Sir, there appears to be some confusion about recent and future changes to prescribing arrangements for dentists, and we would like to clarify the situation. The current British National Formulary (BNF 48) was issued in September 2004. This contains the dental list, which lists all medicines that dental practitioners can prescribe on the NHS. Dental practitioners cannot currently prescribe on the NHS any medication which is not included on the dental list.

However, the aim remains to abolish the dental list and to allow dental practitioners greater access to the BNF. Further changes are due to be implemented in April 2006, and all dentists will be informed of the exact date before implementation.

There is also some debate over whether the BNF is providing up-to-date advice on endocarditis prophylaxis. The BNF continually monitors new information in order to keep the text as up-to-date as possible. In updating text, the BNF takes into account both current evidence and clinical practice.

The Editorial Staff of the BNF are aware of recent recommendations from a working group of the British Cardiac Society (BCS) Clinical Practice Committee and the Royal College of Physicians (RCP) Clinical Effectiveness and Evaluation Unit on “Dental Aspects of Endocarditis Prophylaxis”. These recommendations were issued during the preparation of BNF 48 and were reviewed in detail by the Dental Formulary Subcommittee.

The Subcommittee felt that the recommendations went beyond the evidence available and was also concerned about how practicable their implementation would be. The Subcommittee agreed that the BNF would not be changed to reflect these recommendations. However, the BNF 48 does acknowledge the existence of the alternative recommendations, on p 23: “The recommendations of a Working Party of the British Society for Antimicrobial Chemotherapy (BSAC) are reflected in Table 2, Section 5.1. Alternative guidelines have been produced and may be in use in some settings.”

The BSAC is currently reviewing the recommendations and the BNF and its advisers will continue to keep endocarditis prophylaxis under close review.

We hope that this clarifies the current situation.