Sir, there has been much in the literature and indeed national press recently that has raised serious concerns about the overuse and misuse of antibiotics. In fact the BDA has produced a very useful booklet on that subject but may I be bold enough to suggest another area where we might be using them unnecessarily.

A couple of weekends ago I was doing a three-hour, on-call session for my local NHS Trust. I find this interesting as I get to see acute emergencies that I don't see very often which I put down to the fact I have been at the same practice for 35 years and the majority of my patients have very good dental health.

On this occasion I saw a male in his twenties presenting with a fat face with a fluctuant swelling around a grossly carious lower right first molar. The normal treatment would be antibiotics followed by review and extraction at a later date. All my practising life this has not been my view so once again I gave the patient an ID block very slowly followed by an even slower intra-ligamental injection around the swollen tooth. Complete anaesthesia was achieved, the tooth elevated with a Couplands, a large amount of pus was released and aspirated away and the patient left very happy, had no post-operative problems and was given no antibiotics. Though this may go against traditional teaching, it has always worked well throughout the whole of my practising life and I have seen some spectacular fat faces and swellings in that time!

1. Lowestoft