A dental practice in the City of Plymouth area

5. Mr A complains about the following aspects of the care and treatment he received from the Practice. He complains the Practice:

• did not arrange an appointment for him in a timely manner to receive treatment for a broken tooth. This was despite advice Mr A sent to the Practice from his local department of oral and maxillofacial surgery in November 2024 • failed to complete his root canal treatment • removed him as a patient due to his complaints about the unfinished treatment, and concerns about the standard of care he had received.

6. The lack of treatment for the broken tooth caused damage to Mr A’s tongue and mouth due to the edge of the tooth cutting this. This caused Mr A a lot of pain and affected his ability to eat due to the pain caused by the broken tooth. Mr A says this meant he unintentionally lost weight. He says the incomplete treatment is also contributing to the ongoing dental pain he is experiencing.

7. Mr A says his dental health has significantly deteriorated because of the Practice’s actions. He says this could have been prevented if appropriate care, continuity of care and oversight of his overall care been provided by the Practice. Overall, he says this has ha detrimental effect on his day-to-day life and psychological wellbeing. The actions of the Practice also exacerbated his existing mental and physical health conditions, and this also affected his wellbeing.

8. Mr A says the Practice’s removal of him as a patient left him without access to necessary dental treatment, despite his clear clinical need.

9. As an outcome to his complaint, Mr A would like a financial remedy and for the Practice to review its decision to remove him as a patient.

10. This is a brief background to place the key events to his complaint in context. It does not provide a full account of everything that happened.

11. From March 2024, the Practice held a GDS (General Dental Service) contact with the NHS to provide NHS services at the Practice. Prior to this, a different dental practice, which Mr A was a patient of, held the contract. We will only be considering the events that took place from March 2024. The Practice serves NHS and private patients.

12. In early-August 2024, Mr A attended an oral and maxillofacial surgery clinic at his local hospital. In the letter following this appointment, it advised Mr A to contact his dentist to arrange treatment for the issues identified in the clinic. The clinic sent this letter to Mr A approximately a month later. Mr A emailed the clinic letter to the Practice in early-November and explained the treatment the clinic recommended.

13. Mr A attended a series of appointments at the Practice between June 2024 and April 2025.

14. During this time, Mr A submitted a formal complaint to the Practice in March 2025. There was correspondence back and forth between Mr A and the Practice. The Practice issued its final complaint response in late-April, and decided to remove Mr A as a patient from its patient list.

Treatment

18. Mr A complains the Practice failed to complete his root canal treatment.

19. The Practice explained the NHS does not perform the complex RCT (root canal treatment), which it says it discussed with Mr A during his appointment in April 2025. It advised Mr A how to locate a suitable private clinician for this procedure, as the Practice could not carry out the procedure as an NHS patient.

20. The dental guidelines say that for patients attending for emergency or unplanned visits, the appointment should focus on the presenting complaint and the patient’s symptoms. Once a diagnosis is made, appropriate treatment can start. Adequate notes must also be made, and appropriate follow-up care should be arranged. If a full examination is required, the patient should be advised of this.

21. The guidelines continue to say the patient should be informed of the findings, diagnosis and treatment options. If future treatment is required, the patient must be advised to return for further assessment.

22. The GDC standards also say dental staff must work effectively with your colleagues, and to delegate, refer appropriately and effectively. It says to work within your knowledge, skills and abilities.

June 2024

23. Mr A attended the Practice as an emergency appointment. The notes indicate the presenting problem and the symptoms Mr A was experiencing. This was largely around sensitivity. We can see the dentist noted that they offered to change the appointment to an exam, however they have noted Mr A wanted to focus on the current problem.

24. We can see the dentist performed X-rays and carried out deep cleaning for Mr A. The notes indicate Mr A had a small cracking of the tooth and initial signs of infection, however this did not show on the X-ray. The dentist also performed other tests such as testing sensitivity to cold and hot.

25. The notes show a diagnosis of ‘gum problems, severe bone loss, sensitive teeth and root [resorption][tooth] 46’. Tooth 46 is the lower right first molar (LR6). Root resorption occurs when the body begins to break down tooth roots. It was also noted the UL7 (upper left second molar) was tender. The notes also show the diagnosis of periodontal disease was explained to Mr A in terms of the necessary treatment, maintenance and prevention.

26. The Practice advised Mr A to follow-up with the dentist if his pain increased. The dentist also made a referral for more detailed X-rays. The notes say Mr A was to be recalled every six months for appointments for an examination and to see the hygienist.

