Missed opportunity to identify decay in a child's tooth meant it had to be extracted

What happened

Miss T had an amalgam (silver) filling put into her lower right tooth in late summer 2011. Miss T had further appointments at her dental Practice in spring 2012, winter 2012 and summer 2013.

At the appointment in summer 2013, dental Practice staff diagnosed Miss T with a fractured lower right tooth. It was documented that she had decay in the pulp of the tooth (this is the central part of the tooth where the nerves, blood vessels and connective tissue are) and irreversible pulpitis (a condition in which the pulp of the tooth becomes inflamed, causing pain and pressure in the tooth). Practice staff told her that the tooth needed root canal treatment or extraction under local anaesthetic. Miss T was referred to have the tooth extracted, which happened in early autumn 2013.

Mr and Mrs T complained to the dental Practice about the care and treatment given to their daughter that resulted in the extraction of her tooth. The dental Practice's parent company (the provider) subsequently handled the complaint.

Mr and Mrs T received a response to their complaint in summer 2014. The response concluded that the dentist's examination in November 2012 did not reveal any decay in the lower right tooth and that had the dentist found or suspected any decay or a cavity, they would have investigated the tooth. The conclusion was that the treatment provided to Miss T in winter 2012 was entirely appropriate and with Miss T's best interests at heart following current clinical guidelines.

Mr and Mrs T were dissatisfied with the response and complained to us in summer 2014.

What we found

On the balance of probabilities, given the extent of the decay in Miss T's tooth by the time of the appointment in summer 2013, it is likely that the decay was present at the time of her previous dental appointment in winter 2012. We considered it likely that the decay was not adequately removed from Miss T's tooth before the amalgam filling was put over the top of it in late summer 2011. As a result, the decay was able to progress beneath the filling until summer 2013, when the tooth fractured.

The X–ray examination of Miss T's teeth was not carried out in line with established good practice. If such an X–ray examination had been done, particularly at the appointment in winter 2012, the decay in Miss T's tooth could probably have been identified sooner and the extraction avoided. As a result, there was a missed opportunity to identify the decay in the tooth and avoid extracting it.

Putting it right

The provider wrote to Mr and Mrs T acknowledging the failings we had identified and apologising for the effect this had on Miss T. It also paid Mr and Mrs T £1,500 to recognise the avoidable loss of Miss T's tooth; the significant pain she experienced because of the extensive decay before the tooth was extracted and to contribute towards the cost of dental treatment to address the missing tooth.

The provider agreed to prepare an action plan describing what it had done or planned to do to make sure that lessons were learnt from this matter and to prevent the same thing happening again.