Sir, I read with interest Dr M. Storey's letter concerning out-of-hours dental treatment in a recent edition of the BDJ (2005; 199: 695). For the last three years I have run a private practice which focuses on the weekend and bank holiday treatment of acute dental pain so I have some personal experience of this problem. Two points present themselves.

Firstly, all of my patients have a genuine need; my clinical time is never wasted. I note that Dr Storey suggests that patients initially call a helpline where treatment can be 'accessed by telephone and subject to established triage-algorithms'. What are these I wonder and who provides them? Does the receiver of the call have the power to provide or deny treatment? If so then I would hope they are registered dental surgeons with a current practising certificate, for if not then are not the providers sponsoring illegal dentistry? Our medical colleagues always have a doctor available to speak to a worried patient and furthermore I believe that GMC guidelines specifically say not to diagnose down the telephone, as in – 'when in doubt, always SEE the patient'. This then will of course raise another moot point in that if we do attempt this practice aren't we placing too much reliance on the patient's self-diagnostic skills? I will give you one example of many I have seen in the last three years.

A man phoned complaining of an intermittent pain and slight swelling under his right jaw. He believed it was definitely coming from his wisdom tooth. The pain did not keep him awake at night and was controlled by paracetamol.

My triage protocols are simple — if the patient thinks they've got an emergency, then so do I. Nobody sits in my chair and parts company with hard cash if they haven't got a problem. This patient's diagnosis? Nine days after I saw him the local maxillofacial consultant to whom I'd referred him confirmed he had a malignant lymphoma with several metastices around his body and that gives him only a 50% five year survival. An emergency?

The second matter takes Dr Storey's point about the inadequate training of GMPs to deal with a dental emergency. I would like to take it one stage further and include some GDPs also. Fully 40% of my patients are registered with other GDPs, many in the middle of active treatment. They complain that they could get NO help from them or NHS direct to address their acute pain. Isn't this a breach of some kind of NHS contract requirement? Not to mention a breach of trust with their patients.

Three months ago I received a complaint from a supervisor in NHS Direct. Apparently an exempt and registered patient phoned his dentist and got my number on the answering machine and no other; there was indication that mine is a private practice. When my receptionist offered him an immediate appointment and told him the fee, he declined and complained to NHS Direct who in turn complained to me. When after 10 minutes I was able to make the lady understand I didn't have an NHS contract, the NHS Direct supervisor asked me what I intended to do about it? I patiently explained that it was her problem and not mine.

The second point: who are these people who might be putting into practice these locally agreed triage-algorithms? Who agrees with them? I certainly don't and I think if you asked all my patients, you wouldn't get a single taker either. And finally, what are they? I've written to six PCTs asking this question and to date have yet to receive a single reply. Perhaps one of your readers could enlighten me?

I know it's easy to knock the system without offering a constructive suggestion so here's my two-pence-worth. Why don't you base any new dental out-of-hours service on that of the GMPs? They at least have had a few years' practice.