27. Based on the evidence we have seen, we think the Practice’s actions here are in line with the dental guidelines. The dentist addressed the presenting complaint, the sensitivity Mr A was experiencing. The Practice had noted the diagnosis, provided treatment and arranged follow-up care (a referral for further detailed X-rays).

28. We acknowledge how uncomfortable it was for Mr A to experience sensitivity of his teeth. We have seen no indication of a failing, so we will not consider this part of the complaint further.

July

29. The next appointment took place a month later. This was also an emergency appointment. The notes of this appointment indicate a review of what happened at the previous appointment. The dentist took X-rays and examined Mr A’s teeth. The dentist noted the diagnosis had not changed since the previous appointment, and that it was likely Mr A was still experiencing sensitivity issues. The Practice advised Mr A to return if he noticed fractures or abscesses.

30. The notes also indicate the dentist advised Mr A he needed RCT treatment for tooth 26 (upper left canine – UL3) and that this would need to be a follow-up appointment. The notes indicate Mr A accepted this and left happy after this appointment (we acknowledge Mr A may not agree with this description). The Practice still noted tenderness of UL7 but saw no sign of an abscess.

31. The Practice’s actions here appear to be in line with the dental guidelines. It focused on Mr A’s presenting problem (sensitivity) and advised Mr A he would need to return for further assessment. We have seen no indication of a failing here.

August

32. Another emergency appointment took place a month later. In the notes of this appointment, the dentist noted RCT had failed for tooth 36 and 46 (lower left molar and lower right molar – LM1 and RM1). It advised Mr A the only treatment it could provide was extraction and that extractions can be unsuccessful. The notes indicate that the chance of an unsuccessful extraction of tooth 46 was high, however both teeth were not causing him an issue at the time, so Mr A wanted to leave it. Mr A wanted to smooth the sharpness of broken tooth 46 which the dentist performed.

33. The notes show Mr A wished to seek a second opinion from another dentist. The dentist noted that, so far, all Mr A’s symptoms were generally sensitivity related.

34. At this appointment, we think the Practice’s actions appear to have been in line with the dental guidelines and the GDC standards. Following an examination of Mr A, the dentist outlined the findings and the relevant treatment options. It also advised Mr A that he could have a second opinion from another dentist which demonstrates working effectively.

March and April 2025

35. The next appointment took place approximately seven months later. This was also an emergency appointment but with a different dentist for a second opinion. The notes show the dentist assessed Mr A and took X-rays. They noted pain in several teeth, a sharp filling in one tooth and inflammation of the gum near another tooth.

36. The notes show there was no treatment for LR6 (as mentioned earlier in paragraph 25) and the Practice planned to perform an extraction which it noted Mr A wanted. The dentist also planned to smooth over the sharp filling.

37. The notes also indicate there were two teeth for which the dentist noted that a RCT with a specialist would be needed. This was LM1 (identified before) and UL7 (upper left second molar – tooth 27). The alternative to specialist RCT would be to extract these teeth. For UL7, the dentist noted that antibiotics would help the infection in this tooth in the short term. The notes show Mr A wanted to think about the specialist RCT, and that the dentist had explained the risks, benefits and costs for the treatment plan.

38. This appointment is line with the dental guidelines. It noted the diagnosis, treatment plan and follow-up care for the next appointment which took place the next month. The dentist performed the extraction and smoothed the filling. The notes also show the dentist advised Mr A to continue and pursue the RCT with UL7 and LL6.

39. Our adviser has reviewed the appointment notes and advised that the consultations were all carried out in line with the dental guidance. Mr A’s presenting signs and symptoms were noted, tests and X-rays carried out, and treatment performed in line with the findings.

40. Regarding the RCT, the dentist explained to Mr A that for those teeth affected, it would require specialist treatment which it could not provide at the Practice. The dentist explained that Mr A would need a referral to an endodontist (a specialist focused on diagnosing and treating the pulp and roots of teeth).

41. During the complaints process, the Practice further clarified that no clinicians at the Practice would be able to perform the complex root canal treatment Mr A needed.

42. The Practice’s actions here are in line with the GDC standards. It referred Mr A to contact another specialist dentist who could perform the treatment. The dentists at the Practice did not have the skills to carry out this work.

43. It is clear from Mr A’s complaint and in his correspondence with us, that he has experienced a lot of difficulty with his dental care. We recognise the impact he says this has had on his physical and mental health. Based on the evidence we have, there are no indications of any failings in the Practice’s actions and treatment of Mr A for the appointments he had.

