Poor record keeping made it difficult to investigate dentist's care and treatment

What happened

Mrs A's young son attended dental appointments once a year at the dental practice. He was unco-operative at times.

Mrs A said that during an appointment in early 2012 the dentist did not raise any concerns about her son's teeth and gums. However, when they returned for a further appointment in the summer, Mrs A's son had severe tooth decay and needed a number of extractions.

The practice referred Mrs A's son to the community dental services, where he was put on the waiting list for treatment. He developed an infection late in 2012 and was referred to the children's hospital.

At an appointment with the community dental services in early 2013, he needed ten extractions under general anaesthetic.

Mrs A complained to the practice. She raised another concern, that her son's teeth had not been fluoride coated and that the dentist had been abrupt. In reply, the dentist said that he reviewed her son's teeth and had concerns about decay developing, so he gave advice on brushing to prevent this. The dentist apologised that Mrs A felt he was abrupt and said he would reflect on this in the future. Overall the dentist said that because of Mrs A's son's difficulty in coping with dental treatment and the rapid progression of his decay, the loss of his teeth was unavoidable.

What we found

We asked one of our clinical advisers whether we could say with any certainty that the dentist's examination in early 2012 failed to identify decay, or the extent of it. She said we could not, and it was possible that the decay significantly worsened after the examination. However, the dentist's record keeping fell well below the expected standard so, while we could not say with certainty that he failed to spot the decay, we could not reach any firm conclusions about the standard of his examination in spring 2012.

The dentist had apologised if he seemed abrupt and in our view this was a reasonable response to this issue.

The relevant guidance on fluoride coating is that dentists should apply fluoride varnish to the teeth of child patients between three and six years old twice yearly. This can be increased to three or four times a year for children whose teeth are giving concern. The dentist had not done this, which was a failing. However, we could not specifically link this to the decay in Mrs A's son's teeth.

Putting it right

The Practice apologised that the dentist's record keeping was insufficient to properly address Mrs A's concerns. It paid Mrs A £250 to recognise this, and also apologised that her son's teeth were not fluoride varnished, or if this was not appropriate, that she was not told why.

The Practice also took action to improve its record keeping and complaint handling and worked to make sure that all dentists at the Practice were aware of the guidance on fluoride varnishing.