In this issue of the BDJ we are publishing a controversial opinion article with the provocative title Strap him down or knock him out...Is conscious sedation with restraint an alternative to general anaesthesia? As the title suggests this article basically asks if it is better to use restraint on an unco-operative patient (usually a child) with conscious sedation rather than subject the patient to general anaesthesia with all the risks involved.

This is obviously highly emotive, and considered unacceptable in the UK, which is why we have also published a UK perspective and a commentary on the legal issues involved as well. Readers can make up their own minds what they think (or more likely feel) on the subject. However, what the article also does is provide a different perspective on the subject of treating so-called 'difficult' patients, especially children.

Perspectives are often interesting, and perhaps ignored when we should not ignore them. Last night (as I write this) the evening news programme on the television brought the horrendous situation in Malawi to my attention. Families with AIDS are being faced with the impossible decision of choosing who will live and who will die within the family because they can only afford the drug therapy for one person. The problem is immense, affecting millions of people, many of whom cannot afford any treatment at all. The average life expectancy in Malawi is 37 years old. But, as the programme on the television highlighted, imagine the emotional agony of a husband and wife having to choose between one of them or one of their children (all with AIDS), trying to decide whether the daughter, the husband or the wife should be the one to live.

Surely, beside this virtually everything else pales into insignificance. Apart from the question of why the world allows this kind of thing to happen (imagine if it were virtually anywhere else but Africa) we can hardly worry about the occasional rail strike in comparison. It is a very different perspective to life in most other countries.

So what about dentistry? Are we, in dentistry and especially in the United Kingdom, in danger of getting things out of perspective at times? Of course we are. It would be odd if we did not. As individuals (as the Letters column to any publication illustrate) we often express concerns about matters that really, in the 'rich panoply of life' are not that important. And sometimes, I feel, perhaps we continue to stay out of perspective rather than appreciate the wider picture and do a rethink.

But what about as a group, as a profession? Are our perspectives balanced when we deal with matters concerning dental health and dentistry as a whole, especially when we present ourselves in the media or to other groups? Now that is a far more interesting matter, and one that every dentist should be concerned about and aware of.

Consider fluoridation. The recent change in the law allowing a more democratic approach towards fluoridation is a good example of how well the dental profession expressed its feeling on the importance of enabling people to choose for themselves. I think everyone agrees that the profession maintained its perspective there. Similarly, I believe dentistry over the last decade has handled the gradual move away from NHS dentistry well, despite the difficulty for some patients in accessing an NHS dentist.

Perhaps it is within ourselves that we are more guilty of getting things out of perspective. I well remember the paranoia at a local meeting when the NHS charge rose from £1.50 to £10 maximum. People really believed it would be the end of life as we know it, and voices were raised and tempers frayed. Of course, in the end, it all came to very little change.

After all, a change in working conditions ... is hardly the same as choosing who in your family is going to have to die.

So perhaps, as the new changes coming with the Health and Social Care Bill next year begin to emerge, we can remember to keep it all in perspective and not get too excitable. After all, a change in working conditions (which can be a great opportunity for some) is not quite the same as choosing who in your family is going to have to die.