Dental practice failed to refer patient for unresolved bad breath

What happened

Mr J went to his doctor at the beginning of 2013 with bad breath. He said this made him feel anxious and stressed when talking to people.

The doctor examined him and referred him to the dentist. Mr J went to the dentist about five months later saying that he believed the odour in his mouth was caused by an impacted wisdom tooth. The dentist examined the tooth but found no evidence to suggest this was the case, but did find an overhang from a filling (where filling juts out from a tooth) which could have trapped food and harboured bacteria. The dentist treated this, applied sealant, scaled and polished his teeth and gave him advice on oral hygiene.

Mr J returned to the Dental Practice three months later, still complaining of bad breath. A second dentist examined him but also did not find any evidence that the wisdom tooth was the cause of this. The second dentist did not remove the tooth as there was no clinical reason to do so.

Mr J went back to the Practice early the next year to have a fractured tooth repaired, and was still concerned about his bad breath. He went to a private practice shortly afterwards and had his impacted wisdom tooth removed.  He said that the offensive odour disappeared after this.

What we found

We partly upheld this case. The Dental Practice was right not to remove Mr J's wisdom tooth as there was no evidence that it caused the bad breath. This was in line with National Institute for Health and Care Excellence guidelines which state that the evidence for removing a tooth is dental decay where the tooth cannot be restored, tooth fracture or an abscess, and these were not present in this case. However, the Practice should have referred him to an NHS specialist in the light of his continuing problems with bad breath.  Because the Practice did not do this, Mr J had to pay for treatment privately.

Putting it right

The Practice apologised to Mr J, reimbursed him £475 for the cost of his private treatment and paid him £200 for the injustice this caused him. The Practice wrote to us and to Mr J to explain what it had learned from the complaint, and how it now refers patients to a specialist when symptoms continue and no cause can be found.