44. We understand Mr A holds a different view and strongly believes

45. he has not been provided with the care he should have been given. We hope our explanations here show we have thoroughly considered the care he received.

Appointment

46. Mr A complains the Practice did not arrange an appointment for him in a timely manner to receive treatment for a broken tooth. This was despite advice Mr A sent to the Practice from his local department for oral and maxillofacial surgery in November 2024.

47. The GDC guidance says dental teams must communicate effectively with patients. Our Principles also say organisations should deal with people promptly within reasonable timescales.

48. Mr A sent the clinic letter to the Practice in early-November 2024, and the Practice responded approximately a week later confirming receipt of the clinic letter. It advised Mr A that the letter was awaiting review from his dentist who was on leave, but due to return to work shortly. Once it had received a notification from the dentist, the Practice explained it would contact him for an appointment.

49. Mr A submitted a formal complaint to the Practice in March 2025 as he had not heard anything from the Practice regarding an appointment. The records show Mr A had emergency appointments in June, July and August 2024. Mr A explained to the Practice that these appointments were due to problem with the same tooth which he had been having issues with, and what the clinic letter identified. The next appointment Mr A had at the Practice was late-March 2025.

50. From when Mr A forwarded the clinic letter to the Practice, to when he received an appointment and even communication from the Practice, approximately four months had passed.

51. Our adviser explains that when the dentist returned from their leave, they would expect some action to be taken. The medical notes do not indicate this happened as we cannot see any actions recorded regarding the clinic letter.

52. The Practice’s actions here do not appear to be in line with the GDC standards as it did not communicate any issues, or delays with Mr A about this appointment until he complained. Similarly, the Practice’s actions are also not in line with our Principles of Good Administration

53. There is an indication of a failing here. We consider the impact of this below.

54. Mr A says the lack of treatment has meant his dental health has significantly deteriorated. He says this could have been prevented had the Practice provided appropriate care, continuity of care and oversight of his overall care. Mr A says he has been in a lot of dental pain and has unintentionally lost weight due to this. Overall, he says it has had a detrimental effect on his day-to-day life and psychological wellbeing. It has also exacerbated his existing mental and physical health conditions and wellbeing.

55. We understand that having significant dental pain can cause considerable discomfort to someone and can have a greater impact on a person’s health – physically and mentally.

56. In the communications provided by Mr A, we cannot see Mr A contacted the Practice after the Practice had acknowledged the clinic letter in November 2024. The next time Mr A contacted the Practice was in March 2025, to submit a formal complaint.

57. We acknowledge Mr A was waiting to receive contact from the Practice regarding an appointment. We also have to consider that if Mr A was continually struggling with his dental health, and the pain and distress this was causing him, whether he could have contacted the Practice to enquire about the appointment. The evidence we have does not suggest this happened.

58. We know from the records that Mr A attended emergency appointments in June, July and August 2024 for urgent issues. We have seen no indication to suggest Mr A contacted the Practice after November 2024 to enquire about the appointment.

59. This is not to minimise the impact Mr A says happened to him. We explain later in the statement that Mr A expressed his frustration at the Practice for not having received an appointment in the last four years. This was when Mr A was a patient at the previous dental practice and before the Practice took over in March 2024. We are only considering the care the Practice provided Mr A.

60. As such, we do not think we can solely link the deterioration of Mr A’s dental health to the delay in arranging an appointment here.

61. The complaint standards say, wherever possible, staff should explain why things went wrong and identify suitable ways to put things right for people.

62. Following the Practice’s acknowledgement of the clinic letter sent by Mr A in November 2024, the next contact we can see is when Mr A submits his complaint in March 2025 regarding this matter.

63. Prior to the Practice’s final response in April, Mr A and the Practice corresponded about the complaint over email during the rest of March. The Practice apologised for the delay in booking an appointment as Mr A’s dentist was away. It explained that the clinic letter did not indicate that an urgent appointment was needed, which is why the dentist did not arrange to book an appointment when they returned.

64. It also said that it had to prioritise emergency appointments which also contributed to the delay. The Practice acknowledged Mr A’s frustration at the lack of communication about this and recognised that it should have kept him informed. The Practice advised him to book an appointment with its reception team, and to make them aware the appointment was related to the clinic letter. It also explained that it had advised the reception team to expect a call from Mr A.

