Sir, the last four months of my dental core training post at Guy's Hospital in emergency dentistry, restorative dentistry and oral surgery have highlighted challenges and complications presented by the COVID-19 pandemic.

A large proportion of patients attending our unit have been diagnosed with irreversible pulpitis and acute periapical periodontitis. Root canal treatment, if possible, would be ideal but due to the restrictions of PPE and limitations of aerosol generating procedures, many of these teeth were extracted. Other teeth which were successfully extirpated at the start of the pandemic have subsequently not been root filled due to the length of time that dental practices have been closed.

Consequently, patients have sadly returned to us due to reinfection of the root canal system. In most cases, these patients declined re-extirpation in fear that the tooth will continue to cause pain and infection prior to them being able to see their regular dentist, with extraction being the only alternative option.

Firstly, this raises the question as to whether extirpation was the best option to begin with or whether the time and resources spent on them would have been better served elsewhere.

Secondly, we must also consider the future implications of the increased number of dental extractions. For example, there will be restorative considerations which will need addressing for these patients in the future, with strategic teeth such as last standing molars being lost. This will present dentists in practice with challenging cases and confound the overall impact on oral health presented by COVID-19, such as caries going undiagnosed for long periods of time and relapse of patients' periodontal condition.