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Introduction The paediatric dentistry department at St Thomas’ Hospital transformed its walk-in emergency service to an urgent dental centre during the COVID-19 pandemic, accepting referrals via the NHS 111 service. There are conflicting ethical duties for tertiary care clinicians managing paediatric dental patients. This study measured the current activity levels of the dental emergency service at St Thomas’ Hospital, the appropriateness of NHS 111 referrals, the proportion of referrals accepted for care and the outcomes of those accepted referrals. Methods A retrospective service evaluation was undertaken including 125 patients referred by the NHS 111 service to the dental emergency clinic at St Thomas’ Hospital between 1 September and 29 October 2021. Results Half (50%) of the patients seen were aged between 0 and 5 years. A quarter (24%) of referrals were true dental emergencies. Patients were referred for isolated dental pain (58%), facial swelling (25%), trauma (13%), broken fillings (3%) and other conditions (2%). Three-quarters (74%) were accepted for treatment. Most accepted patients were added to waiting lists for treatment under general anaesthesia (66%), local anaesthesia (5%) or inhalation sedation (4%). Two-thirds of accepted patients (67%) were not registered with a dentist while over three-quarters of rejected patients (79%) had their own dentist in primary care. Conclusions Following the pandemic, paediatric dental emergency services continue to be overwhelmed by children requiring non-urgent dental care. Solutions to deteriorating patient access are crucial, ensuring that provision of care remains ethical and that those who require urgent dental care are prioritised.