Sir, as a Past President of the BDA I am dismayed and bemused to read frequent reports in national newspapers decrying the number of children awaiting many months for tooth extractions in hospitals. Indeed, the Daily Telegraph claims that this is the most frequent referral cause for children to hospital, numbering equating to 177 cases per day nationally at an estimated cost of £41 million. A further report of this problem appears in the recent BDJ (Potential surge in post-COVID child tooth extractions; BDJ 2020; 229: 278).

Is this because dentists, both in practices and community dental services, are either unwilling or unable to perform this treatment? Furthermore, it seems that frequent courses of antibiotics are prescribed to keep infection from carious teeth at bay pending hospital extraction. As we are all too aware, this repeat prescribing is undesirable, building up unnecessary resistances. I presume dental schools still educate undergraduates in the expert technique of extractions, therefore one must conclude that the problem is due to an unwillingness of clinicians in primary care to undertake these treatments. We must remember that for every child suffering from painful teeth, there are parents having to cope with stressful situations.

Many years ago, I was a member of the then termed 'Poswillo' working party, reporting to the Department of Health on the safety of administering general anaesthetics (GA) in practices, but additionally our role included reviewing other means of anaesthesia. Whilst not advocating a return to providing GAs in outpatient clinics, in a primary care setting it is perfectly possible and permissible to extract offending teeth using either sedation or local anaesthesia or a combination of both.

As healthcare professionals, dentists have a duty to relieve pain and to prevent the risk of complications arising from long-term infections rather than referring patients to a seemingly endless waiting list, especially during these difficult COVID-19 times, which is exacerbating this dire state of affairs.