Self-help guide
Making a complaint
Regardless of whether your dental treatment was provided privately or under the NHS, we advise you start by using the complaints procedure. This gives you the opportunity to set out the cause of your grievance and your dentist the chance to respond and try to settle the complaint without need for litigation. For information relating to the complaints process in private healthcare, we recommend reading our guide on private healthcare complaints.
Complaints should usually be raised with the dentist within six months of the date of the incident giving rise to the complaint (or the date you became there was cause to complain). The dentist may consider a complaint after this, but this is only usually if there is a good reason (such as ill health). Most reputable private healthcare providers have copies of their complaints procedures online and must make a copy of this available to you if you ask for this.
The Dental Complaints Service (DCS)
You may be able to get your concerns resolved by contacting the Dental Complaints Service (DCS). Complaints to them have be made within 12 months of the date of the treatment (or the date you became aware of the fact you had cause to complaint). They can help you to try and obtain:
- an explanation and/or apology for what happened,
- a full or partial refund of fees in relation to the failed treatment,
- remedial treatment from your dental professional, if you are both in agreement,
- a contribution towards remedial treatment so that the work can be completed by another professional at the same or another practice.
The DCS can recommend reimbursement of some or all the treatment costs and a contribution to future remedial treatment up to the costs of the original treatment. However, it cannot recommend compensation for pain and suffering, loss of earnings, or other financial losses. For these elements, you would need to pursue a dental/clinical negligence claim.
NHS funded dental care
If the dental treatment was provided under the NHS, you would have to use the NHS complaints procedure. For information regarding the NHS complaints procedure, please read our guide on making an NHS complaint.
With a dental complaint, you have the option of asking the dental practice or the commissioner of the service to deal with your complaint. Complaining to the commissioner may be right if you are uncomfortable complaining directly to your dentist, or do not think this is appropriate (such as if there has been a breakdown of the relationship). If you’ve already complained to your dentist, the commissioner will not be able to re-investigate the same concerns.
The commissioner for NHS dental services is your local Integrated Care Board (ICB). Find your local ICB on the NHS website.
Will I be reimbursed for my treatment costs?
Under the General Dental Council’s standards for the dental team, dentists are advised: “If a complaint is justified, you should offer a fair solution. This may include offering to put things right at your own expense if you have made a mistake.” We recommend that when you write your letter of complaint, you to outline the dental treatment costs you have incurred; and if you have any estimate of future costs, to submit these as well. Avma’s template letter may assist you with formulating your complaint.
Making a claim for compensation for dental negligence
The legal test for dental negligence is the same as for other types of medical negligence claims. For further information, please see the guide to legal action in England, Scotland, Wales or Northern Ireland.
Negligence
Just because a dentist makes a mistake, this does not necessarily mean that they are negligent. The courts have decided that a dentist is only negligent if they do something which no reasonably competent dentist would have done — something that is often extremely difficult to prove.
Negligence is not established by showing that different treatment could have been given, or even by proving management should have been better. A dentist is only negligent if their care, management, or treatment of a patient fell below an acceptable level such that no responsible body of dentists would consider it acceptable. However, if there is a responsible body of professional opinion that would support the conduct of the treating dentist, it is unlikely you will be able to prove negligence. This is sometimes called the Bolam test.
The expression a “responsible body” is a difficult one for most members of the general public to understand. A responsible body might be only a small group of dental professionals. Even if you can show that the majority of dentists faced with the same patient and dental presentation would have acted differently, that on its own will not guarantee a finding of negligence.
The following are some examples of potential dental negligence:
Wisdom tooth extraction
Nerve damage, particularly of the lingual nerve, is a known risk of wisdom tooth removal. You cannot claim compensation simply on the basis that a complication has occurred — there has to be fault.
A dentist will only usually be negligent if, for example:
- they removed a wisdom tooth where this was unnecessary (e.g. it was not painful or impacted causing infection or decay,
- they did not warn you of the risk of such nerve damage and that it can be permanent, which if you had known would have led you to decline the removal (whether the court would accept this depends on how serious the reason for removal was, e.g. if the tooth was badly impacted and led to abscess formation, which can only be managed by extraction),
- they did not inform you of the reasonable alternatives to extraction, such as removal of the crown of the tooth alone,
- they were inexperienced in the removal technique, which made it more likely that damage occurred,
- they did not take steps to assess the position of the nerves, e.g. via X-ray, which would have indicated a likelihood of nerve damage,
- they used a dental bur and cut across the lingual aspect of the tooth without identifying the position of the nerve, or
- they failed to refer a patient who complains of pain or changes in sensation for surgical repair.
Periodontal (gum) disease
This is an area where sizeable claims may be possible if there is extensive bone/tooth loss. Examples of negligence could include:
- a patient regularly attends their dentist and there is a failure to recognise deteriorating gums,
- the dentist fails to take a full history to check for risks of gum disease, such as smoking or drinking, or medical risks such as diabetes,
- there is failure to carry out a basic periodontal examination to assess gum pocketing,
- there is a failure to carry out X-rays to monitor bone levels,
- where gum disease is found, there is a failure to carry out a more detailed examination to identify any tooth loosening,
- there is a failure to provide proper advice to the patient on cessation of smoking and oral hygiene,
- there is a failure to provide appropriate treatment such as scaling, root planning, and medication, or
- there is a failure to provide a referral to a periodontal specialist if the gum disease does not improve.
