The demand for, and provision of, primary dental care was investigated in a teaching hospital setting in 1989 and 1993 - a period which saw the introduction of the new dental contract and the publication of the Poswillo report on general anaesthesia and sedation. Five hundred patients who attended the primary care department for the first time at the University of Wales Dental Hospital were interviewed in May/June 1989, and a further 520 patients were interviewed in May/June 1993. Self-referrals increased from 260 patients (52%) in 1989 to 352 patients (68%) in 1993. The proportion of patients who did not have a general dental practitioner (GDP) increased from 32% (160) in 1989 to 39% (202) in 1993. More patients registered with a dentist self-referred in 1993 compared to those in 1989, reportedly because of inability to obtain an appointment with their own GDP (88), rather than because of cost (17). Over the four-year period there was an increase in demand for treatment of early stage (pulpitic) dental infection from 32% to 40%, and a decrease in relation to end-stage infection (dentoalveolar abscess) from 11% to 6%. This 'safety net' role of dental hospitals needs to be taken into account when contracting for services.