Delay or failure to diagnose and/or treat tooth decay

Dental claims and dental negligence law is a very specialist area. Our experienced dental negligence lawyers understand the anxieties, concerns and frustration that may be caused by negligent dental care and treatment. We are true professionals with both legal and dental knowledge and expertise to help you through this difficult time.

Our specialist dental negligence lawyers have helped many people make successful claims and receive compensation for their injuries as well as for any corrective treatment that may be required.

What happens during a routine check-up?

Dentists are trained to examine not only our teeth and gums, but also the soft tissues in and around our mouth (our lips, tongue, palate, cheeks and the back of our throat – the oropharynx). They also check our jaw joints and examine our face and neck for any irregular changes, swellings or enlarged lymph nodes.

If you have any specific concerns or queries, in particular if you have been having toothache, sensitivity or any other pain or discomfort then your dentist should carry out any necessary investigations (for example, x-rays or special tests such as vitality tests) in order to diagnose the cause of your symptoms and suggest an appropriate treatment plan.

What is tooth decay?

Tooth decay (dentists call it ‘caries’) is a progressive disease where the tooth structure is weakened by bacteria and acids and/or sugars in food and drink. Tooth decay can affect both the outer enamel and the dentine, which makes up the bulk of a tooth structure, including the root.

In order to prevent tooth decay, the balance between good oral hygiene with the use of a strengthening fluoride toothpaste must be greater than the frequency of attack by acids, bacteria and sugar, which all weaken the tooth structure.

It is quite possible that if the balance is towards strengthening the tooth, an area of weakening within the outer enamel can be stopped from developing into an area of tooth decay, which requires treatment.

If an area of tooth weakening grows through the outer enamel covering and reaches the dentine, this is the stage where treatment will be required in order to stop tooth decay spreading and destroying the tooth structure.

Symptoms and diagnosis of early tooth decay

Quite often, there are no warning signs or symptoms for areas of weakening or even for small areas of tooth decay.

However, these can usually be seen on dental x-rays – and if we are told about them, we may have an opportunity to avoid a filling.

In the early stages of tooth decay, there may be very few symptoms of occasional sensitivity to cold or no symptoms at all. Although this may be interpreted as generalised sensitivity, a careful examination of the teeth is likely to be able to identify the exact area of sensitivity and so diagnose whether it is being caused by tooth decay or just simple dentine sensitivity.

An x-ray taken at this stage will most likely show an area of decay that indicates the need and location for a filling. However, if the decay occurs around a pre-existing filling, the filling may mask the area of dental decay and so it may not be visible on an x-ray.

As the decay spreads within the tooth we will experience increased sensitivity to cold and then to hot.

When hot and cold sensitivity occurs, a dentist should be able to diagnose the presence of tooth decay simply by examining the teeth, although an x-ray may be very helpful in confirming the location and also the extent of the decay within the tooth.

At this stage, every dentist should diagnose and arrange to treat the tooth decay. If the decay is not removed and a filling placed at this stage, the tooth will almost certainly go on to need root canal treatment.

Symptoms and diagnosis of advanced tooth decay

If we do not go to a dentist when we are experiencing hot and cold sensitivity symptoms, the decay will spread and we will begin to have sensitivity and toothache even if we are not eating or drinking (for example, when just sitting and reading or watching TV).

If we continue to ignore these symptoms, the decay will continue to spread towards the nerve in the tooth and the severity of the toothache will worsen and when it does start, it will last for much longer – it may even prevent or disturb your sleep.

At this stage, even if the tooth decay is diagnosed and treated, the nerve in the tooth may be too badly affected and unable to recover and repair itself. The dentist should not only diagnose and treat the tooth decay but also consider whether or not the tooth requires root canal treatment.


Sometimes areas of tooth decay are clearly visible in the mouth, either as shaded areas in the outer enamel coating or as obvious holes (cavities) where the tooth structure has completely broken down. However, in order to check every tooth surface, and most particularly the areas between the teeth, a dentist needs to take x-rays.

Although x-rays are an invaluable tool in the diagnosis of tooth decay, they must always provide a clinical benefit – in other words, an x-ray should always clearly show whatever it was taken to show.

Even more importantly, a dentist should always carefully check an x-ray in order to diagnose any areas of weakness or tooth decay that need monitoring or treatment and where necessary, to form a comprehensive treatment plan that includes any relevant preventive care and/or advice.

Treatment of tooth decay

The only treatment for tooth decay is to remove and place a filling to replace the lost tooth tissue. A filling should restore the normal shape and contours of the tooth as well as the strength of the tooth so that it can continue to function in the mouth.

There are two main types of filling material – the silver coloured amalgam and the white or tooth coloured materials. All of these have different pros and cons and so are generally used in different situations, depending on the need for appearance and strength.

Further information about filings and filling materials can be found on the page about unacceptable or inappropriate fillings.

Dental negligence claims arising from the delay or failure to diagnose and/or treat tooth decay

The most common claims involving the delay or failure to diagnose and/or treat tooth decay include the following:

  • Delay or failure to take note of or ignoring reported symptoms/toothache
  • Failure to investigate and confirm the cause of any reported symptoms/toothache
  • Unnecessary and over-reliance on antibiotics
  • Failure to take any x-rays
  • Failure to take clear or clinically beneficial x-rays
  • Failure to adequately review any x-rays taken
  • Delay or failure to remove decay and place a filling
  • Unacceptable or inappropriate fillings
  • Delay or failure to monitor areas of weakening
  • Delay or failure to give preventive care and advice in order to avoid further tooth decay

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