Summary
Mr C complained about orthodontic treatment he received over a number of years to address crowding in both his upper and lower jaws. After he lost one of his upper front teeth due to an injury and infection, the decision was taken to move the remaining upper front tooth across the centre of his mouth to fill the gap, whilst also moving the other teeth to resolve the crowding issues.
Mr C was initially told that the treatment was expected to take between 18 and 24 months. However, after around two and a half years of treatment, his original orthodontist left the practice. The subsequent orthodontist was concerned about the appropriateness of the treatment plan and referred Mr C to an orthodontic consultant after identifying a deterioration of Mr C's bone structure and tooth roots. The decision was taken to cease treatment due to the risk of further damage. Mr C was left with the tooth in the centre of his mouth. A veneer was then required to make the tooth appear more normal.
We took independent advice from an orthodontics adviser on the treatment that Mr C received from the initial orthodontist. The adviser considered the treatment plan was unusual. As such, the adviser would have expected there to be evidence of discussions with restorative dentists, because restorative work would be required after orthodontic treatment was complete in order to make the moved teeth appear normal. However, this did not take place.
The adviser was also critical of the quality of the records, which were unreasonably abbreviated and lacked evidence that alternative treatment options were discussed with Mr C, potentially making the consent he gave for the treatment plan invalid. The notes also failed to confirm whether a previously identified infection had resolved before orthodontic treatment was commenced, meaning this could not be ruled out as a factor in the bone structure and tooth deterioration Mr C experienced.
For these reasons, we considered that the treatment fell below a reasonable standard and we upheld the complaint.
Further to the clinical failures, we also identified concerns with the orthodontist's complaints handling and communication, both with Mr C and the SPSO. Throughout the complaints process, the orthodontist missed 11 deadlines for response, sometimes by a number of weeks or months and often without contact to explain the delay. The orthodontist also failed to provide all of the information requested on a number of occasions.
Redress and Recommendations
The Ombudsman's recommendations are set out below:
What we are asking the Orthodontist to do for Mr C:
|
What we found |
What the organisation should do |
Evidence SPSO needs to check that this has happened and the deadline |
|---|---|---|
|
The orthodontic treatment provided to Mr C fell below a reasonable standard, as did the subsequent complaints handling |
Apologise to Mr C for the failing identified in this report. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance |
A copy or record of the apology
By: 25 July 2018 |
We are asking the Orthodontist to improve the way they do things:
|
What we found |
What should change |
Evidence SPSO needs to check that this has happened and deadline |
|---|---|---|
|
The orthodontic treatment provided to Mr C fell below a reasonable standard, as did the subsequent complaints handling |
All treatment should be provided to a reasonable standard. Records should be detailed, complete, and clear; all treatment options and predicted outcomes should be fully discussed with a patient before commencing a treatment plan and details of this should be documented; valid consent should always be recorded; complaints should be responded to in a reasonable timescale |
To ensure appropriate professional development, details of this complaint and the learning needs identified as a result should be included in the Orthodontist's Personal Development Plan which is submitted to the General Dental Council under their 'Enhanced CPD guidance'. A copy of this should then be submitted to SPSO
By: 27 August 2018 |