Decision Report 202303944

Summary

C complained about the care and treatment that their child (A) received from a dentist. A injured their front tooth and attended their dental practice for an emergency appointment. The dentist noted there was a 1mm extrusion (tooth displacement) but decided that no treatment was needed. C complained that the tooth wasn’t treated with a splint.

The dentist said that dentists are able to use their own clinical judgement to decide whether or not to follow the guidelines in each case. In this case, the dentist decided that the tooth would recover on its own and made the decision not to splint the tooth.

We took independent advice from a dentist. We noted that there are standards a dentist should follow. This includes providing patients with treatment that is in their best interests and keeping up-to-date with current evidence and best practices. If a dentist chooses to deviate from established practice and guidance, the reason why should be recorded. We found that the dentist did not record the reasons why they decided not to follow the guidelines and they did not inform C that there were guidelines that applied in this case. We also considered that the decision not to follow the guidelines in this case was unreasonable. Therefore, we upheld C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to inform them that the treatment recommended was not in line with the trauma guidelines, failing to inform them of the reasons why the guidelines were not followed, including the decision not to splint the tooth, and failing to appropriately record the reasons why in the clinical records. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The dentist should be aware of and familiar with the guidelines on how to manage traumatic dental injuries (https://iadt-dentaltrauma.org/guidelines-and-resources/guidelines). Dentists should follow the guidelines when managing traumatic dental injuries unless there is a specific reason to take a different approach. Dentists should be aware of how and when to record their reasoning should treatment offered deviate from the approach recommended in the guidelines.
• The dentist should be familiar, and act in line with the Standards for Dental Team (particularly standards 1.4.2, 7.1.1, and 7.1.2) as well as, the Professional Duty of Candour.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.