Source · SPSO (Scottish Public Services Ombudsman)

Lothian NHS Board

SPSO (Scottish Public Services Ombudsman) Not Upheld Reference 201406444 Sector Health Category clinical treatment / diagnosis Decided 01 December 2015

View NHS Lothian scorecard

Full decision

Summary

Mrs C complained to us about some dental treatment she had at the practice that she had been referred to. She had a wisdom tooth removed, and during the process, a filling came out of the adjacent tooth, and part of the tooth broke off. The dentist advised Mrs C to see her own dentist to have the damaged tooth seen to. Mrs C complained that the treatment on her wisdom tooth must have been done badly, otherwise the neighbouring tooth would not have been damaged.

We took independent dental advice in relation to Mrs C's dental treatment. Our adviser noted that both Mrs C's dentist and the dentist carrying out the extraction had told her that she had tooth decay. He said that this made her teeth more vulnerable to damage during a dental procedure. He also noted that Mrs C had been told that the procedure of removing her wisdom tooth involved some risk of damage to adjacent teeth. However, there was no evidence that the tooth adjacent to the wisdom tooth was known to be decayed, and there was no record of Mrs C being warned of the risk to this tooth in particular, given its proximity to the wisdom tooth.

We concluded that there was no evidence that the dental treatment had been carried out inappropriately, so we did not uphold the complaint. However, we were critical that the records indicated that the dentist had not been clear during the consenting process of the risks to the adjacent tooth, or noted specifically whether there was any decay in that tooth.

Recommendations

We recommended that the board: feed back the findings of this investigation to the staff involved, for reflection and learning, particularly in relation to ensuring patients are fully informed of the risks of a procedure, and that appropriate records are kept; and apologise to Mrs C that they failed to give clear information about the risks involved in the procedure when she was giving consent.

Related reading

View Decision Report 201406444 as a PDF (12.87 KB) Updated: March 13, 2018

View original on SPSO (Scottish Publ… website

Other decisions involving Lothian NHS Board

Reference Date Summary Outcome
202404449 01 Jan 2026 C complained about the care that their adult child (A) received from the prison healthcare team and particularly a failure … Upheld
202304800 01 Mar 2025 C complained that the board failed to provide reasonable personal care and treatment to their sibling (A). A was admitted … Upheld
202304367 01 Dec 2024 C complained on behalf of their spouse (A) about the standard of care and treatment received in the months before … Partly Upheld
202005296 01 May 2022 C complained that there had been an unreasonable delay in their late parent (A) receiving a prescription of antibiotics following … Upheld
202002582 01 Jan 2021 C complained about the clinical care provided to their child (A) by the board, specifically, that a Chiari malformation (where … Not Upheld
View all decisions for this organisation