Sir, the current issue of antimicrobial stewardship is an important and necessary aspect of healthcare in which we as dentists have a crucial role to play.

The BDA, FGDP and Public Health England have launched action plans to tackle this issue of antibiotic resistance, and require healthcare professionals to be engaged.1

Without urgent action, there is a real threat of entering a post antibiotic era as antibiotics are becoming less effective.2

As guided by NICE, we must avoid overuse and misuse of antibiotics.3 Ensuring appropriate use of antibiotics is crucial to preventing resistance and protecting patients, as well as cutting down unnecessary costs. We must continue to educate our patients about resistance, and why prescribing may not be the ideal treatment modality compared to local intervention.

Standard 1.4 as outlined by the GDC, advises us to provide patients with treatment that is in their best interests, following clinical guidelines relevant to their situation. We are advised to balance their oral health needs with their desired outcomes.

A recurrent difficulty faced by many practitioners is management of anxious patients. These patients simply cannot tolerate any conventional interventions, such as incision and drainage of a swelling, access through the tooth, or an extraction.

This cohort of patients presents practitioners with what at times appears an insoluble problem - where the patient demands are in conflict with ideal local treatment. This leaves us with an ethical dilemma - although patients have autonomy to deny treatment, to leave a patient in pain or with a swelling is both unethical and unacceptable. This could lead to deterioration in health with potentially serious consequences.

Recent media attention, and campaigns developed by the FGDP have been invaluable in educating patients on how 'antibiotics don't cure toothache'.

However, whilst time invested in education of the patient and advice regarding their role in antibiotic stewardship is important, the present contracting arrangements within primary care make this challenging.

With time limitations, stressful UDA targets and ever-increasing patient demands, dentists may feel backed into a corner. One might question what alternatives exist to manage an anxious patient that presents in a time-limited pain slot.