Sir, we read with great interest the recent article regarding repeat patient attendance for urgent dental care.1 It is reasonable to postulate that the COVID-19 pandemic will have long-lasting effects in fortifying such findings.

The reduction and subsequent cessation of elective dental appointments in March 2020 resulted in the transformation of our paediatric dentistry urgent walk-in service based at St Thomas' Hospital, London to an urgent dental care centre accepting referrals via the NHS 111 pathway. Our service evaluation included 125 paediatric dental patients seen between September and October 2021 at St Thomas' Hospital. Nearly 50% of patients were under five years old, 38% of patients were 6-10 years old and 13% of patients were 11-16 years old. A quarter of patients had a significant medical condition including autism, behavioural disorders, co-morbidities such as asthma and three patients had a medical syndrome. Only 46 patients were registered with a general dental practitioner and many parents reported struggling to register their child with an NHS dental practice. Of primary diagnoses made, 13% were for dental trauma, 66% for caries and 11% presented with facial swelling. One patient required urgent admission for intravenous antibiotics. While 24% of patients required true urgent dental care, ie management of facial swellings and dental trauma, 74% of referrals were accepted. These findings allude both to the lower threshold of accepting patients due to the impact of the COVID-19 pandemic on patient access, as well as to the increased pressures faced by dental practices in managing the burden of disease that has amassed during the pandemic.

Twenty-four percent of parents reported their child was already on a dental referral pathway, which is likely to have been underreported. Many families were travelling outside their local boroughs to attend the appointment. These findings demonstrate the knock-on effect of limited patient access on tertiary dental services and the ethical dilemma surrounding the acceptance of patients directly while existing patient waiting lists continue to grow. While reassuring that extra funding has been allocated to dentistry, there is valid concern that this will remain underutilised as dental practices struggle to cope with existing targets of activity.2 It is hoped that the COVID-19 pandemic results in the actualisation of extensively debated NHS contract reform. This may prove to be the much-needed solution to dwindling patient access and reduce the need for urgent dental care in some of the most vulnerable members of society.