Sir, I refer to the editorial The whole population approach to caries prevention in general dental practice (BDJ 2008; 205: 521).

NICE clinical guideline 19, issue date 2004 on Dental Recall Interval is an excellent memorandum accepted by both the BDA and DoH. Their checklist of stated modifying factors is certainly an accurate and reliable tool to predict who is high risk and who is low risk. To doubt that a dentist were to get a decision wrong with consequences for a child who converted from caries free to caries active would be to assume that the checklist was not realised and followed.

Delivering better oral health: an evidence based toolkit advocates professional intervention with fluoride varnish containing 2.2% sodium fluoride twice yearly for children aged 3 to 6 years and 3-4 times yearly for children giving concern. This applies also to children aged 7 to young adults. Presently general dental practices are being targeted by PCTs with prompting from the DoH to comply with NICE guidance on recall. There have been public accusations of dentists gaming on the system. To comply with Delivering better oral health would be to have much shorter recall intervals, unless of course there were to be a separate attendance for caries prevention in addition to a recall attendance. Apart from the costs of the fluoride, the additional costs in involving valuable surgery time would be pretty expensive. Also more importantly, compliance from patients for an extra attendance for caries prevention would be poor.

There would be implications in making dental nurses apply fluoride varnish. The GDC would only permit dentists, therapists and hygienists to do clinical procedures. If the application of fluoride is permitted for dental nurses, there would be a need for a proper training programme which would require validation. Their contracts of employment would have to be redrawn to include this added duty. There would have to be a mandatory indemnity insurance for them.

I am pleased with the toolkit Delivering better oral health and can state that I have gained benefits in oral health education and techniques from it. I would find such a whole population approach difficult to accept in general dental practice. I am in complete agreement to apply fluoride varnish to high risk groups be they a child or an adult of any age.