The legal test may vary if you are bringing an action against your dentist based on matters to do with how they interpreted your dental X-rays, for example. The courts tend to take a more pragmatic view on these sorts of issues, focusing more on whether the treating dentist’s diagnostic decision was right or wrong or reasonable. The court will still need to hear independent expert evidence to help them decide.
Essentially, these issues are about whether the dentist exercised reasonable skill and care when interpreting your dental X-rays, samples, or similar diagnostic test. These sorts of issues are sometimes referred to as “pure diagnosis” cases, but you do not need to worry about whether this is called — your solicitor will help you with this if it is appropriate to your case.
Consent cases
The court will expect dentists to give their clients sufficient information to make an informed decision. This area of law was developed in 2015 when the Supreme Court decided in favour of the claimant (patient) in a landmark case known as Montgomery v Lanarkshire Health Board.
In practice, the law around consent means that an adult person of sound mind is entitled to decide which of the available forms of treatment they wish to follow. It is important to remember that not undergoing any treatment is also an option. However, where there is more than one option, these must be explained, including any potential risks, prior to any treatment commencing.
The dentist has a duty to take reasonable care to ensure the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. If you bring a claim on the basis that your dentist failed to give you sufficient information for you to properly give your consent, a key question for the court will be whether a reasonable person in your position would most likely have attached significance to the risk.
Consent may be an issue in dental claims when it comes to tooth extractions. In this sort of case, common considerations are likely to be whether it was reasonable to extract the tooth at all, if there were alternatives to extraction, and if the patient was aware of those alternatives. Consent may also be an issue in orthodontic cases or dental treatments provided for cosmetic reasons.
Causation
This is discussed in more detail in the guides on legal action referred to above. Essentially, it means you have to show that any negligent treatment provided by your dentist caused you injury and/or loss that you would not otherwise have experienced. This can also be difficult to prove. You will normally need to obtain another report from an independent medical specialist to prove it.
If the patient would have suffered the same outcome from their treatment, even without the negligence, then there is no “causation” and the claim will fail. Causation is difficult to prove in dental negligence cases when the negligent treatment is for a patient who is, in most cases, already having some problems with their teeth.
9. Time limits for making a claim
As with any other claim for clinical negligence, there is a strict time limit of three years from the date the incident occurred (or when you had knowledge that something had gone wrong). For comprehensive guidance related to the statutory time limits, please read our guide on time limits.
What compensation can I claim?
You will only be entitled to compensation if you can show that the care provided by the dentist fell below an acceptable standard, was negligent, and this negligence caused you harm and loss. For more information on the principles around what compensation you can claim, please see our guide on what compensation you can claim for clinical negligence.
General damages for pain and suffering
The figures set out below are taken from the 15th edition of the Judicial College Guidelines for the Assessment of General Damages in Personal Injury Cases (2019). These are a good indicator of what a claim may be worth, but you should seek independent specialist legal advice from a solicitor experienced in this work for a more accurate value of your claim.
In considering the amount of compensation to be awarded, relevant factors will include the extent and/or the degree of discomfort endured. Cases which involve any degree of difficulty with eating, long- term pain (e.g. where the patient has suffered pain from an untreated abscess) may attract a higher award. The guidelines indicate that typically awards may be made as follows:
- Loss of or serious damage to several front teeth: £7,460 to £10,710
- Loss of or serious damage to two front teeth: £3,710 to £7,160
- Loss of or serious damage to one front tooth: £1,880 to £3,710
- Loss of or damage to back teeth: £930 to £1,020 per tooth
Disciplinary action — Complaining to a dentist’s regulatory body
If you consider that your dentist’s conduct has been called into question or you have concerns over their fitness to practice, you may wish to complain to the General Dental Council (GDC), the body that regulates dentists.
The issues that may be investigated include serious professional misconduct, criminal offences, repeated poor performance/issues over competency, and health problems such as addiction or mental illness. The GDC also regulates other dental professionals, including dental nurses and dental hygienists.
In response to a complaint from a patient, the GDC can:
- give the dental professional a warning (private or published),
- restrict the types of work or how the dental professional works for a period of time up to a maximum of three years,
- stop the professional from doing any dental work for a fixed period of time (up to 12 months) by suspending them from the register, or
- take the dental professional off the register (known as erasure), which means they can no longer work in dentistry in the UK.
The GDC cannot:
- help you with a claim for a refund or compensation,
- give you a detailed explanation of what happened to you — this can only come from the professional or organisation concerned,
- fine a dental professional,
- make a dental professional give you access to your dental records,
- make a dental professional apologise to you,
- make a dental professional reinstate or add you to their practice’s list of patients,
- make a dental professional change their fees for private treatment,
- make changes to your dental records,
- investigate general concerns about how a dental practice is run,
- change the outcome of a local investigation into your complaint,
- look into complaints about healthcare professionals who are not dentists or dental care professionals, or
- take action against a dental professional if there is no risk to patient safety, or to public confidence in the dental profession.
In order to report a dentist to the GDC, you can use their online form.
You may also want to read our guide on raising concerns about dentists.