A dental practice in the Kirklees area

4. Miss Q complains a dentist at a practice in the Kirklees area, failed to refer her for root canal treatment in March 2025, when an X-ray showed evidence of infection.

5. Miss Q says because of this she did not receive necessary root canal treatment and the infection worsened, causing her pain over several months. Miss Q says this also resulted in more costly treatment.

6. Miss Q would like the dentist to pay her a financial remedy

7. Miss Q attended an emergency appointment around mid-March 2025 after experiencing pain in her lower right wisdom tooth.

8. The dentist referred Miss Q to hospital for extractions of her upper and lower right wisdom teeth.

9. The dentist also highlighted a potential infection on her premolar tooth at this emergency appointment.

10. Ms Q attended hospital in July, and the consultant confirmed they could not proceed with the extractions due to an infection on her premolar tooth.

11. Miss Q returned to the Practice in August, and the dentist confirmed she had a radicular cyst on the infected tooth.

12. Miss Q complained to the Practice later that month.

16. NHS England guidance states patients attending emergency appointments should first be treated for the acute issue before any other ongoing issues are looked at. The guidance also states it is not necessary to carry out a full dental check at an emergency appointment.

17. Miss Q complains the dentist referred her for a wisdom tooth extraction instead of a root canal treatment procedure. She said she should have been referred for root canal treatment at her appointment in mid-March 2025 when the X-ray showed the infection. Miss Q says she has been left in pain for longer than she should have been and the delay has resulted in further expensive treatment.

18. The Practice said Miss Q was seen at an emergency appointment as she was experiencing pain with her lower right wisdom tooth. It said the issue with her premolar tooth (LR5) was identified in passing but acknowledged it should have addressed the infection before referring her for wisdom tooth extraction.

19. Miss Q requested an emergency dental appointment around mid-March 2025 after experiencing pain in her lower right wisdom tooth (LR8), which her records state had been intermittent for a year. The dentist examined Miss Q and conducted an X-ray of her teeth which revealed an ulcer on her LR8.

20. Wisdom teeth are located in the back of the mouth and are molars which are primarily for chewing food. People can have up to four wisdom teeth, or none at all, and they are generally the last set of teeth to grow. This can cause problems as sometimes there is no space for them to grow which can cause pain, swelling and infection. These teeth are commonly removed if they cause problems.

21. The dentist discussed treatment options with Miss Q for two of her wisdom teeth (LR8 and UR8), and she opted for extractions. The dentist referred Miss Q to her local NHS Trust for the extraction procedure.

22. Simple extractions can be performed by general dentists however surgical removal in a hospital setting is required if the tooth is partially covered by the gum, has long curved roots or is brittle or cracked. These factors can require incisions being made in the gum or the removal of bone which is beyond the capability of a general dentist. A hospital also provides a safer setting if complications arise.

23. During the appointment, the dentist also noted an apical lesion on her LR5 (a pre-molar tooth). An apical lesion is a shadow visible on an X-ray at the root tip of the tooth. It can indicate an abscess, inflamed tissue, cyst healing, natural difference or deviation in the tooth structure, scar tissue healing and other benign conditions.

24. The dentist performed a tender to percussion test which involves gentle tapping on the tooth with a dental instrument and Miss Q confirmed there was no pain. Miss Q said she preferred to leave the LR5 as it was as she was not experiencing any pain.

25. Miss Q attended hospital for her extraction procedure around mid-July 2025 reporting a dull, aching pain in her lower jaw. Her records state she specifically identified the right premolar region, where the LR5 is located, as the source of discomfort.

26. The consultant assessed Miss Q and noted she had an infection on her LR5 which required treatment before her wisdom teeth could be extracted. The consultant said the X-ray from March showed inflammatory lesions on the LR5 and that Miss Q’s LR5 and LR6 would require urgent vitality testing (to assess the health of the inner tooth tissue).

27. Miss Q returned to the Practice around mid-August, and the dentist diagnosed a radicular cyst on her LR5. Radicular cysts are round fluid filled sacs containing blood or pus which are caused by untreated tooth decay and are a fairly common occurrence in dental patients.

28. The dentist discussed treatment options for the infected tooth which included leaving it as it was, root canal treatment to try to save the tooth, or extracting it. The dentist explained that the root canal procedure would require multiple appointments and that a successful outcome could not be guaranteed.

29. The dentist also informed Miss Q that root canal treatment could be carried out privately by a specialist, which would increase the likelihood of success. The dentist provided details of both the private and NHS costs associated with the procedure.

30. Miss Q attended two appointments towards the end of October. One of these was due to pain in the LR5 and the following day she attended for root canal treatment on the LR5. Miss Q then underwent an X-ray in mid-November which confirmed the procedure had been a success.

