A dental practice in the Manchester area

4. Mr A complains about aspects of the care and treatment he received from the Practice between 2012 and September 2025. Specifically, he complains the Practice:

• repeatedly dismissed his concerns and failed to provide appropriate treatment • did not offer dental hygiene appointments • sent an incomplete referral form • did not offer an NHS apicectomy referral • removed him from the Practice with unfinished treatment.

5. Mr A says he has ongoing dental pain, difficulty eating and a decline in his overall oral health resulting in unnecessary tooth extractions. He says the experience has affected his mental wellbeing, causing high levels of anxiety around losing his teeth.

6. As a result of his complaint, Mr A is seeking an apology, service improvements and financial remedy.

7. Mr A has suffered with dental pain, poor oral health and anxiety around visiting the dentist since 2012. Between March and July 2024, Mr A had multiple appointments with the Practice and told us he felt concerns about his teeth were repeatedly dismissed.

8. On 9 July 2024, Mr A formally complained to the Practice about a lack of treatment and ongoing care. In September 2024, he travelled abroad to have significant work done on his teeth.

9. Mr A further complained to the Practice in August 2025 after it removed him from its care due to a breakdown in the relationship between Mr A and the dentist.

Issues one to three: dismissed concerns, lack of hygiene appointments and incomplete form

13. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Mr A to understand the reasons why he could not do so. We have also considered the time the Practice took to respond to Mr A’s complaint.

14. Mr A told us he became aware he should have been having regular dental hygiene visits around April 2024. He said he learnt this at the same time he was feeling that his repeated concerns were being dismissed. He also told us he felt the dentist had repeatedly dismissed his concerns and failed to provide appropriate treatment across a 12-year period prior to the events of 2024.

15. We consider Mr A’s date of knowledge for the first two complaint points to be April 2024. This is because he told us it was at this time he learnt about the need for regular dental hygiene visits and felt for sure his concerns were being dismissed. Although the issues had potentially been going on longer than this, we are satisfied that this date of knowledge is when Mr A had the level of awareness of something potentially going wrong that would action him to do something, following independent research into his dental problems.

16. Mr A told us he did not fully understand the extent of the failings he had experienced until a trip abroad in September 2024 for significant dental treatment. He told us this was when an independent dental professional told him the extent of his problems.

17. Our Service Model Guidance (SMG) section 2.278 says a complainant may be aware of an issue at the time but not experience a serious impact until a later date. It says the date a complainant had notice to complain is when they were first aware of an issue, not when the injustice became serious enough, they decided to complain about it. We recognise Mr A may not have fully understood the impact of the claimed failings until September 2024, however we are satisfied he had reason to complain to the Practice in April 2024.

18. We consider Mr A’s date of knowledge for when he learnt a referral form had been incorrectly filled in, as the date of the referral appointment, 9 July 2024. It was on this day that Mr A could not undergo a planned extraction at another dental practice due to the form being incorrectly filled in. He also made his formal complaint to the Practice on the same day.

19. We received Mr A’s complaint form on 31 October 2025. Based on Mr A’s date of knowledge, the complaints about a lack of hygiene appointments and treatment should have reached us by April 2025 and are therefore three and a half months out of time. The complaint about incorrect paperwork should have reached us by 9 July 2025 and is six months out of time.

20. In coming to our decision, we have established periods of delay between Mr A becoming aware of the issues and his complaint reaching us. We have taken into account Mr A’s reasons for these delays in addition to the time it took for the Practice to respond to his complaint.

21. Mr A’s first complaint reached the Practice on 9 July 2024. This was the same day he learnt a referral form had been incorrectly filled in. The Practice responded on 22 July 2024. We explored with Mr A the reasons why he did not complain to the Practice or us sooner after his date of knowledge for the other issues.

22. Mr A told us that throughout 2024 and 2025, he was experiencing a combination of anxiety, depression and chronic dental pain which was directly linked to his deteriorating oral health and the fear of losing multiple teeth. He told us that his capacity to deal with a formal complaint was compromised during this period.

23. He told us that in September 2024, he had entirely lost trust in the Practice’s care and felt forced to travel abroad to undergo dental treatment which then required time to recover from the overwhelming experience. Mr A also told us that in April 2025, he underwent a surgical procedure which required a period of recovery afterwards.

