Sir, we read with great interest the letter by Dadnam et al. presenting the case of a Romanian patient and we felt it might be helpful to provide some additional insight as dentists who trained and/or are practising dentistry in Romania.1

We agree with the authors that most dental care in Romania is delivered privately and as evidence suggests, treatment costs can present a significant barrier for accessing care for certain members of the community. However, it is important to point out that socio-economic inequalities regarding access to oral healthcare are not a problem unique to Romania but are prevalent worldwide.2 Furthermore, it is important to consider the significant limitations of interpreting health insurance data for international comparisons and the need for additional research in this area.3

Evidence suggests that privately delivered dental care is being consistently underreported in various Eastern European countries as a way of avoiding fiscal duties.3 For context, the tariff paid through the limited national health insurance system for a non-surgical extraction is around £12 (free for low income patients) meanwhile the same treatment delivered privately could cost starting from £10 or more depending on the location of the practice (urban/rural) and other factors such as being delivered by a GDP or specialist. It is worth noting that the national minimum wage is around £400/month.4

Considering the limitations of the available data, our direct clinical experience of working both in the private and public healthcare systems suggests that the case presented in the letter might be an exception rather than a representative example for the entire population. These are uncertain times for ethnic minorities, and it is important to remember the risk of stereotyping which might lead to some unintended consequences through unconscious bias and may inadvertently increase the levels of inequalities experienced by vulnerable populations.