65. The Practice has explained to Mr A what went wrong here after he had sent the letter. It has acknowledged that it should have kept him updated with the situation regarding his appointments, as well as appointments in general. The Practice informed the reception team that Mr A would be calling for an appointment in relation to the clinic letter. Mr A attended an appointment at the Practice a week or so later as outlined in paragraph 35.

66. The Practice’s actions here are in line with the complaint standards. We think the Practice took action here to put things right for Mr A.

Removal from patient list

67. Mr A complains the Practice removed him as a patient due to his complaints about the unfinished treatment, and his concerns about the standard of care he received.

68. In the Practice’s final response to Mr A’s complaint, it explained that it was clear Mr A remained ‘wholly unhappy’ with the Practice. The Practice felt there had been a significant breakdown of the relationship, and therefore it was no longer able to see Mr A as a patient.

69. The GDC standards say that, in rare circumstances, the trust between dental staff and a patient may breakdown and the dentist may find it necessary to end the professional relationship. It says the service to a patient should not stop solely because of a complaint has been made.

70. The GDC standards also say before the end of the professional relationship with a patient, dental staff must be satisfied that the decision is fair and justifiable. It says the dentist should write to the patient about the decision and the reasons for it, and make arrangements for continuing care of the patient.

71. As outlined in paragraph 49, Mr A submitted a complaint to the Practice in March 2025 regarding not receiving an appointment.

72. As outlined previously, Mr A and the Practice were corresponding back and forth over email about his complaint. Mr A expressed his dissatisfaction with the care he was receiving from the Practice (some of which been covered in this complaint).

73. Mr A also expressed his frustration about not having received any care and treatment for the past four years. As explained towards the start of this statement, the Practice only held the contract to provide NHS dental services from March 2024. On one occasion Mr A accused the Practice of lying about its affiliation with the previous dental practice.

74. Mr A also questioned the Practice on how it treats it patients. He believed that as he was an NHS patient, he was receiving different treatment than a private patient. He said that if he was a private patient, the Practice would not have refused to facilitate a referral to an endodontist for specialist treatment. Mr A said the Practice had no respect for him as an NHS patient.

75. The Practice explained to Mr A on several occasions that it was not affiliated with the previous dental practice Mr A was under, and that it did not treat NHS and private patients differently. For the treatment Mr A required (complex RCT), it said no dentist at the Practice was able to provide that treatment, either via the NHS or privately.

76. Over the course of March, Mr A and the Practice went back and forth over the same points. From the correspondence, we can see Mr A did not accept what the Practice had told him about the previous dental practice. Mr A also did not accept the Practice’s explanations regarding treatment of NHS patients and private patients.

77. We can see how all these factors led to the breakdown of the relationship between the Practice and Mr A. The Practice referred to the breakdown of the relationship in its final written response to Mr A’s complaint. We cannot see any evidence to suggest that the removal of Mr A was due to his complaints about the Practice.

78. We understand Mr A’s frustrations. We also understand Mr A’s continued insistence of the Practice’s ownership, and its treatment of patients, would make it difficult for the Practice to continue a productive working relationship with Mr A. This was despite the Practice providing multiple assurances and explanations.

79. We recognise Mr A is still struggling to find an NHS dentist to register with which we are sorry to hear. We also recognise that being removed from a Practice can be upsetting and can lead to uncertainty over future care.

80. Considering the above, we think the Practice’s action of removing Mr A as a patient is in line with the GDC standards. Mr A’s treatment plan had also been completed as the next steps were for him to seek a specialist endodontist to carry out the complex RCT. The Practice provided details to Mr A of how to find an alternative practice who is taking on NHS patients, therefore ensuring that Mr A could access continuing care.

1. We have carefully considered Mr A’s complaint about the Practice. We were sorry to hear about the events Mr A complains about and of the physical and mental health issues these events have caused him.

2. We have seen an indication of a failing in the Practice not arranging an appointment for Mr A in a timely manner. We understand the delay in receiving an appointment to resolve any issues would be worrying, particularly while having ongoing dental pain. We cannot solely link this delay to Mr A’s dental pain. The Practice has acknowledged and apologised for this delay and it has assisted with arranging an appointment for Mr A. We think this is enough to put things right here.

3. We have not seen any indications of failings in the Practice’s treatment of Mr A’s teeth nor in its decision to remove Mr A as a patient.

4. Because of this, we will not consider Mr A’s complaint further. We understand we have not reached the outcome Mr A was looking for when he brought his complaint to us. We hope our explanations in this statement reassured him that we have considered his concerns thoroughly.