24. We recognise Mr A has struggled with his mental health, particularly regarding his ongoing oral health. We appreciate this will have made bringing his complaint to us more challenging and take more time.

25. We have seen evidence of Mr A’s sister helping with his complaints to the Practice and advocating for him. There are several occasions in Mr A’s dental records which outline his sister’s involvement. We are of the opinion that although Mr A’s mental health difficulties have made bringing a complaint to us more challenging, he had the support of his sister who could have assisted him to bring his complaint to us sooner.

26. Mr A also travelled abroad to complete significant dental treatment in September 2024 which he told us further contributed to his mental health difficulties and recovery. We recognise that significant effort can be required to collate the evidence to submit a complaint to us, and Mr A’s mental health difficulties made this harder. However, we are of the view that if he was so unhappy with the Practice’s treatment and was well enough to organise and attend a trip abroad, he could have begun to submit his complaint to us earlier.

27. We have also seen no evidence of Mr A continuing with his formal complaint after the Practice’s initial response in July 2024.

28. We recognise that Mr A required a period after his surgery to recover. The surgery took place in April 2025, and we consider a break of six weeks post-surgery where he would have been unable to progress his complaint further due to his recovery reasonable given the particular procedure. However, this does not account for the full delay in Mr A’s complaint reaching us.

29. Mr A had an appointment with the Practice on 11 July 2025, a year after his original complaint. The records show Mr A’s sister contacted the Practice on his behalf to further complain. On 27 August 2025, the Practice sent Mr A a letter saying he had been removed from the Practice due to a breakdown in the relationship between him and the dentist. Mr A complained again to the Practice over the course of September 2025 about the more recent issues. He then approached us on 31 October 2025.

30. We are of the view that if Mr A was in a position to continue formally complaining to the Practice about more recent issues between July and September 2025 (which we consider in time and have set out our view below), then he could have also submitted his previous complaint to us at this time.

31. We recognise Mr A has suffered with poor mental health over the course of his complaint and are sorry to hear about the challenges this has caused him. We have carefully considered Mr A’s reasons for the delay in bringing his earlier complaint points to us sooner and do not believe there are grounds to set aside the time limit in this case. This is because he had his sister’s help, was well enough to go abroad to fix the issues he was unhappy with, did not formally continue his original complaint with the Practice after his trip abroad, and was able to complain about different issues the following year before finally approaching us.

32. We consider there were several opportunities where Mr A could have contacted us sooner. On this occasion, we have not found reason to set aside the time limit and decline to investigate the issues of a lack of dental treatment, a lack of dental hygiene appointments and an incorrect referral form. We recognise this decision is disappointing to Mr A but have considered his other issues which were brought to us within the time limit below.

Issue five – NHS apicectomy referral

33. 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 for the remaining issues Mr A brought to us.

34. Mr A told us in July 2025, the Practice told him an apicectomy could potentially save one of his upper front teeth. An apicectomy is usually performed when a root canal treatment has failed and involves removing the tip of a tooth’s root and the surrounding infected tissue. The Practice told Mr A this procedure would need to be performed privately. Mr A told us he later found out an apicectomy is available on the NHS and felt he should have been informed of the potential treatment pathway.

35. Our adviser told us Mr A’s dental records show the Practice assessed the prognosis of his upper front tooth over a prolonged period. They explained the Practice’s decision to not refer Mr A for an NHS apicectomy was based upon repeated clinical assessments dating back to 2017.

36. The periradicular surgery guidance says treatment should only be undertaken following careful case selection. There should be a reasonable expectation of long-term retention of the tooth, favourable periodontal support (healthy tissues and bone around the tooth) and good restorative prognosis.

37. Similarly, the endodontic practice guidance says that teeth should only be considered for endodontic treatment or referral where they are restorable, maintainable and have a long-term prognosis.

38. Our adviser explained this guidance is reflected within NHS endodontic referral pathways. They generally require that teeth demonstrate a favourable prognosis. Teeth with significant disease, poor restorability or an unfavourable long-term prognosis are commonly considered unsuitable for NHS surgical endodontic treatment. In Mr A’s case the records show longstanding disease, recurrent symptoms, progressive bone loss, and a previously treated root canal with a poor prognosis.