31. Miss Q considers she should have been referred for root canal treatment from her emergency appointment in March. Our adviser said it would not have been appropriate to refer Miss Q for root canal treatment as it was her LR8 and not the LR5 which was identified as the source of the pain.

32. NICE TA1 guidance states wisdom teeth which have not fully descended through the gum or are healthy and problem free should not be extracted. Our adviser said the dentist had identified an ulcer on Miss Q’s LR8 which was a clinical justification for the referral.

33. Our adviser said the apical lesion identified on the LR5 X-ray in March was not necessarily confirmation of infection. Miss Q did not identify her LR5 as the source of the pain at the emergency appointment although our adviser said this tooth would have benefited from further assessment.

34. Our adviser also said dental pain can be difficult to pinpoint, especially if multiple teeth or factors are involved. Pain may vary based on triggers or stimuli, radiate from one area to another, occur alongside another source, or exist on its own.

35. Our adviser said further assessment of the LR5 would be needed for a diagnosis which would then inform treatment planning. Our adviser also said if there was suspicion of infection the dentist should have planned to monitor or review the LR5 and provide advice if symptoms progressed.

36. Miss Q’s records show her LR5 had been highlighted as a tooth which needed to be clinically monitored. There is no evidence the dentist arranged a follow-up appointment for Miss Q or any evidence her symptoms progressed after her emergency appointment.

37. We consider Miss Q did receive appropriate treatment at her emergency appointment in March for the tooth causing her pain, which is in line with NHS guidance. Root canal treatment would not have been initiated at this appointment as this tooth was not identified as causing her pain. It had been examined and tested and Miss Q said she preferred to leave it as it was.

38. CG19 guidelines state that dental checks should be tailored to each patient based on their clinical need and risk. The guidelines also state the shortest period between dental checks being three months and the longest period twenty-four months. Miss Q attended her hospital appointment three and a half months after her emergency appointment. She then attended the Practice for a check-up three weeks later, in August.

39. Miss Q’s LR5 tooth was flagged for clinical monitoring, and we think the dentist should have arranged follow-up with her sooner, due to the suspicion of infection. We note Miss Q did not seek further treatment in the three and a half months before her hospital appointment. Our adviser said a patient is expected to contact their dental practice or 111 if their dental symptoms progress.

40. Miss Q has told us she was in pain for over four months from March. The pain from this appointment was identified as her wisdom tooth. We cannot say when the LR5 pain began as it was only identified in July which means it would be difficult for us to link the lack of follow-up with the pain Miss Q experienced. There is also no record of Miss Q contacting the Practice or 111 reporting pain or progression of her symptoms.

41. Miss Q considers the delay in the root canal treatment allowed the infection to worsen. We cannot take a view on this as a suspicion of infection is not confirmation of an infection. Miss Q did not have any presenting symptoms at her emergency appointment. Our adviser said apical lesions are not always indications of infection and therefore we cannot know when the LR5 became infected before her hospital appointment in July.

42. Miss Q considers she had to have more complex, costly treatment. There is no evidence of any complications during Miss Q’s root canal treatment and our adviser said there is nothing in the clinical records which suggests her treatment was more complex. Miss Q has told us as soon she had the procedure her symptoms eased almost immediately.

43. We understand it can be difficult choosing between NHS and private treatment and the dentist had informed Miss Q that private treatment from a specialist would increase the likelihood of success. From what we have seen it is likely that Miss Q would have still needed root canal treatment and faced the same choice between private and NHS care.

44. In view of this we could not ask the Practice to reimburse her private costs as she received appropriate treatment and referrals at her emergency appointment, and we cannot determine when the tooth became infected.

45. We note the Practice did not charge Miss Q for an appointment in October which related to pain in her LR5. The Practice did this as a good will gesture which it did not have to do. This shows the Practice being customer focused and sensitive to Miss Q’s needs in line with our Principles of Good Complaint Handling.

46. Miss Q has said the delay in her root canal treatment caused her anxiety in the leadup to the procedure. The Practice has apologised to her, reflected on her concerns, acknowledged she should have received an earlier check-up and given her a private appointment for free as a good will gesture.

47. We consider the Practice has done enough to address Miss Q’s concerns and we have decided not to investigate this complaint further.

1. We acknowledge Miss Q’s concerns that the dentist failed to promptly refer her for root canal treatment despite an X-ray revealing an infection in her tooth. We acknowledge her concerns this delay caused her unnecessary pain, led to more costly treatment, and heightened her anxiety about the procedure.

2. We have carefully considered Miss Q’s complaint about Bupa Dental Care. We consider Miss Q did receive appropriate treatment at her emergency appointment. The dentist should have arranged follow-up treatment for Miss Q, but we consider the Practice has done enough to put this right.

3. Our statement below sets out the reasons why.