A dental practice in the Oxford area

4. Mrs L complains about aspects of care and treatment her daughter, Miss Q received from the Practice. Specifically, Mrs L complains the Practice incorrectly advised her in 2021 that patients are required to have braces fitted before their 18th birthday.

5. Mrs L said the Practice provided her with incorrect advice which meant Miss Q did not receive orthodontic treatment and now has misaligned teeth. Mrs L says this has affected her daughters’ self-confidence. She also says her daughter developed fear of dentist and has refused to attend any dental appointments since the missed treatment in May 2022.

6. As an outcome to her complaint, Mrs L is seeking financial remedy to cover the cost of her daughter’s missed treatment.

7. In October 2019, Miss Q was referred to the Practice by her dentist for orthodontic treatment.

8. Mrs L says, the Practice incorrectly advised her daughter had to have braces fitted before her 18th birthday. She says this misinformation meant her daughter did not receive the orthodontic treatment she needed after declining treatment in May 2022.

9. She says she later discovered, in May 2025, that it was not necessary for her daughter to have braces fitted before turning 18. She explains her son turned 18 in May 2025 and also needed braces, but his treatment was due to start after his 18th birthday.

Incorrect information about orthodontic treatment

13. Mrs L says the Practice incorrectly advised her daughter needed to have her braces fitted before she turns 18.

14. In its response, the Practice explained it advised Mrs L and her daughter that orthodontic treatment needed to start before a patient turned 18. It said this was explained several times during consultations and at later appointments.

15. The General Dental Services Contracts regulations 2005 says routine, free orthodontic pathways apply strictly to children and young people. It differentiates between the date of referral, the date of assessment, and the fitting of the appliance.

16. The date of referral marks the day the referral is logged. Legally, this is the most critical date for patient eligibility. For example, if the patient is under 18 on the date of referral, they maintain their eligibility for free NHS care, even if they turn 18 while waiting for the assessment or appliance fitting.

17. The date of assessment is the day the orthodontist examines the patient to diagnose the malocclusion using the Index of Orthodontic Treatment Need (IOTN). This date legally establishes the clinical justification for treatment. If a patient is aged 18 or over at this stage, they are typically required to obtain prior Commissioner Approval.

18. The date of appliance fitting is the day the braces are actually placed on the patient's teeth. It is the official start of the active treatment phase and is the date used by NHS Business Services Authority (NHSBSA) or regional health boards to begin tracking the dental contract.

19. For primary care orthodontic treatment, a general dental practitioner must refer the patient before they turn 18. The legislation requires the referral before the patient’s 18th birthday. It does not require the orthodontic appliance to be fitted before then. Our adviser has confirmed our view.

20. Based on the aforementioned guidance, we consider Miss Q could have had her braces fitted after her 18th birthday, as the referral was made in October 2019, before she turned 18. We consider the Practice gave inaccurate information about the treatment deadline, which indicates a failing.

21. As we have identified indications of a failing, we have considered whether this has had a negative effect on Miss Q which the Practice has not yet put right.

22. Mrs L says Miss Q has misaligned teeth as a result of this failing. Mrs L explains this has affected Miss Q’s self-confidence and she has also developed a fear of dentist and orthodontist.

23. Our principles for remedy say where poor service has led to injustice or hardship, public organisations should try to put things right in a way that returns the complainant to the position they would have been in before the poor service took place. If that is not possible, the organisation should compensate the complainant properly.

24. Our NHS Complaints Standards say organisations should find suitable and appropriate ways to put things right for people who raise a complaint.

25. During this process, we approached the Practice and asked if it would be willing to put Miss Q back in the position she would have been in had she not been given inaccurate advice in 2022.

26. The Practice has accepted it did not give correct information about orthodontic treatment. It has agreed to offer free treatment to Miss Q at any of its clinics. It said it would provide the treatment within three weeks once an arrangement is made between it and Miss Q.

27. We consider the provision of the treatment Miss Q missed out on is an appropriate remedy for the injustice suffered by Miss Q. This follows our principles for remedy and our NHS Complaints Standards. This is because this remedy will enable Miss Q to receive the treatment she was entitled to originally. This treatment would be tailored to her current orthodontic needs, therefore addressing any current misalignment.

28. Mrs L declined this offer because she would prefer financial compensation so that Miss Q can receive orthodontic treatment from a different provider. We understand Miss Q's experience with the orthodontist in May 2022 caused her anxiety and that she does not want to return to the same orthodontist.

29. We raised this concern with the Practice, and it offered for Miss Q to receive her treatment at any of its clinics instead. We consider this gives Miss Q the opportunity to see a different orthodontist at a different clinic, which may help address the anxiety she experienced.

30. Taking this into account, we consider the Practice's offer to be appropriate and sufficient to put right the injustice caused to Miss Q.

31. We consider the Practice has done enough to remedy the injustice it caused Miss Q as such, we will not take any further action.

32. We appreciate the frustration Mrs L and Miss Q have experienced as a result of the event and hope the Practice’s offer gives Mrs L and Miss Q closure on this complaint.

1. We have carefully considered Mrs L’s complaint about the Practice. We are sorry to hear Mrs L’s daughter, Miss Q, suffers from misaligned teeth and has developed a fear of dentist as a result of her experience with the Practice. We appreciate this must have been a distressing experience for her.

2. We have seen there are indications the Practice did not act in line with the relevant guidelines when it told Miss Q her braces had to be fitted before she turned 18. The Practice has acknowledged it incorrectly told Miss Q her braces had to be fitted before she turned 18. It confirmed it will provide the missed orthodontic treatment to Miss Q at any of its clinics at no cost. We consider this is enough to put things right for this complaint, therefore we have decided we do not need to take any further action on the complaint.

3. We hope our decision gives both Mrs L and Miss Q some assurance that the Practice has taken her concerns seriously and are willing to put things right.