A dental practice in the Barking and Dagenham area

4. Miss G complains a dental practice in the Havering area did not correctly carry out the first stage of root canal treatment for her upper right seven (UR7) tooth and took too long to complete the second stage in November 2022. She also complains it did not correctly carry out a filling on her lower left five (LL5) tooth in March 2023.

5. She says the initial treatment for her UR7 tooth and the long delay to complete the root canal treatment meant that her tooth became weak and fractured during the wait and this then needed to be removed. She told us this could have been avoided with different action from the Practice.

6. She explained the incorrect filling of her LL5 tooth led to months of persistent pain, bleeding, swelling, and sleepless nights. She told us the whole experience was extremely stressful, impacted her quality of life, and the Practice’s actions left her unable able to eat without difficulty. Miss G wants an apology and an acknowledgement of what went wrong, service improvements, and a financial remedy.

7. This very brief background is only intended to place the key events in context, not to provide a full, chronological account of everything that happened.

8. Miss G attended the Practice with problems with her UR7 tooth in September 2022. The Practice examined her and found her UR7 tooth was cracked. It advised her she needed the tooth extracted or root canal treatment. Miss G decided to have root canal treatment on the tooth.

9. In November, Miss G returned to the Practice, and it carried out the first stage of root canal treatment for her UR7 tooth. She attended the Practice for the second stage of treatment five weeks later in December. The Practice informed her it could not complete the second stage as the crack in the tooth had worsened and it could not save it. It recommended removing the tooth and carried this out in January 2023.

10. In March, Miss G attended the Practice with a loose filling in her LL5 tooth. On examination, the Practice found the margins of the filling was leaking and carried out a replacement filling one week later. From the medical records it appears Miss G continued to experience issues in her LL5 and LL6 area following this filling.

13. 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. We have done this and have not found any indications that something has gone wrong.

UR7 root canal treatment 14. Miss G complains the Practice incorrectly managed root canal treatment for her UR7 tooth in November 2022. She says it did not carry out the first stage correctly and the treatment was inadequate. She explained the Practice then took too long to complete the second stage of the treatment.

15. She told us the inadequate treatment and gap between stages meant her tooth became weak and fractured, and it needed extracting. She says this impacted her ability to eat and different action from the Practice would have avoided this.

16. We were sorry to hear about the difficulties Miss G experienced with her UR7 tooth. Losing a tooth is understandably upsetting, especially when it impacts daily life and causes worry or discomfort. From what Miss G told us, it has clearly been a difficult time for her, and the Practice’s actions continue to cause her ongoing worry and distress.

17. Root canal treatment is a dental procedure that removes an infection from inside a tooth. The tooth is cleaned and filled to stop it from becoming infected again. The procedure is usually carried out over two or more appointments.

18. Guidelines from the British Endodontic Society say root canal treatment is indicated for several reasons including if the pulp (the soft part inside the tooth) is necrotic (when the pulp tissue inside a tooth dies) with or without inflammation in the tip of the tooth root.

19. The guidance goes on to explain what actions a dentist should take during a root canal procedure. These include using a rubber dam to isolate the tooth, files and a disinfectant solution to clean and shape the root canals, an electronic apex locator (a tool to measure the working length of a root canal) to measure the length of the canal, and X-rays before starting the treatment and after completion. However, the guidelines do not specify how long the time between each stage of the treatment should be.

20. Miss G attended the Practice for an emergency appointment in September 2022. She complained of pain and swelling in her upper right teeth. The Practice examined her, carried out an X-ray, and found a crack in her UR7 tooth. The medical records document it told her she needed root canal treatment or an extraction as the crack went into the pulp of her tooth. In October, Miss G decided to have root canal treatment of the tooth.

21. Our adviser explained root canal treatment was indicated for Miss G as the crack in her UR7 tooth went into the nerve chamber of the tooth and the Practice located dead tissue in the root canals.

22. In November, Miss G returned to the Practice for the first stage of her root canal treatment. From the information recorded in the medical records, it appears the Practice discussed the risks of treatment with her including that root canal treatment might not work.

23. During the appointment it carried out the actions listed in the British Endodontic Society guidelines. We can see evidence that it used a dam to isolate the tooth, files and a disinfectant solution to clean and shape the root canals, an electronic apex locator to measure the length of the root canals, and it carried out an X-ray in September, before starting the treatment. This means we cannot see any indications the Practice got anything wrong with the first stage of the procedure and our adviser agrees with our view on this.

24. When Miss G attended the Practice for the second stage of treatment approximately five weeks later in December, she complained of pain and swelling in the tooth. The Practice examined her and found the UR7 tooth had fractured, and it needed extracting. We recognise this news would have been upsetting and disappointing for Miss G.

25. As the guidelines from the British Endodontic Society do not say when the second stage of a root canal treatment should happen, we cannot say the Practice’s choice to wait five weeks to complete the treatment, was wrong.

26. Our adviser explained that the fracture in Miss G’s tooth had become more evident when she returned for the second stage of her treatment and unfortunately it appears the extraction of the tooth was the only option.

