Sir, I am currently undertaking postgraduate research into the attitudes towards the use of dental auxiliaries (PCDs) across the world, particularly in the EU.

My research will show that the data for Greece and Portugal are different than quoted by Dr Antonarakis in his letter (BDJ 2004, 196: 127) and the different views about the use of PCDs are very complex. Until all the factors are understood there is no chance of any consensus on the training and duties of dental hygienists.

The EU Manual of Dental Practice 20041, to be published in May 2004, will show the population to active dentist ratios of Greece and Portugal are 1,246 (2002) and 2,240 (2001) respectively. There are no hygienists in Greece and there were 150 hygienists in Portugal (about one for every 30 dentists). The respective DMFTs at 12 years were 1.80 and 1.502.

The (current) EU/EEA country with the highest population to active dentist ratio is Spain, at 2,672. There are 9,000 practising hygienists in Spain, (about one for every two dentists) – yet the DMFT in 2002 was 2.302.

The six countries with similar low population to active dentist ratios as Greece were the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) together with Italy – all of which also have high numbers of practising hygienists.

Whilst four of these countries have low DMFTs (around 1.0 at 12 years), perversely Iceland and Italy have high DMFTs (2.7 and 2.12 respectively)2.

I have not yet been able to ascertain any obvious connection between the various methods of service delivery and DMFT, to form any conclusions.