Sir, we have read the recent article on guidelines relevant to paediatric dentistry1 with interest. Many issues raised by the authors were identified in a small qualitative study we completed at a district general hospital.

We completed clinician-led questionnaires with 110 children and their parents attending for the removal of carious teeth under general anaesthesia. The questionnaires were used to gather information on the percentage of children who were prescribed antibiotics in primary care prior to referral. We also explored the effect dental caries had on the quality of life of the children.

Worryingly, 24.5% of the children had missed school for dental-related issues prior to attending their hospital appointment, while 39% of parents felt they were not given advice on the causes or how to prevent dental caries. The absence of adequate preventative regimes at primary care level means that the oral health of children is unlikely to improve.2

In addition to the guidelines discussed in the article,1 we feel it is important to recognise the guidance available for antibiotic prescribing.3 Forty-one percent of children included in this study were prescribed one or more courses of antibiotics prior to attending their hospital appointment. Of the total number of children prescribed antibiotics, 82% of parents reported that their child's primary complaint had been of pain when seeking emergency dental treatment and that no facial swelling or increased temperature were noted.

Guidelines for antibiotic prescribing emphasise that antibiotics should be prescribed in the presence of systemic factors or in addition to local measures and not as an alternative treatment option.3 Needless to say, cooperation plays a vital role in providing emergency dental treatment with local anaesthesia to children.

In this sample, only 20% of children were offered alternative treatment options to antibiotic prescription whereas 42% of parents felt their child could cooperate for simple treatment with local anaesthesia. This suggests there is room for improvement in the provision of emergency treatment for children presenting with dental pain. Further audits could help to reveal which areas require change.

As healthcare professionals, we have the responsibility to monitor our prescribing practices. The number of antibiotic prescriptions by general dental practitioners count as almost 10% of all NHS prescriptions in primary care.4 Further research is needed to assess how systems within primary care can be improved to facilitate better emergency care provision whether it's through re-education or reallocation of resources.