Sir, with reference to the letter from P. Williams on fat faces and swellings (BDJ 2013; 214: 48), I am pleased to learn that early interventional treatment for dental abscesses is being employed in emergency dental services. The so-called 'traditional teaching' of routinely prescribing antibiotics for dental abscesses and arranging extractions at a subsequent visit is certainly not contemporary teaching in our oral surgery department. Early reduction of bacterial load in dental abscess by removing the cause of infection and draining pus is essential in preventing further spread of infection. Cases of failure of local anaesthesia for extraction are extremely rare in our unit, even with severe dental abscesses, as careful consideration is given to appropriate type and volume of anaesthetic agent and the importance of local anatomy. Although emergency dental clinics can be busy and dentists are often under time pressure, and I write from personal experience in these services, one would hope the basic principles of decreasing the bacterial load early through drainage or extraction for dental abscesses, rather than relying on antibiotics alone, is one that is firmly fixed in clinicians' minds.

1. Bristol