Sir, the paper An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance (BDJ 2005; 198: 759–763) is timely because of the increasing worldwide problems of antimicrobial resistance and the evidence of inappropriate and overuse of antibiotics in dental practice.1,2,3 What I found interesting was that only 112 patients were included in the audit period from January 1999 to January 2003. Is this an indication that there are very few incidences of acute dentoalveolar spreading infections in patients attending emergency clinics? I was also interested to see that only soft tissue incision and opening root canals were used and that no teeth were extracted to establish drainage in this group of patients.

The indications for prescribing antibiotics, with drainage, in the treatment of dentoalveolar infections are well defined in the literature, namely, raised body temperature, signs of spreading infection and local lymphadenopathy. In this audit a note of the presence of extraoral or intraoral swelling was recorded, but there was no measure of whether there were signs of a spreading infection and of the 112 cases only 17 had a raised temperature. I was also surprised that in a University Dental Hospital six different antibiotic regimens were used, some of which were outside the recommendations of the Dental Practitioners' Formulary. Is this further evidence of inappropriate antibiotic prescribing in dentistry?

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