One of the tragedies I experienced when I was in general practice was the unexpected death of one of the young dental nurses working for another dentist in the practice. She had contracted hepatitis while on her honeymoon, and six weeks later died in hospital. The shock was immense, and a sense of unreality permeated everyone concerned for weeks afterwards. Part of this was the actual loss itself, but some of our bewilderment was caused by the fact she had gone into hospital well in time and was receiving all the right treatment, but had still succumbed. Surely, we told ourselves if not each other, that didn't happen these days? People just didn't die from an illness so young.

But they do.

This belief that the health professions can cure almost everything is increasing as we become more and more successful at defeating disease. Even cancer is less of a threat today. In some ways we have created a culture that sees the health professions as almost omnipotent in their abilities, resulting in greater shock when the doctor cannot find a cure or the patient simply succumbs to the disease. While no-one suggests we should cease striving to continue to fight all diseases, perhaps we should also ensure that public expectations remain a little more realistic.

In dentistry perhaps we have even more of a problem because there is very little in dentistry that is life-threatening or has the fascination of medical situations. After all, while the film and television media thrive on a plethora of hospital and medical dramas, virtually no-one considers a similar tv series or film on dentistry to be interesting enough to attract the fee-paying punters. Thus expectations in dentistry are perhaps even higher for the general public because we all know dental disease is not as serious as cancer or a heart attack.

This level of high patient expectation can be difficult to deal with when we do not deliver, and may well be partly responsible for the increase in legal action against dentists when things appear to go wrong (or simply not get better). When the denture does not behave like natural teeth used to, or the crown is not quite what we expected, or the strange taste cannot be cured, or the toothache persists despite the best efforts of the dentist - then surely something is wrong here because it cannot be that difficult to fix it.

When faced with this apparent paradox - a professional expert who cannot give a patient exactly what the patient wants and expects - it is no wonder that patients assume this particular expert is not as competent as he or she should be and the lawyers are called in. To an extent we ourselves are to blame for this by not ensuring we keep expectations realistic. We are happy to promote the positive findings of the Dental Health Surveys to help meet our objectives in raising oral health, but less effective at cautioning the media over realism (or perhaps I should say the media do not always seem to want to hear it).

So what should we do to try and ensure that patient expectations are realistic? We could start by ensuring that every dentist always obtains informed consent before embarking on any treatment. I know this is an old chestnut, but I am not convinced that, as a profession, we have really succeeded at ensuring that what patients hear is the same as we think we are saying. We must also ensure that we are realistic ourselves with patients, not promising too much in terms of our own individual ability and the current state of knowledge. Perhaps, and this is a difficult one, we must also be realistic about own competence in certain areas.

Dentistry has made amazing strides forward in the last few decades, and will doubtless continue to do so for the benefit of our patients. But, along with this progress must come a realism as to what is still possible. The balance is vital.

I started this leader by recollecting a tragic event from my past. I would like to end by looking forward to the future. Dentistry has made amazing strides forward in the last few decades, and will doubtless continue to do so for the benefit of our patients. But, along with this progress must come a realism as to what is still possible. The balance is vital.