Sir, I was interested in the observations by Shelley et al. (BDJ 2009; 206: 449) on the management of potential airway obstruction in the dental surgery.

The authors are right to raise concerns, but not about the ability to treat emergencies such as the sublingual haematoma. Their concerns should be directed at the inability to recognise and arrange appropriate management of such patients. This includes diagnosing the problem and seeking help from the most appropriate source in a timely manner.

Intubation in the conscious patient requires the use of muscle relaxants and, in the event of developing obstruction, can be challenging even for anaesthetists with extensive experience. It would be inappropriate for a practitioner to attempt to intubate in the circumstances described. What will the practitioner do with a paralysed patient after a failed intubation? Perhaps ring his or her defence organisation.

In the example of a developing sublingual haematoma an urgent phone call to the local Maxillofacial or ENT Unit is probably the best way to get the patient seen and treated quickly. Attempts to treat the condition in the surgery will delay definitive treatment and may result in a sub-optimal outcome.

The authors state that the training to manage these emergencies does not seem to exist. This is not true. SHO posts in maxillofacial units do exactly this, they expose the practitioners to patients with compromised health and developing emergencies, the sublingual haematoma being just one of these. In a structured clinical environment they learn how to manage these emergencies and if they encounter such problems in practice later in their careers they are able to put this training to use.

It is therefore unfortunate that some postgraduate dental deans do not seem to understand how useful the experience gained as an SHO in a hospital post can be, especially as much of this experience is gained when 'on-call'. Some of these deans have publicly stated that they do not want 'dental' SHOs to be on call as it has no relevance to general dental practice. I beg to differ. Perhaps a period of time spent in an on-call post should be a compulsory part of the proposed 'F2' year in order to ensure all graduates have exposure to the management of patients with potentially life threatening emergencies.