Sir, positive engagement of patients with their dental care is frequently vital for long-term positive clinical outcomes. In the chat thread of a recent poll on a website for dentists, attention was drawn to the importance of securing patient engagement as an element of valid consent to treatment: 'there are often different treatment options that should be considered and it is difficult to ensure valid consent if the patient abdicates responsibility and does not engage'. A risk management strategy using a phased approach to care was also advocated: 'At the initial consultation split the treatment plan into phases and describe each phase to the patient as such'. Interestingly, the recent contract reform pilots and the prototype models currently in progress use a care pathway approach which echoes the former suggestion. More specifically, NHS England is developing new Patient Reported Outcome Measures and Patient Reported Experience Measures with a view to incorporating them into the Dental and Quality Outcomes Framework.1

A brief literature search failed to identify any articles which reported on the prevalence of patient under-engagement in dentistry and/or its effects on clinicians. However, patient under-engagement seems likely to result in a poorer patient experience and research suggests that the latter is positively associated with both clinical effectiveness and safety (these being the two of the three pillars of care quality).2 Therefore, the development of more successful patient engagement strategies may not only improve patient care but also reduce stress levels experienced by dentists. Furthermore, the development of a simple assessment tool for the level of patient engagement could assist in tailoring care to individual patient needs, provide a metric value which could be recorded in clinical notes and assist clinicians when responding to complaints.