Sir, I note with interest the paper on clinical governance in dentistry by Patel and Jenkyn.1 Clinical audit is one of the seven pillars of clinical governance. The authors used the audit of image quality of dental radiographs as an example of clinical audit. In the past, the guidance from the Faculty of General Dental Practice (UK) was that no less than 70% of radiographs should be categorised as grade 1 and no more than 10% should be categorised as grade 3.2

Since this paper was accepted for publication, the second edition of Guidance notes for dental practitioners on the safe use of x-ray equipment was published in October 2020. The use of three-point scale for the subjective quality rating of dental radiographs has been replaced by a two-point scale. The images are now rated either 'diagnostically acceptable' ('A') or 'not acceptable' ('N'). For digital imaging, no less than 95% of dental radiographs should be rated as 'A' and no greater than 5% as 'N'. For film imaging, the targets are slightly lower - no less than 90% should be rated as 'A' and no greater than 10% as 'N'. The use of a two-point scale is now recommended for all forms of dental radiography and dental cone-beam computed tomography imaging.3

Peer review was not mentioned in the paper by Patel and Jenkyn but this and clinical audit are part of clinical governance. They allow dental professionals to assess the quality and effectiveness of aspects of their service and to demonstrate compliance with quality outcomes of the various quality standards bodies. The Care Quality Commission considers peer review to be one of the hallmarks of well-led practice.4

Peer review provides an opportunity for groups of dental professionals to get together to review aspects of practice, share experience and identify areas for change. Groups comprise between four and eight dental professionals and there must be at least two different dental practices involved. The project can consist of two or three meetings, with a variety of different topics being considered. The thought of working together in a peer review group with other colleagues may at first appear daunting, but the benefits of this type of activity are now widely accepted.