Sir, your timely editorial in the BDJ on 18 November1 highlights a clinical management process that was always thus. More than 20 years ago, after a very busy day supervising students in the Primary Care Unit (Dental Casualty Department) at Guy's Hospital, I asked what was the most commonly prescribed analgesic given for toothache in the patients who had already seen a GMP or GDP. It was quite clear to everyone that the answer was 250 mg of amoxicillin tds for five days.

Toothache can be a pervading and very dominating pain, and the demands by patients who say they have already used OTC analgesics and have 'still been up all night' puts huge pressure on the practitioner to move the problem on from a busy schedule. Even in the correct climate of a teaching department, it was often not possible to offer these patients exodontia in less than several days, and much longer for endodontic treatment. Because many patients report that they feel more comfortable after a course of antibiotics given for toothache, there has developed an understandable association which fosters the antibiotic cure-all myth. While the understandable should not substitute for professional judgement, a clinician short of time and an agitated patient distracted by pain do not make for a very easy solution.