Sir, I avidly read the editorial Defensive dentistry (BDJ 2014; 217: 327) but think that the points you raise are not just a concern of young colleagues.

As quite an experienced GDP I have fully embraced the new concept of minimal intervention dentistry in recent years. In some aspects I have had tremendous results and huge improvements in grass-roots standards of oral hygiene and awareness etc. But within the NHS this has effectively been at my own expense. While prevention is certainly a lauded and admirable approach it can undermine livelihood and be self-sacrificing. As you write, altering this defensive position is very difficult to the point that even when treatment is necessary there is considerable resistance to this and lengthy verbal explanation and coaxing compounds the financial situation. One cannot just 'get on with things' easily anymore.

I have given this much thought and been lobbying here in Northern Ireland for many years. There have been recent threatened cuts imposed and the situation is very tricky indeed within the health service. Whilst one can be defensive one can only be spurred on if one's very livelihood is threatened. One just cannot take that lying down.

I always use the argument that the obvious solution is to be paid for prevention but for some reason they don't trust dentists to do this. Teachers are paid good salaries for doing something that cannot be quantified as such on a daily basis and are trusted to do.

I am getting results with my minimal intervention techniques and should be rewarded for this not getting poorer the more time I spend at work, which is what is happening at the moment. I know I am not alone in this as there was a letter in The Times recently commenting on the very issue of increased demands placed on dentists on reduced resources.