2. Allergy, interactions, delayed plans

Allergy is not a vague rash in 1994

Ask what happened, how soon, and whether they have had the same class since. Many “penicillin allergies” are side effects. Do not challenge allergy in the dental chair. Do use the allergy-alternative in current dental tables, and record the history you took. Never use an agent from a class they describe as anaphylaxis.

Interactions

Warfarin, methotrexate, and other interacting medicines are why you read the BNF. “They said they don’t take anything” still needs a prompt for over-the-counter and herbal products.

Delayed prescribing

A delayed prescription can be reasonable when you have examined, started local treatment, and want a safety valve if spreading signs appear before review. It is not a way to end a difficult conversation. Give written advice: when to start, when to seek urgent help, and that many people will not need to start at all.

Patient pressure

Acknowledge pain. Explain that the evidence for antibiotics in localised pulpitis is poor and the harms are real. Offer what does work. If they decline local treatment, document that, the risks, and the safety-net — do not trade a clinically useless script for a five-star review.