Sir, the increase in accidental analgesic overdoses (AAOD) during the pandemic at Queen Elizabeth Hospital in King's Lynn (QEHKL) has indirectly highlighted the shortage of primary care dental services in the East of England. Patients with dental pain were at an increased risk of AAOD when attempting to self-manage due to difficulties accessing dental services during lockdowns.1 Our retrospective audit from QEHKL and Norfolk and Norwich University Hospital (NNUH) showed an increase in AAOD compared to pre-COVID levels.

At the QEHKL we observed a remarkable 50% increase in the number of emergency department admissions with paracetamol overdose caused by dental pain during 2020 vs pre-COVID levels in 2019. The majority of patients were unregistered with a dentist. It appears that this region has been disproportionately affected from longstanding shortages of dental services, which have been historically poor. The 2019 data show there were 37 dentists per 100,000 population in West Norfolk including King's Lynn, compared to 76 in Norwich.2 Although over 50% fewer dentists, our data show only a 22% reduction in number of overdoses in King's Lynn compared to a large city like Norwich. Since NNUH covers a larger demographic area, one would expect a greater difference in the number of overdoses between this large hospital vs a small district hospital such as QEHKL; however, that is simply not the case. The QEHKL only saw two fewer cases of overdoses than Norwich. The number of dentists in West Norfolk in 2019 also falls below the average for England, which is 44 dentists per 100,000 population.

King's Lynn and West Norfolk as a region had the highest percentage of patients unable to obtain an NHS dental appointment in England in the preceding two years.3 Furthermore, a report by NHS England for General Dental Services (Norfolk) in 2019 recognised that King's Lynn was amongst the areas in England with the lowest percentage of child and adult population visiting an NHS dentist with less than 60% of children and less than 50% of adults visiting a dentist.

Closure of routine NHS primary dental services during the pandemic has placed a significant burden on hospital OMFS units due to increased AAOD from an entirely preventable cause. We urge dental commissioners to re-evaluate the provision of dental services within the East of England to prevent further unnecessary harm to patients and learn from this pandemic.