Sir, it was with great interest that I read the article State-sponsored dental terrorism?1

As a dentist who has worked in an NHS practice I can identify with Mr Kelleher's words and I too have experienced the fear of complaints constantly hanging over my head. I witnessed colleagues who suffered with complaints and subsequently had their names exposed on the GDC website as though they were criminals, even before any investigation had taken place. This action is extremely derogatory and can ruin dentists' reputations.

I believe the current state of affairs has led to many dentists now practising 'defensive dentistry'. It is easier to refer the problem on than to deal with it and risk incurring a complaint.

I am currently working in an oral and maxillofacial unit and I see several referrals for dental extractions every day. The unit implemented a new system for triaging referrals in late 2014, with the purpose of ensuring that only appropriate referrals would be accepted. Despite this, the number of referrals has been increasing every year and we see a large number of inappropriate referrals. There are several cases of moderately difficult or sometimes even simple extractions that are referred to our unit, under the claim that the patients are 'nervous'. Most of the time we will find that this is a false pretense and that patients are indeed able to cope well with dental treatment; however, dentists will make that claim to avoid rejection of the referral.

It is very worrying to see that so many dentists nowadays feel so afraid that 'something might go wrong'1 and that patients might complain that they will resort to lying just so they don't have to deal with the problem. Of course, another issue is the fact that multiple extractions under the NHS are worth nothing more than three UDAs (the same as a single extraction). Who can blame dentists for not wanting to do their work for free?

As Mr Kelleher pointed out, it is not only the dentists who are affected by this flawed system, but also (and more importantly) the patients. Patients who are referred to hospitals wait longer to receive treatment and on multiple occasions are left in pain whilst waiting for an appointment.

If the GDC's premise is 'protecting patients', then they are not doing a very good job at it.

The GDC has created a culture of fear amongst dentists which has impacted on how dentistry is practised and delivered. This together with an extremely flawed and unfair UDA system has led to many patients not receiving the standard of care they need.

I believe these times call for a change of culture in the GDC and an urgent revision of the NHS UDA system imposed by the Government.