A dental practice in the Wyre Forest area

3. Miss D complains about aspects of dental treatment completed by the Practice between 2019 and 2025. She specifically complains the Practice: • gave her fillings which were not needed and did not carry out fillings appropriately • did not complete a root canal not properly • did not provide appropriate dental care to a tooth that she subsequently lost • gave wrong information to the hospital for the removal of a wisdom tooth.

4. Miss D says as a result she has been left feeling failed and in pain. Has lost teeth and working days due to the poor treatment she received.

5. Miss D wants an apology, service improvements, and a financial reward.

6. Miss D moved to a new dental practice in 2025. Her last appointment with the Practice was on 10 April 2025.

10. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation 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.

Fillings

11. Miss D complains from 2019 the Practice gave her fillings that her new dentist said were not needed and not carried out appropriately.

12. The Practice told Miss D it is unusual for a new clinician to know the previous condition of her teeth to know if fillings had been placed incorrectly. It also said Miss D had most of her upper front teeth fillings completed in 2019 due to dental decay, wear and tear, and tooth grinding.

13. General Dental Council, Standards for the Dental Team principle two, Communicate effectively with patients says; ‘Patients expect to receive full, clear and accurate information they can understand, before, during and after treatment, so that they can make informed decisions in partnership with the people providing their care.’

They can also expect a clear explanation of the treatment, possible outcomes and what they can expect.’

14. The records show the Practice completed fillings on Miss D’s upper left one and two. upper right one, two, and three teeth and lower right two in mid-January 2019 because of tooth decay, fractured teeth, and restorations (fillings) needing treatment. Miss D consented to this treatment after the Practice discussed this with her.

15. The Practice noted Miss D did not regularly attend for routine checks and advised her poor dental hygiene could result in the loss of her teeth from decay or gum disease.

16. This is in line with GDC, principle two as the Practice gave Miss D information and gained her approval to complete the treatment. It also gave outcomes she could expect due to having poor dental hygiene.

17. Our adviser said irregular dentist attendance and poor mouth hygiene increase the risk of decay and the lifespan of already placed fillings. They also said radiographs (X-rays) provided were taken at different stages and times of Miss D’s care and do not show pre and post fillings to see if these were completed appropriately.

18. We acknowledge Miss D was concerned as her new dentist commented her fillings were not completed correctly.

19. Based on the evidence we have seen, the Practice acted in line with GDC guidelines in giving Miss D fillings. The evidence shows the Practice spoke with Miss D about concerns over her teeth care and how these could affect the success of her treatment. We have not seen the filling were completed incorrectly. We therefore will not consider this further.

Root canal

20. Miss D complains the Practice did not complete a root canal treatment properly in 2017 and had to be corrected by her new dentist.

21. The Practice said it successfully completed Miss D’s root canal in line with clinical guidelines.

22. British Endodontic Society, A guide to Good Endodontic Practice, Chapter six, Primary root canal treatment says, ‘… For successful root canal treatment that prevents or resolves infection around the tooth's root (apical periodontitis), it's essential to diagnose the problem accurately and complete each step of the treatment properly. Infection happens when the pulp inside a tooth is damaged or infected, leading to bacterial growth in the root canal system. The goal of treatment is to remove these bacteria and prevent them from returning by sealing the root canal and protecting the tooth with a strong restoration.’

23. The records show Miss D had an emergency appointment at the Practice on 3 May 2017 as her lower right tooth was chipped. The Practice completed an examination and took an X- ray of her lower right four and five teeth.

24. The Practice discussed the tooth fracture, caries (tooth decay), and infection it found in Miss D’s lower four tooth. It explained the fracture had reached the pulp (centre) of the tooth which would need root canal treatment and explained how poor oral hygiene can affect the longevity of the treatment. Miss D agreed to go ahead with the root canal treatment after accepting the risks and completing a course of antibiotics.

25. In mid-May 2017, the Practice completed Miss D’s root canal to remove the nerve that had decayed and placed a temporary seal on the tooth until a crown (custom made tooth shaped cap) could be fitted later. This is in line with British Endodontic Society chapter six guidelines of treatment as the decayed nerve causing infection was removed and long-term plans to seal the tooth were completed.

26. Our adviser told us the success of a root canal is determined by clinical symptoms such as no swelling in the mouth and pain in the tooth not reoccurring. They also said the X-rays are not clear enough to show the success of the root canal, but no infection can be seen near the root of the tooth.

27. Based on the evidence we have seen, the Practice acted in line with British Endodontic Society guidelines for completing a root canal correctly. The evidence shows the infection of the nerve was treated appropriately and removed to resolve the pain Miss D experienced. The Practice also gave Miss D advice for taking care of her oral hygiene and how this could affect the success of her treatment. We cannot see that Miss D returned with any further lower four tooth pain after it was treated.

28. We have seen no indication of failings with the root canal treatment completed.

Emergency dental care

29. Miss D complains on 9 December 2024 the Practice gave her incorrect dental care resulting in her losing the tooth. She told us this caused her upset and distress as this affected her appearance.

