Sir, working within oral and maxillofacial surgery (OMFS), we frequently manage severe acute dental infections which present through A&E. These can be a life-threatening condition and require urgent hospital admission and surgical intervention. But what about the less severe cervicofacial infections?

We recently completed two local audits on the presentation of these patients to OMFS units in Leeds and Liverpool. Around 50–60% of patients who attended A&E required hospital admission, however, half did not and had arrived as a first port of call for emergency dental treatment. This has the potential to pressurise an already hugely burdened health service when acute dental treatment could be provided in a primary care setting.

Of the patients who did access primary care dental services with odontogenic infections, the mainstay of treatment provided was oral antibiotics alone. This treatment contradicts guidance produced by the Faculty of General Dental Practitioners UK and the Scottish Clinical Effectiveness Programme who recommend that antimicrobials should only be used as an adjunct to operative treatment, be it incision and drainage, extraction, or opening of the pulp chamber.1 In addition, excessive use of antimicrobials is contributing to an ever growing concern regarding antibiotic resistance and it is estimated that 25,000 people die annually in the EU as a result of this.

There are significant financial implications with regard to inpatient treatment of odontogenic infection. Hospital episode statistics show that over the past five years there has been an increase in the incidence of admissions for drainage of dental abscesses: 2,281 admissions during 2014–2015 in England alone.2 Reasons which may prevent treatment in primary care may include limited access to NHS dentists, reluctance of patients to visit a dentist, the cost of treatment or dental phobia. We found that a proportion of patients also favoured initial presentation to their general practitioner rather than their dentist.

As threats to divert and close A&E services loom, we have to be realistic about the impact that these admissions are having on the NHS. The reality is that many dental infections seen are entirely preventable and can be effectively managed in the community. We propose that there should be enhanced education for patients, dentists and medical practitioners, alongside financial incentives and targeted treatment goals which may be a means to encourage appropriate first line treatment in primary care.