Sir, the new contract in 2006 brought with it the 'UDA' which has been highly criticised and commented on. However, a greater problem was the removal of the guidance on the type of treatment to be offered on the NHS. We moved from one extreme of a very prescribed list with 'items of service' to the other extreme of a completely open-ended contract where it was up to the individual dentist to decide what was 'clinically appropriate' and which treatment modalities would be offered on the NHS.

Dentists have had to act as the 'judges' in what is clinically appropriate and cost effective for the NHS. In medicine these controversial decisions can be left to a third party and then funding allocated appropriately. In dentistry, the lack of a clear boundary or limit to NHS services has left us in a situation in which if we decide a treatment using a certain material or equipment is too costly to offer on the NHS we are advised that it is unethical to then offer that same material or treatment modality privately, take the example of rotary endodontics.

When going through treatment options, the dentist is holding a dentolegal hot potato when they start mentioning technologies that are available privately but not on the NHS. A trend is emerging in NHS practices where the clinician is taking the 'safe option' and only offering the NHS option at their practice. Any items which simply can't be completed with the 1990s tools and materials we still use get referred on to specialists or fully private dentists.

Recently, I went to a CPD session on advancements in endodontics and the use of cone beam CT. The sad fact is that without provisions in the new contract for new (more expensive) technologies to be commissioned and whilst a cheaper option to 'secure oral health' still exists, new technologies will not be adopted as part of the NHS. But without clear guidance on the 'scope' of NHS dentistry it is also preventing a dentist from offering the treatment privately at the same practice and hence limits patient choice.

Current and future versions of the contract still leave it to the dentist to individually make the decisions which commissioners are too afraid to make themselves. It is unfair to put the dentist in that position. This means that difficult decisions are coming directly from the person who both treats you and collects your dental charge, leading to mistrust in the profession which holds us back even further.

In the recent Westminster Health Forum 'Dentistry 2014',1 it was mentioned that dentists with enhanced skills are actually just 'dentists'. I would like to go further and state that dentists with 'enhanced skills' are actually just dentists 'with modern day tools and materials'.