Sir, we were interested to read the recent letter by Mr Hogg (BDJ 2005; 199: 128) with regard to specialist dental training in the UK. He is clearly unhappy with the current situation, both in terms of the requirements for entry and the manner in which this training is carried out.

Current requirements for entry into specialist training have been identified and developed as the ideal, with input from a number of relevant bodies, not just the Royal Colleges of the United Kingdom.1 A candidate should carry out a minimum of two years general professional training, in both primary dental care and the hospital or community dental service. This provides a platform for development of interests in specific specialities of dentistry and ensures the appropriate career progression, prior to specialisation. A broad understanding of clinical dental surgery also equips the future specialist with the necessary skills to undertake safe and comprehensive treatment within a specialist environment.

Far from being an 'intellectual mountain', the current MFDS examination is modular, accountable, clinically relevant and eminently passable. In does exactly what it was designed for — allows the candidate to demonstrate a broad knowledge of general dentistry prior to specialist training. The MFDS does not represent a repetition of undergraduate academic requirements and the idea that '90% of the profession' are unable to pass it is condescending to say the least. The concept that specialists are people that have 'fled' an unhappy life in general dental practice for the ivory tower of a dental school is not supported by the evidence. Taking our own speciality (orthodontics) as an example: we train a number of highly motivated individuals, the majority of whom go into specialist practice and provide the highest standards of patient care within the general dental services of the NHS. If so many specialists retreat into dental schools after qualifying, why is there a current crisis in the recruitment of dental academics?

Mr Hogg does suggest an alternative training pathway: entry requirements for specialist training should consist of some rudimentary clinical scrapbook that an individual has pasted photographs of a variety of restorations into over an undefined period of years, to demonstrate the full range of their clinical competence. This is then followed by two years of clinical training, spending one day a week in a specialist practice. We would argue that this is a retrograde step; education in a salaried position removes the commercial interest that can undermine training in practice. The two-year timeframe does not provide sufficient clinical exposure for specialisation. The majority of complex fixed appliance orthodontic treatments would be unfinished with such a curriculum, particularly as orthodontic specialists are undertaking clinical procedures that have not been experienced during undergraduate training.

Unfortunately, Mr Hogg wants it both ways; the opportunity to enter specialist training but without the inconvenience of taking any postgraduate examinations or a reduction in his material income while he is doing it. In reality, we do not believe that either is realistic or desirable in the interests of patient care.