Sir, each year there are approximately 12,200 new cases of head and neck cancer diagnosed in the UK.1 For patients undergoing radiotherapy (either alone or in conjunction with resective surgery), the detrimental effects on oral health are well established, including the risk of developing osteoradionecrosis (ORN) of the jaws.

Preventative advice is paramount to reduce the need for future 'high risk' procedures including exodontia, which could initiate ORN. Clinical guidelines on the oral management of oncology patients recommend that adults are prescribed 5,000 ppm fluoride toothpaste and to rinse at least once daily with an alcohol free fluoride mouthrinse (0.05%).However in reality, this is not always the case. For oncology patients without a regular GDP, or those who may have intermittent treatment in a tertiary dental centre, accessing prescriptions for high fluoride products may be particularly challenging during COVID-19. Although fluoridated products could be prescribed by patients' general medical practitioners (GMPs), funding restraints have resulted in NHS Clinical Commissioners advising against the routine prescription of high fluoride toothpaste in primary medical settings.2

We conducted a pilot survey investigating the awareness of ORN amongst GMPs and GMP trainees in the Midlands in 2019, the results demonstrating that this was very limited, but that there was a willingness to engage in teaching and education. The potential role for GMPs to support with preventative measures and vulnerable patients struggling to access routine dental care was identified. While dentists can continue support for these patients, future education and collaboration with our medical colleagues in primary care must also be considered in order to improve patient access, and ensure holistic patient care is being provided across all clinical settings.