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Appleby J. BMJ 2016;355: i5986 10.1136/bmj.i5986

During the first 9 months of the NHS since its inception in 1948, a staggering 33 million removable dental prostheses ('artificial teeth') were supplied. There have been fundamental changes in dental care since this early and questionably effete cycle of 'drilling, filling, and extraction'. Now enhanced oral health reflects the 'general improvements in living standards and diet, greater use of fluoride toothpaste, and the efforts of the dental profession.' But despite this there is still a substantial burden of dental disease experienced particularly by those from deprived backgrounds. For example, there is a positive correlation between deprivation and extractions but a negative association between deprivation and the provision of crowns. It is suggested that this is because some treatments are cheaper than others. The thrust of this BRIEFING paper is 'equal access for equal need'; but the commentator also asks 'is a perfect smile a medical necessity worthy of public subsidy?'