Sir, most readers of this journal appreciate the continuum from dental abscess to cervicofacial infection. In my OMFS DCT post, however, I have observed that some non-dental colleagues appear more concerned with the aetiology rather than the potential severity of the sequelae. Surprisingly, dismissive attitudes from some hospital staff have been noted when something is of odontogenic origin, resulting in a drop of their guard, lack of urgency and delays to theatre. Consequently, our department is frequently bleeped several hours post-presentation of the patient to A&E. Considering the time-sensitive nature of some cervicofacial infections, I believe this not to be best practice. In September 2021, across all emergency departments in England, only 64% of patient attendances were managed within four hours.1 These delays can be significant for those with airway compromising swellings. We therefore must rely on our A&E colleagues to appropriately triage and involve us in cases that require surgical intervention.

Conversely, some small, isolated dental abscesses that present to A&E are being referred to us with buzzwords such as 'Ludwig's' to encourage a swifter maxillofacial input. This can create frustration amongst juniors and ultimately has the potential to harm those with actual Ludwig's angina since it is impossible to attend every referral with the same required resources.

In response, our hospital is working with ED staff to ensure suitable and timely maxillofacial triaging is carried out. There is a lot of room for improvement, but one suggestion could be a situation in which local practices, with contracted emergency dental services, have a closer working relationship with secondary care. This would facilitate efficient referrals to dental settings for cases that can be appropriately managed there. This can ease the pressure off an already stretched A&E system and allow prioritisation of urgent cases.

With the total number of dental abscess-related admissions increasing more than 3.5-fold in the last 20 years,2 I feel strongly that our community should highlight this continuum to prevent patients with a deteriorating airway from sitting unattended in the corner of an ED waiting room. A dental abscess is best managed by a dentist. A cervicofacial abscess, even of odontogenic origin, is best managed in hospital.