Sir, I am writing to convey concern over the latest campaign being run jointly by the British Society of Periodontology and Public Health England that purports to be raising awareness of periodontal disease: How's Your Smile? The campaign centres on members of the public and dental professionals wearing 'selfie mouth-cards.' These cards depict the mouths of patients who have lost teeth, presumably through periodontal disease. The campaign video shows members of the public with the cards, the cards being a source of amusement and fun. The message from this seems to showcase how ugly and distasteful those with periodontal disease appear. The people in the video are laughing and enjoying the experience, much in the same manner that they might wear Halloween masks. Peripheral to the campaign, posted upon the Facebook page of the BSP, are dental professionals in dental surgeries wearing the cards, pulling faces and grimacing. The campaign is reliant upon the assumption that the effects of tooth loss due to periodontal diseases are somehow shameful. Whether or not these cards are supported by information on periodontal diseases is irrelevant; this campaign is based upon shaming the victims of periodontal disease. There is little acknowledgement in the video or the primary front of the campaign that periodontal diseases are chronic, related closely to the social determinants of health. This campaign may have the best of intentions, but instead stigmatises those suffering with periodontitis. The shaming of the victims of disease is never ethical. Did anyone from the parent organisations of the campaign consider what a patient with periodontal disease might think of this campaign and how their disease is portrayed? I am disappointed that as a dental professional, if any of my patients were to see this campaign, they might think that I believe that their disease is something to the ashamed of.

Phil Ower, President, British Society of Periodontology, and Ian Needleman, President-elect, British Society of Periodontology, respond: The BSP is delighted with the response to our campaign #howsyoursmile. In terms of the level of engagement by the public and dental sector, we know we have reached millions of people through social media alone.

We have chosen this route to raise awareness in the UK as it is a powerful way to make people stop and really think about the effects of gum disease and importance of gum health. There is no intent to stigmatise those with gum disease but to focus people's attention on the reality of the effects of periodontitis. Gum disease exists and it can cause shame – we know that from our patient interviews – however, categorically, the campaign is not intended to cause any offence. We haven't exaggerated the issue – the perio cases depicted are real and, sadly, not unusual.

We have consulted with patients and it is clear that they feel more should be done to raise awareness of a condition that affects over half the UK's adult population, especially as gum disease is often 'silent' but highly treatable.

As the BSP is a charity we could not afford the luxury of using TV or an extensive print media campaign to spread our awareness message. In addition, we know that grabbing the public's attention around this issue, one of thousands that are demanding their attention every day, is not easy. Therefore, we needed an approach that clearly depicted the reality of gum disease whilst also targeting the public in a way that was engaging enough for them to want to interact with us to help spread our message far and wide. It is testament to this approach that Mr Holden has written to the BDJ from Sydney.

Whilst our campaign may appear on the surface to be 'a source of amusement and fun' we are in fact spreading a serious message and have placed education at the core. We have a serious and professional tone to our messaging and clearly direct people at every opportunity to an educational website where we explain more about the symptoms, treatment and importance of gum health. To date, we have had nearly 5,000 unique page views on www.howsyoursmile.co.uk and a Twitter/Facebook reach of nearly 4 million, which is a good barometer of how successfully we are spreading the word.

Shock tactics are nothing new and they will always attract controversy. So this is our stark message: if you don't look after your gums, you risk losing your teeth. We think a hard hitting approach showing the reality of serious gum disease is vital – it's much more effective than an educational leaflet for example. If our approach achieves our aims and helps people understand more about their own oral health, we are satisfied that we have made a good start on improving the state of the nation's gums.

1. Sydney