Sir, we would like to respond to A. C. L. Holden's critique1 of our recent paper.2 We welcome debate on the issue of regulatory scope but we disagree with the characterisation of our position. We do believe behaviour outside the clinic can have a bearing upon professional practice. Our contention is that judgements should be made on whether patient wellbeing is threatened, not on the reputation of the profession. In the Armstrong case the reprimand was given because her actions, '...placed the profession at real risk of being brought into disrepute.'3 However, she had not treated patients badly and the Committee did not believe she would do so in the future. If the Committee had found that she was likely to treat her patients in a sectarian manner they would have been right to take action. However, they did not. The reprimand was seemingly intended to show the regulator disapproves of such conduct.

We are concerned that too much is expected of dental professionals. The ninth standard of Standards for the dental team is to, 'Make sure your personal behaviour maintains patients' confidence in you and the dental profession'.4 We believe that this standard needs to be questioned. The implication is that the dental professional is judged by how it is thought the public will perceive their personal behaviour.

We do not see professionalism as a 'temporally-based concept'1 but rather as a situationally-based concept. It applies in a professional situation, such as interacting with a patient, but not in others, such as in personal, sexual relationships. Holden agrees with us on this fundamental point when he acknowledges that the nurse having an affair would not be impaired to practice, '...as infidelity in a relationship in itself is very unlikely to affect patient care'.1 Our point is not that an affair is morally equivalent to posting hateful material, but that judgements of personal behaviour should be based on relevance to that professional's practice rather than the reputation of the profession. Akin to Holden, we would greatly welcome further responses to develop this debate.