30. The Practice said it found a fracture to her incisor (flat front teeth) tooth which it repaired appropriately on the same day.

31. GDC, Principle one, put patients’ interests first, point 1.1.1 says, ‘You 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.’

Point 3.1.2 of the GDC guidance says, ‘You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.’

32. The records show Miss D lost a previous filling from her upper left two tooth which caused the incisor to feel sharp. The Practice completed an examination and found Miss D had other decayed teeth which would need treatment but agreed to restore the tooth that was causing her pain.

33. Miss D signed a consent form, and the Practice noted her verbal consent to repair the fractured tooth. This is in line with GDC point 1.1.1 and 3.1.2 as the Practice considered Miss D’s best interests and had an open discussion about her treatment. Following this the Practice documented verbal and gained written consent for the treatment.

34. The Practice also strongly advised Miss D to improve her oral hygiene due to decay being found on multiple teeth which had been previously filled in 2019.

35. Our adviser said there is no specific guidance governing the emergency management of a fractured tooth. They also told us the emergency assessment to establish a diagnosis, discuss the treatment options and the risks were documented as expected.

36. We acknowledge Miss D’s distress that her tooth fell out when she said the Practice told her this would not happen.

37. Based on the evidence we have seen, the Practice acted in line with GDC guidelines by gaining consent and giving treatment as agreed by Miss D. The Practice also gave warning information to Miss D to improve her dental hygiene to support the longevity of the treatment it gave.

38. We have seen no indications of failings in this element of the complaint.

Wisdom tooth

39. Miss D complains the Practice referred her to the hospital incorrectly for a wisdom tooth removal in 2023. This caused her frustration, upset and pain as her care was not correct.

40. The Practice said it saw Miss D for repeated episodes of pericoronitis which is recurring infection and inflammation around partially erupted wisdom teeth and it gave her advice appropriately.

41. National Institute for Health and Care Excellence (NICE), Guidance on the extraction of wisdom teeth point 1.3 says, ‘Surgical removal of impacted third molars should be limited to patients with evidence of pathology. Such as …unrestorable decay, non-treatable tooth fractures, abscesses and disease such as cysts and tumours.’

Point 1.4 says, ‘…Specific attention is drawn to plaque formation and pericoronitis. The degree to which the severity and reoccurrence of pericoronitis should influence the decision to remove the third molar.’

42. The records show Miss D went to the Practice on 15 May 2023 with tooth pain. The Practice examined Miss D and found she had limited ability to open her mouth, aching jaw, pain when chewing and left sided swelling around the jaw.

43. The Practice noted she had no tongue or lip swelling and diagnosed pericoronitis. This where the gum tissue around a partially erupted tooth becomes swollen and infected. The Practice advised Miss D to take anti-inflammatory medication, prescribed antibiotics, mouth rinsing and completed a mouth wash and removal of any debris from her mouth.

44. The Practice noted if this became a regular problem, she may need to be referred to hospital for the tooth to be removed. This is in line with the NICE wisdom tooth referral guidelines which says the reoccurrence of the pericoronitis should influence the decision for the tooth to be removed.

45. Miss D called the Practice four days later saying the mouth swelling had not gone down and had gone towards her eye. She was still in pain, could not open her mouth wide and felt lethargic but with no temperature.

46. The Practice advised Miss D to go to her local hospital due to a risk of cellulitis (infection of the mouth tissues) or a salivary gland infection as antibiotics had not helped.

47. Our adviser said the referral for more specialised care at the hospital was appropriate as the care given by the Practice had not helped in this instance. Informing Miss D to go to hospital for the infection was the correct action to take to prevent it becoming more serious.

48. This is the only mention of suggesting she goes to hospital we have seen in the notes. Miss D says she was referred to hospital for wisdom tooth removal. We have seen no evidence in the notes to suggest this was the case. From the records at the time of the events the infection could have been caused by a number of different things and in any case any infection would need to be resolved before further dental treatment could be completed.

49. We appreciate that Miss D experienced pain during this time and this would have been worrying for her. We recognise the strength of Miss D’s feelings on this matter.

50. As we have not seen any referral information from Miss D or the Practice in relation to the removal of a wisdom tooth, we cannot say exactly what happened. We therefore will take no further action on this element of the complaint.

51. We understand and acknowledge the pain, distress, and frustration this experience has caused Miss D. We hope our explanations goes some way to explaining how the Practice acted in line with GDC, NICE and British Endodontic Society Guidelines in providing her dental care.

1. We have carefully considered Miss D’s complaint about a dental practice in Worcestershire (the Practice). We are sorry to hear about the difficulties Miss D experienced with aspects of her dental treatment. We understand how frustrating it is to feel you are not getting the care and treatment you need.

2. Having investigated her complaint, the evidence suggests the Practice treated Miss D in line with relevant guidance. We hope she is reassured by what we have seen.