Sir, I would like to thank R. Moore (Hypocritical tosh; BDJ 2010; 209: 265) and R. Elvin (Check the facts; BDJ 2010; 209: 367) for responding to something I feel passionately should be aired.

I humbly take on the chin the accusation of listening to patients, except that I know one of them personally. I'm not sure how I would apply my molar rcf skills for the NHS fee, so I want to highlight the problem rather than point fingers (casting first stones and referring to black kettles comes to mind). However, whether you think a £500-£600 fee for a 2+ hour molar root treatment is outrageously expensive, or that patients have the right to expect a proper professional root filling, following 'best practice' for the NHS fee, the nub of my concern is that I feel it may be dentists who make that decision.

Can it really be right to tell someone their tooth can't be saved, when it can? If I went to the doctor with an in-growing toenail I'd be a bit miffed if all I was offered was amputation.

As I understand the meaning of 'professional', it is someone who does their very best for the patient, without concern for self interest or the interests of staff and colleagues, financial or otherwise, even when they don't feel like it.

I have the greatest respect for colleagues who can cover expenses for this fee, and take the time and care necessary to perform molar root treatments, or who couldn't opt out of a system which forced this on them. I'm sure one can justify telling a patient their tooth can't be saved, and that extraction is the only choice, but I can't be part of that system (my expenses exceed this figure!).

A quick price check for three k-flex, an endosonic, five NiTi rotary files and three thermafils, exceeds £45.60 and that's not including rubber dam, EDTA, sealant, X-ray films/processing, final filling, DSA and receptionist time, etc (perhaps colleagues can correct me on the figures). If one used just files and lateral condensation surely it would take longer. The ESE quality guidelines stipulate rubber dam, pre and post-op radiographs etc, and the general consensus is that however quick the mechanical preparation, the biological preparation should be a minimum of 30 minutes' disinfection, usually by sodium hypochlorite, this is after preparation and before filling, so even a speedy prep, say ten minutes (including LA) and a five minute filling gives a minimum of 45 minutes. So the NHS must be assuming that dentists are happy to make a loss on this (I will apply this technique to my plumber's estimate...)

Bottom line, it is reprehensible that highly trained professionals, as we all are, who undertake complex, intricate, delicate, often inverted work, using sophisticated techniques, should be held to ransom by a system which simply dictates a fee. Was it a bit like the Al Capone method? '..your signature or your brains on the contract..' (For brains read livelihood of course.)

Very proud to be hypochloritical.