Sir, as a co-author in the paper, Macluskey, Slevin, Curran and Nesbitt (BDJ 2005, 199: 671–675) I was disappointed to see that your journal had published a letter by Ali et al. (BDJ 2006; 200: 359) without affording us an opportunity to reply in the same issue.

There are certain issues raised by Ali et al. (BDJ 2006; 200: 359) that merit further clarification. Firstly, no assumption of similarities in referral patterns was made between these two disparate sites. In fact, as clearly stated in the beginning of the paper, our aim was to investigate differences in the referral pattern between the two sites. However, our results suggest that very similar referral patterns do exist.

One difference in referrals noted was that the well established specialist practice received the majority of referrals from dental colleagues who would all be familiar with guidelines for the referral of third molars. This may not be the case with the general medical practitioners referring to the dental school. This was one explanation given for the fact that all patients referral to the specialist practice were treated. The inference that patients received intravenous sedation for financial gain, rather than patient benefit or preference, is objectionable.

The teaching of the fundamental principles of oral surgery is the primary responsibility of academic oral surgeons within the environment of an academic institution. We strongly advocate that this essential component of the undergraduate curriculum should not be delegated to individuals out with such a protected teaching environment. However, outreach is a reality with the majority of UK undergraduate institutions exposing their senior students to outreach in its various guises. Many of these programmes are supervised by non-academic staff. Students are afforded an opportunity to undertake treatment in outreach that may include surgical procedures, thus enhancing their experience. Observation of an appropriately qualified, experienced professional, whether it be a surgical dentistry, endodontic or orthodontic specialist practice, would show students the possibilities feasible in practice, inform referral patterns, as well as inspire future generations of specialists. At no point in our manuscript do we suggest that teaching be delegated to a specialist practitioner, but that does not mean that an enthusiastic practitioner with special interests does not have something to contribute to the undergraduate experience.