Sir, like Dr Burton in his letter Diagnosis tosh (BDJ 2010; 209: 106), I too am appalled by the incorrect treatment and diagnosis provided by the two practitioners as well as the level of care in so much as allowing the patients to wait weeks before definitive pain relieving treatment could be provided.

However, I do hold a certain sympathy for the NHS practitioners concerned as they would expect a fee of say around £75 (three UDAs) for the molar endodontics which would of course include diagnosis, X-rays as well as a completed restoration, thorough examination and charting and possibly other treatment as well if it were needed.

I suspect the fee of £75 would certainly cover Dr Burton's expertise in diagnosis and X-rays and might even cover the final restoration if it were a smallish one, but it would nowhere near cover the fee for the endodontic treatment.

I have been running a predominantly NHS practice for over 33 years and certainly do molar endodontics, and see my patients within 24 hours if they are in acute pain, but I am more in fear of litigation nowadays if the finished result is less than perfect. Recently a patient was making a claim through a solicitor for an ongoing periodontal condition and a report came back from her expert practitioner that a root filling was inadequate on an upper third molar because it was slightly short of the apex and would have to be redone, despite me getting the patient immediately out of pain some ten years previously and the tooth having remained symptom free ever since, and showing no signs of periapical pathology.

Congratulations to Dr Burton for providing excellent care, but what would he have done if those young ladies had turned up claiming benefit and not being able to afford his treatment costs – might he too have been tempted to employ also a degree of 'diagnosis tosh'?