Sir, firstly, many congratulations on the fascinating counterbalance you have managed to achieve between the recent online publication A patient notification exercise following infection control failures in a dental surgery (BDJ 2008; 205: E8), the review commentary from Millership, Irwin and Cummins, and your own insightful summary (BDJ 2008; 205: 194–195).

Serving, as it does, over 70% of UK dentists and over 50,000 dental health professionals worldwide, Dental Protection is well placed to appreciate both sides of this story, and we have fought to protect the rights of infected healthcare workers in many countries over many years – including the UK case of H (a Healthcare Worker) vs Associated Newspapers Ltd, which confirmed a healthcare professional's right to confidentiality as a professional, as a citizen and not least as a patient.

We can well understand the public health dilemma faced by those whose role it is to protect the public against transmissible disease. Many of these public health consultants are also members of this organisation. We also invest a great deal of time, money and effort in encouraging our members to maintain high standards of infection control, and we too take patient safety very seriously.

When confronted with suggestions of poor infection control practices, and/or a clinician who is known to be infected, there is an undeniable weight of public perception to deal with. These judgements are not easy. The cost of patient notification exercises (PNEs) is high in both financial and operational terms, as well as in terms of the stress and anxiety caused for those patients who are contacted and screened but later found not to have become infected by a transmission from the clinician in question. But as one meticulously-conducted and wide-ranging PNE after another demonstrates the absence of any transmission – even from healthcare professionals where all the main risk factors are present – there are continuing concerns that the costs we are all counting are not those of public safety at all, but those of research. The unpalatable reality is that many past PNEs were not based on evidence, but searching for it.

It is suggested that the day may be fast-approaching when the healthcare worker would be required to personally fund the PNE that they have 'caused'. If this were to be the case, then Trusts and individual public health consultants could similarly find themselves in the courts, facing huge claims for lost careers, massively reduced practice values, and stress and subsequently unnecessary anxiety caused to individual patients who are included in a PNE which subsequently reveals no transmission.

It is true – as stated in the commentary which appeared alongside this article – that the risk of transmission (though small) does still exist, but with each additional PNE that yields no demonstration of any transmission, despite meticulous science and diligent application, the evidence is growing to make such litigation a realistic prospect and any 'public interest' and 'public safety' defence will need hard evidence to support it. Another factor, surely, to place in the 'mix' of the suggested debate on this important subject?

In this same context of PNEs, I would also suggest that we should consider the implications of most of dentistry being categorised as 'exposure prone procedures' especially in respect of dentists with HIV.