In an open letter to Wes Streeting, dentists have warned that a failure to fully meet demand for urgent dental care will only increase the pressures on our health service, as antibiotics become a substitute for treatment. [1]
The chances of a dental appointment resulting in an antibiotic prescription increased tenfold during the pandemic, and new research from the University of Manchester shows even now prescribing levels have not returned to where they would have been if the pandemic hadn’t happened. [2]
Labour pledged and has begun commissioning of 700,000 urgent appointments. However, the BDA has published NHS England messages shared with local health bosses indicating officials discovered total unmet need was actually 2.2 million. The professional body stress any chance of consigning ‘DIY’ dentistry back to the Victorian era requires a solution for all these patients.
The BDA stresses the best way to protect the health service from the existential threat of antibiotic resistance is to ensure patients have timely access to urgent care.
Study author Dr Wendy Thompson, a member of the British Dental Association’s Health and Science Committee added:
“Even before the COVID-19 pandemic, we know that dentistry was responsible for around 10% of antibiotic prescriptions and that rates of unnecessary use were high. During the early part of the COVID-19 pandemic, the amount of antibiotic prescribing by NHS dentists increased dramatically.
“Our research has shown how frustrated dentists were at this situation which UK Health Security Agency researchers have linked to the use of teledentistry. Our latest research shows just how slowly antibiotic prescribing in NHS dentistry is returning to its pre-pandemic pattern.
“Antibiotics don't cure toothache and their unnecessary use puts patients and the public at risk from the spread of infections which don't respond to antibiotics. The quickest fix for toothache and dental infections is generally a procedure rather than a prescription, although sometimes antibiotics are vital. Access to the right dental care at the right time to prevent and treat toothache and dental infection should be an essential part of national efforts to tackle antimicrobial resistance by reducing the unnecessary use of antibiotics.
“Until prescribing for dentists is digitised, for example via electronic prescribing, routine monitoring of antibiotic prescribing by dentists providing care to NHS patients will be impossible. Integrating high-street dentistry into NHS digital systems will be an important part of national efforts to help keep patients safe by ensuring antibiotics are only prescribed when strictly necessary.”
Dr Thompson is also a Clinical Senior Lecturer at the University of Manchester, leads on Antimicrobial Stewardship for the College of General Dentistry, and is chair of Preventing AMR and Infections for FDI World Dental Federation.
[1] Rt Hon Wes Streeting MP
Secretary of State for Health and Social Care
Department for Health and Social Care
Sent by email
9 March 2025
Dear Wes,
In October 2023 the Labour Party first promised to deliver 700,000 urgent NHS dental appointments. We welcome the fact that commissioning has begun, but we note your officials have discovered unmet need for urgent dentistry of as many as 2.2 million patients, and have not set out any plans for the ongoing care for the 700,000 they do aim to deliver urgent appointments for.
Ministers have rightly labelled the state of dentistry in this country as ‘Dickensian’. If we stand any chance of consigning ‘DIY’ dentistry back to the Victorian era we need a solution for all of these patients.
During COVID, the approach taken by the last Government restricted access to face-to-face dentistry. Antibiotics became a cure-all to desperate patients with toothache. People with toothache require an operative intervention, but they got prescriptions instead. But these policies exposed patients to unacceptable and preventable risks of dangerous complications such as anaphylaxis and C diff, and the development of antibiotic-resistant infections which can be life-threatening due to sepsis.
Figures show that not only was dentistry the only NHS setting to increase antibiotic prescribing, but the chances of people ending up with antibiotics from a dentist increased almost ten-fold during lockdown. And the latest research from the University of Manchester shows that we are yet to return to the downward trend in antibiotic use seen in dentistry pre-COVID.
Even before COVID, ‘normal’ was excessive, because under the UDA system dentists simply are not given the time to care for patients requiring urgent treatment.
Research also shows that there has been widespread frustration among dentists who know that procedures rather than prescriptions are generally the safest and quickest fix for toothache. Careful diagnosis is required to be able to tell what's causing an urgent dental problem and whether antibiotics are necessary for treatment. Specialist skills and equipment are needed for this, and it is why GPs and pharmacists are advised not to treat dental problems. Antibiotic only treatment plans are rarely appropriate.
Clearly antibiotics do not cure toothache, but they do fuel antibiotic resistance. Ensuring meaningful access for all to face-to-face urgent dental appointments gives people with toothache the dignity they deserve to alleviate their pain while keeping them safe from this existential threat to human health.
Last month’s announcement must be the beginning, not the end of this Government’s interest in urgent care. We hope you do not lose sight of the fact that the huge unmet need that we see for urgent dental care is indicative of the failure of the system we work under, and measures you just announced only temporarily address the problems created by our flawed contract. The only way to reduce this need – and avoidable antibiotic prescribing in dentistry – is to move at pace to reform the failed contract fuelling the crisis in this service.
Yours sincerely,
Eddie Crouch
Chair
British Dental Association
Shiv Pabary
Chair
General Dental Practice Committee
[2] Impact of the COVID-19 pandemic on antibiotic prescribing by dental practitioners across the United Kingdom’s four countries: a pharmacoepidemiological study of population-level dispensing data, 2016–2023 DOI: 10.1111/cdoe.13037