A dental practice in the Kirklees area

3. Mrs G complains about the treatment provided by the Practice on 11 August 2025. She complains the dentist was unable to identify or treat the cause of her toothache which had been ongoing for nine months.

4. As a result of the poor care provided by the Practice, Mrs G alleges that:

• she continued to be in pain after her 11 August 2025 NHS appointment, when she had to resort to further root canal and tooth extraction done at a different private dental practice between mid-August 2025 and January 2026 • she experienced the distress and trauma of further dental work • she had to take three weeks of unforeseen leave from work in August 2025 because of her ongoing toothache • she incurred high and unforeseen private dental expenses.

5. As an outcome to her complaint Mrs G would like:

• an apology from the Practice for damage caused to her mental health and ongoing stress because of prolonged, unresolved toothache and what she considers could have been avoidable private tooth surgery at a different private dental clinic • financial compensation for her unforeseen private dental expenses at the other private dental practice.

6. Mrs G attended a routine NHS checkup at the Practice on 8 November 2024. She also attended an emergency NHS dental appointment on 11 August 2025 due to ongoing pain and unresolved toothache after private fillings she had in January 2025.

7. During her 8 November 2024 NHS dentist appointment, following an examination and having taken X-rays, the dentist identified decay in Mrs G’s upper right first molar (UR6) and upper left first molar (UL6). They confirmed decay was into the dentine (that is, it was deep) and that her teeth needed restoring with a filling.

8. From available records, we note Mrs G’s dentist did warn her these fillings were deep and further treatment may be necessary, such as root canal or tooth extraction. Her dentist then offered NHS amalgam fillings or private composite fillings. Mrs G opted for two private composite fillings, which she had done in January 2025.

9. On 11 August 2025, Mrs G attended an NHS emergency appointment at the Practice due to continuing pain in her upper teeth. The dentist did X-rays and other tests and determined they could not identify if Mrs G had hypersensitive dentine or irreversible pulpitis. Pulpitis is inflammation of the dental pulp (the innermost part of a tooth containing nerves and blood vessels).

10. They advised Mrs G to lather her teeth in Sensodyne before eating or drinking and before sleeping, and to call back if the problem worsened.

11. After a few days, as her pain was still not resolved. Mrs G saw a private dentist in September 2025. The private dentist recommended a tooth extraction on one side and a root canal on the other side. She had this treatment with the private dentist.

15. 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.

16. We have done this and have not found any indications something has gone seriously wrong in Mrs G’s 11 August 2025 appointment. We will explain the reasons for our decision in more detail below.

17. The Examining and Diagnosing Guidance, chapter one, says, to make a diagnosis, dentists should collect relevant information from the patient, through examinations, and through relevant special tests.

18. Chapter four says dentists should not attempt a definitive treatment procedure without first obtaining an accurate diagnosis. This is particularly the case in emergencies where the history and symptoms may be variable, clinical examination unremarkable, and diagnostic tests confusing. Reaching an accurate diagnosis is the first step in successful management.

19. In line with this, through speaking to Mrs G and reviewing her examinations in the appointment, we saw the dentist established where her dental pain was. They established this pain caused Mrs G difficulty sleeping. She had been taking painkillers to manage this and allow her to sleep.

20. To assess these painful areas further, the dentist did the following tests:

• an endo-frost test (assessing the response of Mrs G’s teeth to different temperatures) • percussion testing (assessing the health of the structures around the teeth) • X-rays.

21. All of these are tests the Examining and Diagnosing Guidance say dentists can use to assess and diagnose the cause of dental pain. Our dentist said these were the appropriate tests to do in Mrs G’s case to assess her pain.

22. On this basis, having reviewed this evidence and advice, we consider the dentist acted in line with this guidance in the tests they did to investigate Mrs G’s pain. They went through the correct process to assess and try to identify the cause of her pain.

23. Our dentist said Mrs G’s X-ray findings suggested both her aching upper teeth possibly required further treatment. However, such X-ray findings are not always reliable, and it is common to monitor symptoms if X-ray findings do not lead to a conclusive diagnosis.

24. Our dentist agreed with Mr G’s dentist ‘there was nothing crystal clear on each X ray … with regards to infection’. The X-rays showed deep fillings only and the dentist took them to examine whether any infection at the bottom of the affected teeth was detectable. The findings showed no clear evidence of infection.

25. Based on the clinical evidence the dentist gathered, our dentist said Mrs G’s dentist gave her the correct advice to manage this situation and the pain she reported (by lathering her teeth with Sensodyne before eating, drinking and sleeping).

26. Mrs G’s clinical records also show her dentist advised her to contact them again if her pain got worse after a week or so, and she understood this advice. Our dentist also said this was the advice they would expect the dentist to provide.

27. We appreciate the Examination and Diagnosing Guidance says dentists should not attempt definitive treatment procedures in these situations. The tests Mrs G’s dentist did, which were appropriate, did not indicate a clear diagnosis. Therefore, we saw no failing in them deciding against a procedure like a tooth extraction at the time and providing the advice they gave Mrs G to manage her pain and keep this under review.

28. We note the Analgesia Guidance says where patients are experiencing dental pain, dentists can advise patients to take painkillers. For example, paracetamol or ibuprofen. These medicines can help relieve most tooth related pain.

29. We appreciate the dentist did not provide this advice to Mrs G during the consultation. That said, we do not see this fell so far below the standard we would expect that we consider it indicates a failing in care.

30. Our dentist said this was only a small thing the dentist could have done to improve. Even had they done so, this pain relief would not have stopped the progression of any tooth decay.

31. We also note Mrs G told the dentist she was already using pain relief to manage her tooth pain. Therefore, given the dentist was already aware she was using pain relief, and our dentist considering this a small detail, we did not see not advising her about pain relief constitutes a failing.

32. This means, in summary, we see the dentist attempted to diagnose Mrs G’s pain in line with guidelines during her 11 August appointment. They then provided her appropriate advice based on their assessment of her condition.

33. We recognise Mrs G’s pain persisted following her appointment. That said, she did not contact the dentist about this as they had advised. As Mrs G did not do so, we cannot have expected the dentist to have taken any further action to manage her pain.

34. We understand Mrs G later had invasive dental procedures to resolve her tooth pain. We recognise this was a difficult and painful experience for her, which cost her money she had not expected to pay.

35. We hope we have clearly explained our decision, and that this helps bring Mrs G some closure on her concerns.

We are very sorry to read about Mrs G’s experience at her NHS dental practice (the Practice) and recognise the painful challenges she has faced. We acknowledge the importance of having her concerns on the care her dentist provided on 11 August 2025 addressed and we have carefully considered all of them.

1. We have found Mrs G’s dentist acted in line with standards in investigating the cause of her ongoing toothache from available dental X-rays they took on the day. We did not see the dentist could have taken any other exams or other treatment to reach a conclusive diagnosis and recommend a specific treatment for her dental pain.

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