Sir, as a doubly qualified maxillofacial trainee who qualified as a dentist in 2005, then a doctor in 2011, I have had the misfortune to see contracts imposed on both of my professions by successive governments. The 2006 dental contract came under much criticism due to its rushed implementation, cost cutting measures and little emphasis on prevention, and the new contract due to be implemented in 2018/19 is currently being piloted in practices across the country.1

Having first looked at trends in cervicofacial infections requiring surgical treatment in 2006,2 we completed a prospective survey of all those presenting in Leeds, Mid Yorkshire, York and Hull across a one month period completed in April 2016, ten years following imposition of the new contract.

The number of patients presenting with cervicofacial infections requiring surgical treatment in this 30-day period was 66, over a 4 × increase in the same period ten years ago. Fifty-six percent presented directly to accident and emergency without primary care input compared to 48% previously, and overall, 44% had no registered dentist compared to 56% ten years ago.

These results are alarming, and although the reasons are presumably multifactorial, it does lead to concerns about further pressures on an already troubled system. Death from dental sepsis is rare in the United Kingdom,3 but every dental abscess must be considered potentially life threatening if left untreated. The increased workload on accident and emergency, in addition to the unplanned activity in emergency theatres, can only be assumed to negatively impact care elsewhere. We must ensure as a profession that any new dental contract addresses the issues of access and preventative dental care to hopefully slow this troubling trend, and ease the burden on an already stretched system.