Sir, I enjoyed reading the articles on the management and rehabilitation of head and neck cancer patients in the 11 November issue of the BDJ (Volume 233 Issue 9). I would like however to comment on Drs Kalsi, McCaul and Rodriguez's article on the role of primary care practitioners in the dental after-care of such patients.1

A number of practical challenges exist to delivery of continuing care in general dental practice. Firstly, treatment in the General Dental Service in the United Kingdom incurs charges (for those not in exempt groups). This may be a barrier to some in seeking care.

The transition from hospital treatment to primary dental care, for which there is a charge, questions the principle of the NHS to provide appropriate healthcare free at the point of delivery. Is this routine dental treatment or the ongoing management of the consequences of the malignancy?

Second, complex rehabilitation with free flaps and/or implant anchorage, poor oral access, unusual tissue morphology and unconventional restorations may be markedly different from that with which general dental practitioners are familiar and may pose real challenges in primary care. Have they received any practical training or support in managing such patients? As recurrent disease and technical complications may well occur and require early (often specialist) intervention, a properly trained and funded continuing care network is essential. As there appears to be an increase in head and neck malignancy, I think these issues need addressing by those commissioning and providing such care.