I was asked by the professional magazine medical Pulse to discuss the question of whether GPs can refuse to treat dental abscesses.
A study published in 2016 reported that around 600,000 consultations annually with GPs are for dental problems. Reasons why people present to GPs with dental problems include the poor provision of NHS dental services in many parts of England and the £19.70 charge that some patients must pay for a dental consultation.
If you decide that your patient may have a dental abscess, assuming there are no red flags (such as signs of spreading infection or sepsis) that would warrant an urgent referral for emergency hospital assessment, then the patient should be informed that they need to see a dentist. You should explain to the patient that a dentist is trained to treat dental abscesses but you are not. The dentist has the expertise and equipment needed to assess the patient, carry out suitable investigations (such as dental radiographs), and drain the abscess if this is required.
The dentist can also treat any underlying problems, through procedures such as root canal treatment or a tooth extraction, to minimise the risk of recurrence of the abscess. You should also explain to the patient that issuing an antibiotic is an inadvisable course of action for GPs for someone with a suspected dental abscess as this won’t address the underlying problem; may mask symptoms and result in a worse long-term outcome for the patient; and will encourage the development of antimicrobial resistance. If the patient does not have a regular dentist, inform them they can call NHS 111 or use the NHS Choices website to find the location of local services for emergency dental treatment.
It is NHS England and NHS commissioners, and not GPs, who are responsible for ensuring the population has access to adequate NHS dental services. This includes access to services for emergency dental treatment.
The published article can be read in Pulse, along with the views of two other doctors.