Sir, we would like to support our hospital colleagues, Messrs Carter and Starr, in their letter Alarming increase in dental sepsis (BDJ 2006; 200: 243). As members of the salaried dental services in Hull and East Riding, the level of dental disease in our area has increasingly shocked us over recent years. It is comparable to levels in East London in the early 1980s, when facial swellings were admitted to hospital, at least weekly, for intervention under general anaesthesia. We are at present developing an audit and protocol for facial swelling and are liaising with the maxillofacial team at Hull Royal Infirmary for verification and guidance.

From our experience, although many patients who present at our dental access centres rarely visit a dentist, a significant number of patients that present with facial swelling have lost their GDP through retirement or to the private sector.

On a general note, the level of caries in the population that attends our centres is staggering, often with 10 or more carious teeth, frequently with significant medical histories. It is not unusual to meet children who have never been able to access dental care, despite trying to. Our perception is that we tend to see acute necrotic ulcerating gingivitis on a weekly basis in our clinics.

As stated by Messrs Carter and Starr, this part of England has an unfavourable dentist:population ratio – a situation which has endured for many years. To alleviate this problem, a network of dental access centres was built in Hull and the East Riding of Yorkshire over the last five years. From the start, it was evident that there was a huge demand for this service from patients seeking emergency and routine dental care.

Although we prioritise patients with urgent dental needs, we are not per se an emergency dental service. The access dental service has increased patient contacts in the area by upwards of 40,000. This service is complemented by an out of hours emergency dental service with centres in Hull, Bridlington and Goole, which deals with about 14,000 patients per year. Even with these services, we are 'fire-fighting' with no apparent bottom to this well of dental disease. So why have we not solved the problem of access for our local population and why are more and more patients presenting themselves at the local A&E department with acute dental problems?

Firstly, we still have too few NHS dentists to provide treatment for the population, with many dentists closing their NHS lists and some shifting to the private sector. This has been balanced, only slightly, by the opening of a number of dental practices, mainly by dentists already working in the area.

Secondly, there is a large section of the population who only seek dental treatment when needing pain relief. To a certain extent up until 2001 in the Hull area, their needs were catered for by easy admittance to dental treatment under general anaesthesia. These patients will invariably leave their acute situation until a very late stage of deterioration or morbidity and will perceive that their dental needs are best suited at a hospital. While we applaud the reduction of general anaesthetics in Hull, little by way of an alternative has been provided locally, possibly due to lack of specific funding.

We cannot see any immediate solution to the shortage of NHS dentists and are fearful that, as Lester Ellman predicts, the new contract will not improve access for patients.

Are we a predictor of the future of NHS dental care in England?