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As the summer draws to an end and the days become shorter, we've seen unprecedented (in my lifetime, anyway) coverage of the power - and need - for trade unions. Mick Lynch has become somewhat of a cult hero, depending on your news source of choice, and the straight-talking, fact-based approach trade union spokespeople take has been somewhat refreshing against the backdrop of discussions about standards and ethics.

Whether you agree with train drivers, tube drivers, bus drivers, postal workers, journalists - and in the past teachers, nurses and junior doctors - going on strike, what we can all agree on is at some point, enough is enough, and there is a decision to be made. For these workers, it's about saying 'no more', particularly in the face of the cost-of-living crisis. For others, it's about working conditions.

At the time of writing, on the first page of the British Dental Association's press releases page, you'll find phrases such as 'new plans papering over cracks', 'exodus from NHS', 'demand lifeline as 'dental inflation' soars', 'unfit for purpose', 'NHS dentistry at a tipping point' and 'service on its last legs'.1 Come on folks, tell us what you really think.

It's always been a source of befuddlement that many within the profession are unaware the BDA is the trade union for dentists. Even junior members need to be reminded of this on certain occasions. Put to one side the fact all of these headlines and snippets focus solely on NHS dentistry, you have to wonder whether dentists will say enough is enough, and if so, what will they do? It is the role of a trade union to better the working conditions of their members, and 'marginal changes' and 'absurd and unjust' pay awards just won't cut it.

You have any number of figures that show just what decision dentists are taking; the Association of Dental Groups reported that in the 12 months leading up to March 2022 the NHS lost over 2,000 dentists in England on top of a further 1,000 in 2021,2 while in May the BDA reported 45% of high street dentists reduced their NHS commitment since the onset of the pandemic, with a further 75% saying they are now likely to reduce - or further reduce - their NHS commitment in the next 12 months.3 More will come, and with the overall state the profession finds itself in, I'll have a cheeky bet on them revealing a further exodus.

For those that do stay, and for those who want to replace their NHS commitment with something else, clearly a move to providing private dentistry is the lead option. No targets, better pay, better working conditions, more flexibility - who wouldn't want those things? After all, they're what's broken with NHS dentistry.

In this issue we feature a number of articles from practitioners who made that decision some time ago. Dr Marcos White's insightful article4 on the next stage in the digital revolution is a million miles away from NHS dentistry and shows what can be achieved in an environment where you set your boundaries. Dr Victoria Martin's piece assessing the relationship between clear aligner providers and sustainability5 should make us all think about the 'hidden' elements to everyday practice, particularly on the back of Brett Duane's focus on sustainability in August's BDJ.6 It is a discussion that NHS practitioners simply do not have.

Had you asked me over the summer about where I thought the future of dentistry lay, I'd have had no hesitation in telling you it was in the private sector. With the cost-of-living crisis showing no sign of slowing down, I'm not so sure now. However, unless NHS dentistry changes - quickly and dramatically - in the coming months dentists will have a decision to make, and if current trends are anything to go by, there may not be much of an NHS left to work in. â—†