Sir, I read with interest the Opinion paper After the first 125 years of the BDJ where might clinical dentistry be heading? by John Renshaw (BDJ 2005; 199: 331). He highlights the dilemma we, in the UK, face as a profession for the future: 'So what are we? Are we professional healthcare workers or are we now in the beauty trade? Should we be taking a dramatic vow of chastity?' In this paper the reality of disease distribution is identified in that the majority of the patients affected live in the poorer, deprived sectors of the community. It is also recognised that general medical practitioners have always been better paid by the NHS than dentists without any accusation of being 'gold diggers' and attributes this to the fact that society recognises doctors' efforts on behalf of the whole population.

Using Norway as an example, Grytten1 makes the point that increased costs for dental services are driven by the financing system in conjunction with imperfect competition. This has led to an increase in the capacity of dental education markedly so as to satisfy the demand for workforce. Grytten2 states: 'But this will lead to even more ineffectiveness in the dental market. More dentists will treat fewer patients, with higher fees. The experience from Norway illustrates the importance of looking at the financing system in relation to the employment situation and the training of dentists.'

In the UK we are about to embark on a new dental contract designed to reward dentists for applying twenty-first century principles of care based on the aims of dental health policy. However, there is dissatisfaction among general dental practitioners regarding this contract. This is understandable following the reported negotiations in the dental press and associated implementation delays. Also change in itself brings uncertainty.

If this dissatisfaction is translated into the loss of healthcare workers into the beauty trade then it is likely that there will be an expansion of what Downer3 terms 'unsupervised neglect' An alternative route is available to us as general dental practitioners and that is to embrace the new contract with the associated funding to facilitate access to the community and provide services based on need. In addition to this, we are able to use our clinical judgment to provide services based on patient desires within private agreements. The NHS:private ratio is likely to change as younger cohorts age, based on epidemiological evidence of disease trends. The number of patients requiring 'no dental intervention' has already increased by 10% over the last 10 years.4

This way we maintain our professional status and job security in the long term.