Dental practice failed to give patient opportunity to make informed choice about treatment

What happened

In early 2013 the practice filled one of Mrs J's teeth as an NHS procedure. The next month, she had root canal treatment to an upper left tooth. She says that the filling material was not discussed until the procedure was underway, at which point she was offered a choice of an NHS amalgam filling or a private white composite filling. Mrs J says that she was only able to signify her choice by hand signals. She chose the privately‑provided white filling at a cost of £90. Follow-up NHS treatment to this tooth  cost another £57.

Mrs J complained to the practice that she should have been offered NHS white fillings for both teeth. She also said that she should not have been charged for more treatment to her upper left tooth because problems with the tooth arose from the failure of NHS root canal treatment earlier in the year. She suggested that if the practice had applied the charges properly, the unsuccessful root canal treatment to her upper left tooth, and all the necessary follow-up treatment for this tooth, would have been covered by the NHS dental treatment band 2 charge she had paid earlier in 2013.

The practice did not accept any failings and explained that white fillings were not the expected NHS option for the large multi‑surfaced fillings required for these two teeth.

Mrs J then complained to us about the practice's decision to charge for the white fillings, its failure to discuss treatment options before the start of the upper left tooth treatment, and that she had not been offered either an NHS-funded bridge or an implant to replace her upper left tooth. She explained that, had she been aware of the probability that the tooth would eventually need to be extracted, she would not have chosen to have a private white filling for this tooth.

What we found

There were no failings on the part of the practice when it decided not to offer Mrs J NHS white composite fillings for her teeth; when it decided to charge for additional work to the upper left tooth, or when it did not offer an NHS bridge or an implant to replace the upper left tooth.

However, in the case of the upper left tooth root canal treatment, the practice failed to discuss treatment options or get Mrs J's consent to private treatment in advance. In fact, according to Mrs J, the only discussion was when the treatment was underway and she was unable to speak. This denied her an opportunity to make a properly informed decision that included the possibility that the tooth might eventually need to be removed.

Putting it right

The practice wrote to Mrs J to apologise for the failings we found. It explained what it had done to make sure that these failings did not happen again.

It paid Mrs J £90 in recognition of the fact that she did not give informed consent to the private root canal treatment to her upper left tooth, and to recognise the inconvenience of bringing her complaint to us.