A dental practice in the North Somerset area

3. Miss A complains about the following aspects of her care and treatment at the Practice between August 2024 and July 2025. She complains the Practice:

• failed to provide treatment for cavities • has not provided hygiene cleaning • has refused to provide composite fillings in gaps between her teeth.

• does not provide treatment but instead spends the time discussing her teeth.

4. As a result of this Miss A says her oral health has deteriorated.

5. She wants to compensation and improvements to how the Practice provides treatment.

Failed to treat cavities

9. Miss A says she has suffered with cavities in her teeth where food is regularly trapped causing discolouration to her teeth.

10. We discussed this with our adviser to see if the Practice followed guidelines in its treatment.

11. A cavity is a hole in a tooth. Miss A attended the Practice for five appointments between August 2024 and July 2025. The Practice noted abfraction, erosion and abrasion lesions (types of lesions that cause tooth structure loss near the gumline) and natural spaces between her teeth. Miss A’s records do not show that she had any cavities.

12. The appointments show that she did not have cavities, but the shape of the tooth leaves gaps at the gumline. Our adviser has reviewed Miss A’s clinical records and the images we have received and agrees with this finding.

13. The GDC guidelines say dentists ‘must provide treatment that is in their best interests […] following clinical guidelines relevant to their situation’.

14. We cannot say that the Practice failed to provide treatment for Miss A’s cavities because there is no evidence she had cavities. We will, therefore, not proceed further with this aspect of the complaint.

It has not provided hygiene cleaning

15. Miss A says that with her ongoing issues with her teeth, the Practice failed to provide her with suitable hygiene care.

16. The NHS website said ‘The NHS will provide any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain. Decisions about which treatment is appropriate will be based on a clinical assessment and clinical judgement.’

17. A hygiene clean often involves Professional Mechanical Plaque Removal (PMPR) but can also use methods such as air-abrasion (uses compressed air to spray a tiny stream of abrasive particles onto the teeth) and prophylactic polishing (uses a spinning rubber cup and a gritty paste to smooth tooth surfaces) to remove superficial tooth staining. These methods do not remove intrinsic (within the tooth) staining.

18. Miss A attended for two appointments where the Practice carried out PMPR, these were on 21 May and 2 June 2025.

19. Prior to this, on 17 April 2025, Miss A had said she had plaque on her teeth. During her appointment she was told that this was a stain and she would need to see a hygienist.

20. The NHS website said:

‘If your dentist says scaling is clinically required, this is available on the NHS.

‘A simple scaling is included in a Band 1 […] course of treatment, but more complex treatment for gum problems may be charged within a Band 2 […] course of treatment.

‘If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay for it privately.’

21. The Practice considered that the stains were aesthetic and as such hygiene cleaning would not be clinically necessary so she would need to pay for this privately. Miss A’s notes show the Practice mentioned this to her, but no appointment was made by her.

22. NHS guidelines for treatment cost and banding from April 2024 says that:

‘Band 1 treatments include examination, diagnosis (including radiographs), advice on how to prevent future problems, scale and polish if clinically needed, and preventative care (e.g. applications of fluoride varnish or fissure sealant)

‘Band 2 covers everything listed in band 1, plus any further treatment such as fillings, root canal work or extractions.

‘Band 3 This band covers everything in bands 1 and 2, plus course of treatment including crowns, dentures, bridges and other laboratory work.’

23. Our adviser explained the term ‘hygiene clean’ is often used synonymously with PMPR. They said this term relates to cosmetic stain removal and is therefore not within the remit of NHS care.

24. The NHS banding does not include anything regarded as aesthetic or cosmetic. Therefore, if the scale and polish was to remove stains, the Practice was correct to refer her for this to be done privately. We can see no indication that the Practice acted against guidelines in this element of her treatment and we will not proceed further with it.

Refused composite fillings for gaps between her teeth

25. Miss A says the gaps at the bottom of her teeth have caused her a lot of problems with food regular getting trapped. She says the Practice should have provided her with composite fillings to fix this issue.

26. Miss A’s clinical records indicate that the gaps between her teeth are the result of improved oral hygiene causing the gums to shrink back after initial diagnosis of generalised inflammation (reversible gum inflammation), tenderness and bleeding.

27. Miss A returned for further appointments on 5 September 2024 and 21 January 2025 complaining of food becoming trapped and stuck between her teeth. The Practice told her filling the area was a good idea as it would make it more difficult to keep the area clean and would lead to more food being trapped and allow bacteria to build.

28. We discussed this with our adviser to see if the Practice should have offered the fillings to close the gaps in her teeth. Our adviser said there is no guidance specific to this situation. They said that it is difficult to know whether this treatment should or should not be provided. They said there is evidence to support the use of restorative materials to close/mask the gaps created by loss of interdental papilla (the soft tissue between teeth). This can improve aesthetics and reduce food packing. But the evidence-base is limited mainly to case-reports (as opposed to Randomised Controlled Trials), and it is generally accepted that the decision is also dependent on the clinician’s experience and skills.

29. Restorations do not regenerate the interdental papillae, and over-contouring can harm the periodontal (gum) health. The key risk being plaque retention of poorly adapted restorations.

30. The consensus of the clinicians at the Practice was to avoid closing gaps with restorations due to the risk of damage to the periodontal health. This was a decision based on their clinical judgement, and Miss A was advised to seek a second opinion if she was unhappy with this decision.

31. The GDC guidelines say dentists

‘must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation. You may need to balance their oral health needs with their desired outcomes. If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits and likely outcomes to help them to make a decision’.

32. Overall, we can see no indication the Practice did not give Miss A suitable treatment for her condition and provide her with correct information and reasons why it will not carry out the requested treatment. We note it did also adviser her to seek a second opinion if she was unhappy. We can see no indication that the Practice has failed to follow suitable guidelines on this aspect of her care and treatment and we will not proceed further with this aspect of her complaint.

Never provides treatment

33. Miss A says that when she attends her appointments she does not receive treatment, instead the Practice talks to her about what it could do instead of doing it.

34. We can see from the previous issues that the Practice has provided relevant treatment when she has attended. There is no indication that it failed to provide her with suitable treatment during her appointments.

35. We also note that communication is part of the GDC guidelines. It says dentist must ‘discuss treatment options with patients and listen carefully to what they say. Give them the opportunity to have a discussion and to ask questions’. Talking about her treatment is in line with that guidance. We will therefore not proceed further with this aspect of the complaint.

36. We recognise that Miss A’s dental health is distressing for her, and we hope she can manage her condition in the future.

1. We have carefully considered Miss A’s complaint about a dental practice in the North Somerset area (the Practice). We have decided not to consider the complaint further. This is because we saw no indication that the Practice failed to follow suitable guidelines when providing her treatment.

2. We recognise that Miss A’s dental health is distressing for her, and we hope she is able to manage her condition in the future.