27. They explained the timeline of Miss G’s root canal treatment does not appear to have impacted the overall outcome or worsened the fracture in her tooth. This is because the fracture in the tooth was likely to worsen regardless of when the Practice attempted to carry out the second stage of treatment.

28. They went on to explain this could have happened even after the Practice had completed the second stage of the root canal treatment and unfortunately would have still resulted in a tooth extraction. It appears the Practice attempted to save Miss G’s tooth by offering her root canal treatment.

29. We hope this information from our adviser helps to reassure Miss G that it does not appear the wait between root canal stages impacted the outcome of her UR7 tooth.

30. From the information we have seen and the clinical advice, we are satisfied that the Practice followed relevant guidelines from the British Endodontic Society when it carried out the actions needed the first stage of Miss G’s root canal treatment. The guidelines do not specify how much time should pass between each treatment stage, so we cannot say the Practice was wrong when it decided to wait five weeks to carry out the second stage of Miss G’s treatment.

31. It is understandable that this concern continues to cause Miss G distress and worry. We hope our findings go some way to reassure her the Practice followed relevant guidelines when it managed her root canal treatment in November 2022.

LL5 filling 32. Miss G complains the Practice did not correctly carry out a filling on her LL5 tooth in March 2023. She says the filling was inadequate and led to her experiencing pain, bleeding, swelling, sleepless nights, and difficulties with eating. We were sorry to hear how Miss G experienced significant problems with her LL5 tooth. It is clear from what she told us that this impacted her daily life and caused her distress and pain.

33. GDC guidance says dentists must provide good quality care based on current evidence. Our adviser explained that there are no specific guidelines on how to carry out a filling.

34. Miss G attended the Practice in March 2023 as she was having trouble with her LL5 tooth. The Practice examined her and found the filling in the tooth was loose and needed replacing.

35. One week later, Miss G reattended the Practice for the refilling of the tooth. The Practice carried out an X-ray and found decay under the filling. It filled her LL5 tooth with a composite filling. A composite filling is made from a tooth-coloured plastic, resin, or ceramic-based material.

36. From what we have seen in the medical records, it appears the Practice told Miss G the filling was very deep, and she may need root canal treatment or an extraction in the future.

37. Unfortunately, Miss G continued to experience problems with her LL5 tooth despite the new filling, so it is understandable that she is concerned something went wrong during her appointment in March.

38. Our adviser explained that dentists use a simple standard filling such as amalgam (metal) or composite to begin with. Unfortunately, sometimes fillings can fail, which can cause problems like pain, as Miss G sadly experienced. However, this does not always mean the filling was done incorrectly.

39. They explained that the position of Miss G’s teeth made it difficult for the Practice to place the filling in the tooth to prevent food from getting trapped, and the edges of the filling more precise. They noted she also had a long-term infection in her LL6 tooth and explained this could have contributed to the painful symptoms she experienced in her LL5 tooth.

40. From what we have seen and the clinical advice, it appears the Practice followed relevant GDC guidelines when it refilled Miss G’s LL5 tooth in March 2023. We can see it examined her tooth and made a decision to re-fill it based on the fact the original filling was loose, and the tooth was decayed underneath it. Therefore, it appears the Practice provided good quality care based on current evidence as the guidance says it should.

41. It appears there are no specific guidelines on how to carry out a filling and as our adviser explained, fillings can fail. We also acknowledge Miss G had a long-term infection the tooth next to her LL5 tooth which could have impacted the symptoms and pain she experienced. This means we cannot say the Practice’s actions during Miss G’s appointment in March directly caused the symptoms she described in her LL5 tooth, and we cannot see it got anything wrong when it carried out the filling.

42. We understand how important it is for Miss G to feel confident about the care she received. We hope that our findings, along with the information from our adviser, help to provide her with clarity and reassurance about the Practice’s actions.

43. Overall, based on the evidence we have seen and our clinical advice, it appears the Practice followed relevant guidelines when it managed Miss G’s dental care in November 2022 and March 2023. It is understandable that Miss G’s concerns have caused her the ongoing distress she described, and we were sorry to hear how dental problems impacted her life. We hope that our report and explanations go some way to reassure her that the Practice followed relevant guidelines when it managed her dental care, and we have found no indications that anything went wrong.

1. We have carefully considered Miss G’s complaint about a dental practice in the Havering area (the Practice). We were sorry to hear her concerns about how the Practice managed her dental care on two occasions, in November 2022 and March 2023. From our conversations with Miss G, it is clear she found her experience incredibly difficult and painful, and her concerns about her care continue to cause her ongoing distress.

2. Based on the information we have considered, we have seen no indications that anything went wrong. We have seen the Practice followed relevant guidelines when it carried out Miss G’s dental care on the dates she complains about. We have decided to take no further action on this complaint for this reason.

3. We recognise how important this complaint is to Miss G, and we would like to take this opportunity to thank her for taking the time to explain her complaint to us. We do not underestimate how distressing her dental issues have been for her. We hope our explanations below show how we have considered her complaint and gives her some reassurance the Practice followed relevant guidelines when it managed her dental care.