Sir, I read with great interest the short communication by Pankhurst et al.1 regarding the role of consultants in oral microbiology (COMs) and the adverse issues faced by the dental profession in light of their dwindling numbers, particularly in relation to inappropriate prescription of antimicrobial agents.

Having worked in oral and maxillofacial surgery (OMFS) units for several years in an on-call capacity, managing patients with acute odontogenic cervicofacial infections is a clinical scenario frequently encountered – no doubt my colleagues in similar settings will corroborate this anecdotally. The incidence of deep neck space infections from dental causes which require admission to hospital appears to be rising.2 While the central tenet of 'incision and drainage' firmly holds true, patients with odontogenic infections are invariably prescribed antimicrobials as an adjunct to surgical management. These tend to be of the broad spectrum ilk, prescribed with the arguably misguided intention of 'covering all bases'.3

As the mainstay of OMFS is in secondary care, there is access to hospital-based medical microbiology teams but I would welcome a greater degree of interprofessional working with OMFS teams and COMs, to update on emerging trends in the microbiology of odontogenic abscesses and on the most suitable empirical antimicrobials. There appears to be a lack of awareness of oral microbiology as a specialty,4 and this raises some questions regarding the practicalities of working with OMFS units. With most COMs situated in dental schools how would we ensure that COM advice is available to OMFS units based in district general hospitals, particularly in an out-of-hours situation? This perhaps necessitates development of a network by formally linking with a named COM in a dental school in the first instance.

At a dental undergraduate level and beyond there needs to be greater awareness of the clinical training and scope of practice for COMs. For example, in an established odontogenic infection where a patient subsequently becomes septic would it be appropriate to consult an oral microbiologist for antimicrobial advice, or would we then revert to contacting the hospital's medical microbiologist? Or indeed is there benefit to be derived from involving all above parties to achieve a favourable outcome for the patient? I would be most interested to hear thoughts from any colleagues.