where the crown of the tooth tilts backward, or away from the midline of the face, while the root points forward).

43. The records state ‘UR1 erupting with distal direction’ and does not state that there were any concerns with the placement of the UR2.

44. Our adviser has explained the UR1 came through at an angle, but the adjacent tooth did not come through at an angle.

45. We recognise Ms A was worried the adjacent tooth came in at the wrong angle. We understand it would be concerning to feel this is being overlooked. We have not identified any evidence to support that the UR2 was coming through in the wrong location. We therefore will take no further action.

Complaint handling

46. Ms A also complains the complaint handling was poor because the person they complained about is the same person who investigated the complaint. She said this was not independent.

47. NHS Complaint Standards state, ‘staff recognise the need to be accountable for their actions and to identify what learning can be taken from a complaint’.

48. It also states, ‘wherever possible, staff explain why things went wrong and identify suitable ways to put things right for people. Staff give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned.’

49. The complaint standards also state the responses should ‘give colleagues the confidence and freedom to offer fair remedies to put things right.’

50. We can also see the complaint response was thorough and provides explanations to each of Ms A’s concerns.

51. We consider the dentist who carried out the appointments is best placed to achieve this. We understand the concerns Ms A has raised about the investigation of her complaint not being impartial. We also recognise the value of the dentist’s own insight into the work they carried out and the decisions they reached. We would expect any investigation to involve the practitioner who provided the treatment to reflect and provide information to support the investigation. We have therefore not identified any indications of failings in complainant handling.

52. We understand this has been an upsetting and difficult experience for Ms A and her son, and we know it is hard to feel the advice and treatment being offered is incorrect. We hope our decision statement provides them with reassurance and answers any concerns they have.

1. We have carefully considered Ms A’s complaint about a dental Practice in Hampshire (the Practice). We understand how important a child received the appropriate dental care. We recognise how the requirement for extra dental care can cause you to question the care received.

2. Having completed our consideration of this complaint, we have seen no indication that anything went seriously wrong.

3. We understand this was worrying and a very difficult experience for T and Ms A. We hope our decision can provide them with reassurance about the care that was provided.