Sir, I read with considerable interest the comments of Professor Kidd1 and Mr Richards2 concerning the new Quintessence publication Ozone: the revolution in dentistry.3 I agree with Professor Kidd that it is unfortunate that the reviewer did not comment on the Cochrane review4 or the appraisal by NICE5 which both concluded that evidence of efficacy was lacking at the time they did their assessment. For example I believe the Cochrane review stopped sometime in 2003 and therefore did not consider excellent peer reviewed papers published after that date which have since proved the efficacy of the HealOzone to treat caries. This is a fertile area for discussion as not only does it refer to the specific subject of ozone, the principles behind it refer to how as a profession we view the importance of evidence-based research.

I would contend that the majority of current clinical practice is based on no real evidence base. As clinicians we are left to apply our own critical faculties as to which techniques to adopt based on traditional teaching, personal clinical experience, pragmatism and a good dose of common sense. In addition there is a professional requirement to be involved in CPD and clinical audit as part and parcel of the concept of clinical governance.

The importance of an adequate evidence base is indisputable, however, at the current stage of knowledge it is a poor cousin to the hard earned clinical experience of individual practitioners. Clinical outcome research is the ultimate measure of the validity or otherwise of clinical methods and as individual clinicians our reputations with our patients stand or fall according to how well we do by them. Whether or not our work is audited our patients vote with their feet and their chequebooks and we are rewarded or penalised accordingly.

The question I would pose is one of should we as clinicians not adopt novel treatment modalities in the absence of a concrete evidence base? I think that if this were to be the case it would act as a major brake to the development and introduction to practice of new ideas, equipment and techniques. Modern dentistry is a highly competitive business driven by consumer demand for new and better methods. In my view the fiscal incentive for clinical excellence in the rapidly expanding market of private practice is to be whole heartedly welcomed as it is a profound catalyst for change. Patients as consumers choose caring practitioners who offer the most up to date methods. The clinical outcome has to match the patient's expectations as failure to deliver the goods is severely frowned on by today's discerning consumer.

In the specific case of ozone I am now in my fourth year of use and both I and my patients are more than merely happy. From my hard earned clinical experience I know that ozone works. I use it as a sterilising agent as an additional step to my more conventional repairs. There is no evidence of any harm arising in consequence to applying ozone with the HealOzone and I am confident that in time the next Cochrane and NICE reports will demonstrate a marked clinical advantage for the use of ozone. The routine sterilisation of cavities prior to restoration makes obvious sense. To suggest I shouldn't do it in the absence of a large evidence base is nonsense as if I only did clinically what I can support with a large evidence base I know I would be doing very little clinical dentistry. The Cochrane review and NICE have effectively thrown the baby out with the bath water. Without doubt in time Cochrane and NICE will catch up with the experience of the now thousands of practitioners like me who have found ozone an invaluable adjunct to modern restorative practice which has helped our patients enormously.

As for the book I have read it and liked it. The first third consists of a description of the research supporting ozone as a therapeutic treatment. The rest of the book is a beautifully illustrated manual showing the many and versatile ways ozone can be used in dentistry. The restorative methods described are state of the art and the accompanying articles by amongst others Carsten Stockleben, George Freedman and Liviu Steier deserve to be read by any forward thinking practitioner regardless of their liking or not of ozone in dentistry.