39. We have seen no indication that anything went wrong in the Practice’s decision to not make an NHS apicectomy referral. We consider the decision was in line with relevant clinical standards and endodontic guidance as Mr A’s tooth did not have a favourable long-term prognosis.

40. Mr A says the Practice should have made him aware there was an NHS pathway, even if it did not consider him a suitable candidate. Principle three of the GDC standards says dental professionals must provide patients with the information they need in a way they can understand, so they can make informed decisions about their care. This includes discussing the reasonable treatment options, together with the risks, benefits, likely outcomes and costs of those options.

41. The endodontic practice guidance also says patients should be provided with sufficient information regarding the treatment options that are clinically appropriate for their individual circumstances. Our adviser told us the standards do not require clinicians to discuss every theoretical treatment pathway irrespective of its clinical appropriateness.

42. As addressed above, we consider the Practice acted in line with relevant guidance in not referring Mr A for an apicectomy through the NHS. The records support the Practice’s view that an NHS apicectomy referral was not considered a clinically appropriate treatment option.

43. As this was not considered a reasonable treatment option, we consider the Practice acted in line with GDC standards and endodontic practice guidance. The records show the Practice provided Mr A with treatment options clinically appropriate for his individual circumstances.

44. We have seen no indication anything went wrong in either the Practice’s decision to not refer Mr A for an NHS apicectomy, or in its communication of his treatment options. We will not be taking any further action on this issue.

Issue six – removal from Practice with unfinished treatment

45. Mr A told us the Practice removed him from its care when he still had unfinished treatment. Section three of the Practice’s discharge policy says it may conclude NHS care if there is a breakdown in the professional relationship or abusive, aggressive, or disrespectful behaviour toward the team.

46. The records show that during various appointments in 2024, Mr A repeatedly requested a second opinion. The Practice provided this and after his first complaint in July 2024, the Practice placed Mr A under the care of a different dentist at his request. Following an appointment in July 2025, the records show Mr A’s sister contacting the Practice as she had done several times previously on his behalf where the competency and qualifications of the dentist were called into question. The notes state the receptionist “felt quite threatened”.

47. We have seen no indication anything went seriously wrong in the Practice’s decision to stop providing care to Mr A. This is because we have seen evidence of both a breakdown in the professional relationship and aggressive and disrespectful behaviour towards the Practice.

48. The discharge policy also says if NHS care ends, the Practice will complete any active course of treatment already started. Having reviewed all of Mr A’s dental records, we have seen no indication that an active treatment plan was in place when the Practice stopped NHS care in August 2025.

49. During 2024, Mr A had several treatment plans in place. However, records show in September 2024, Mr A cancelled his forthcoming treatment appointment after receiving treatment privately abroad. The notes state he had "all the work that needed doing" completed there, and that he "does no longer want any more treatment done".

50. Following this entry, there are no further NHS treatment plans and there were no other clinical records demonstrating that a new course of treatment was opened.

51. We consider the Practice acted in line with its discharge policy when ending NHS care for Mr A as the records show evidence of a breakdown in relationship between Mr A and the dentist, and we have seen no indication Mr A was under a current course of treatment when the relationship ended.

52. We recognise the issues Mr A has suffered with have caused him distress. We also recognise the challenging current situation regarding the availability of NHS dentists and hope Mr A finds alternative treatment elsewhere. We hope Mr A is reassured that his concerns have been thoroughly considered with independent clinical advice.

1. We have carefully considered Mr A’s complaint about a dental practice in the Manchester area (the Practice). We are very sorry to hear of the circumstances surrounding Mr A bringing his complaint to us and the impact the events have had on his life, particularly his ongoing dental pain.

2. We have considered all information provided to us by Mr A and the Practice. The issues Mr A has raised from between 2012 and July 2024 fall outside of our time limit. We have identified delays in Mr A bringing these issues to us and having carefully considered all the reasons, do not believe there are grounds for us to set aside out time limit in this case.

3. We have obtained independent clinical advice on the other issues Mr A brought to us. We have seen no indication anything went seriously wrong in the Practice’s decision to not offer or advise Mr A of an NHS apicectomy referral. We have also seen no indication Mr A was under a current course of NHS treatment when the Practice removed him from its care in August 2025.