Complaint about a Dental Practice and a Dentist
Jump to
Inappropriate dental care and inadequate complaint handling
Background to the complaint
On 20 February 2006 P, then aged seven, was taken to a dental practice (the Practice) by his father, Mr A. He was seen by Dr H who carried out fillings to two baby molar teeth. Mr A remained with his son during treatment. At around lunchtime, P began complaining of pain to his lip. The inside of the mouth was lacerated. Mr A returned to the Practice with P, where he was examined by Dr H and a colleague (the Second Dentist). He was referred to hospital, and examined by a Consultant. P needed stitches.
Complaint to the Practice and to the Healthcare Commission
The same day, Mrs A complained to the Practice that she believed the laceration had been caused by a drill used by Dr H when treating P. In his reply, Dr H said he believed that the laceration had been caused by P biting his lip while it was anaesthetised. He explained that the Second Dentist had pointed out the shape of P’s teeth imprinted over the wound. He was sure that the laceration had not been caused in the Practice.
On 28 February 2006 the Practice Manager told Mrs A that Dr H was returning to Germany. In March the local Primary Care Trust (the Trust) told Mrs A that Dr H had not left a forwarding address, and suggested that she might involve the Healthcare Commission (the Commission). Mrs A duly referred her complaint to the Commission in March. In response to Mrs A’s complaint and a subsequent request by the Trust, P was examined by the Dental Reference Service (part of the clinical governance arrangements for NHS dentistry). The Dental Reference Officer concluded in his report of 10 April that the restoration was confluent (meaning that the fillings were placed in the two teeth as one filling), and he advised that the restoration would need to be replaced to allow for individual tooth movement. He also identified further visible decay at two other baby molar teeth. Later, Mrs A told the Commission that P had developed a massive abscess in the teeth that Dr H had filled, which had then been removed under general anaesthetic.
Because of the perceived complexities caused by Dr H’s relocation abroad, the Commission asked the Ombudsman to accept Mrs A’s complaint for investigation. The Ombudsman agreed to do so.
What we investigated
We investigated whether the laceration to P’s lip had been caused by Dr H’s drill; whether the fillings installed by Dr H were substandard; and whether the Practice had handled Mrs A’s complaint appropriately.
We studied the available documentation, including P’s dental records, and discussed the complaint with Mrs A, Dr H and the Practice Manager, and contacted the Dental Nurse present on 20 February, along with the Second Dentist. We asked the Consultant for his opinion and studied the medical records taken for P while he was under his care. We also saw the photographs of P’s lip taken by the family and sought clinical advice from two Dental Advisers.
What our investigation found
The laceration to P’s lip was significant. The Consultant thought the trauma was ‘considerable’ compared with bite injuries he had seen, but was not absolutely certain that the injury was caused by a drill. Our own clinical advice was that if the injury had been caused during the appointment, the wound would probably have bled significantly. That would have been very apparent at the time, or at least sooner than a few hours later; it was ‘most likely’ that P had bitten his lip. The Second Dentist believed he witnessed impressions of P’s front teeth on his lower lip. We could not reconcile the different opinions and, on balance, we could not be certain that P’s injury was not self-inflicted.
The standard of care provided by Dr H to P was not wholly appropriate. Our clinical advice highlighted that it was ‘poor quality dentistry’ to have installed confluent fillings, and it was noted that there was a justifiable need for X-rays to be taken before the fillings were installed (which would almost certainly have picked up the decay found by the Dental Reference Service).
Although the Practice Manager told Mrs A that Dr H was leaving the Practice, we saw no evidence that Mrs A was told what action she could take under the NHS complaints procedure if she remained dissatisfied with the Practice’s response to her complaint. The Practice’s Code of Practice for Patient Complaints advises patients to approach the Patient Advice and Liaison Service if they are not satisfied. Whilst that signposting was helpful, the Code of Practice was misleading and inaccurate as it did not advise patients of their right to contact the Commission if dissatisfied with the Practice’s response to their complaint. Mrs A could have been advised more appropriately about what to do next.
We concluded our investigation in February 2008, and partly upheld Mrs A’s complaint (we did not uphold the complaint about P’s lip laceration and upheld the complaints about the care provided to P and the Practice’s complaint handling).
Outcome
The Practice agreed to amend their Code of Practice to reflect the provisions of the NHS (Complaints) Regulations which advise on the Commission’s role.
Dr H agreed to:
- review the Ombudsman’s report and reflect on the learning points identified;
- send Mrs A a written apology for the shortcomings in his restorative dentistry practice; and
- identify an appropriate person under his working arrangements abroad and share our findings and conclusions with them as part of his ongoing appraisal, and learning and development process.
Principles of Good Complaint Handling
The Principles of Good Complaint Handling were not referred to in our report but this case summary serves to illustrate the following Principles:
- ‘Being open and accountable’ (publishing clear, accurate and complete information about how to complain, and how and when to take complaints further).
- ‘Seeking continuous improvement’ (using all feedback and the lessons learnt from complaints to improve service design and delivery).
