Sir, we read with great interest the recent article by Jevon and Shamsi regarding the use of National Early Warning Score (NEWS) 2 in the dental practice.1 From our combined experiences of working within hospital medicine and general dentistry we write with great perturbance that NEWS2 might open a Pandora's box of cognitive shortcuts, confusion and increasing medico-legal claims against dentists.

Whilst we recognise and agree with the article that the use of NEWS2 in the community can be a useful tool in communicating with emergency services and potentially help to improve triage, the potential problems and risks associated with this are paramount and should not be ignored. The authors highlight that the NEWS2 can improve the objective assessment of patients with suspected sepsis, asthma attack and anaphylaxis. However, it does not consider how commonly these issues are encountered in a primary dental care setting. A general dental practitioner will on average experience a medical emergency at least once every two years, the most common medical emergency being vasovagal syncope.1,2,3 There is no mention of how the NEWS2 score may be applied in such a scenario. Rather, in such a scenario and for more fatal emergencies such as a cardiac arrest, it is imperative that practitioners apply the Resus Council Life support algorithm.4 In contrast, implementation of a NEWS2 score may confuse practitioners about whether they should calculate a NEWS2 score or start resuscitation, with the latter being critical.

The authors comment that a completed NEWS2 observation form is an excellent documentation record, providing the dental team with justification for their actions. However, it may also create a culture of fear of 'failure to act'. In a hospital setting NEWS2 has a pre-specified response, however, this may be difficult to replicate in a primary dental care setting. Therefore, failure to take appropriate action may be grounds for a negligence claim. Furthermore, the evidence provided regarding benefits of NEWS2 is limited to GP practices where medically-trained professionals are available to interpret this score alongside clinical experience and judgement. This is most certainly absent within a dental practice.

The issue of NEWS2 scores in primary care is complex and ongoing, and it is likely to continue throughout our medical and dental careers. Whilst we acknowledge the benefit in communication and urgency of transfer, NEWS2 is best used as an adjunct to clinical judgement with its sole use being limited by the posed associated risks.