Sir, I found the discussion section of the article on Dental Access Centres (BDJ 2009; 206: 257–261) by Milsom et al. to be contradicting itself.

After identifying the DAC population as being more likely to prefer symptomatic attendance and to not view regular care as a priority it goes on to talk about the opportunity in 'high street' practices for these patients to develop commitment to a more holistic approach. This, from a group of patients that the authors admit elect not to be pressurised into developing long term professional relationships and who prefer safety net services. This just does not make sense. The conclusions are also totally contrary to the Government's notion of patient choice.

The study identified DAC patients as generally coming from disadvantaged localities, to be exempt patient charges and that their dental health is substantially poorer. It would be interesting to have included how good they were in keeping appointments compared to those patients attending 'high street' dentists. Such a study might help to explain some of the dental public health concerns.

Dr Keith Milsom responds: Thank you for your letter in response to the article on Dental Access Centres.

The study identified differences in characteristics between patients attending 'high street' dentists and DACs, with DAC patients more likely to:

  • Come from more disadvantaged backgrounds

  • Have decay

  • Prefer symptomatic attendance.

The conclusions drawn by the authors appear to have raised in the mind of the respondent something of a dilemma. Should the 'high street' NHS dentist's role be restricted to addressing the needs of those patients whose dental health is good, who attend regularly and who are not exempt from dental charges, leaving the care of the less dentally motivated in society to others? It could be argued that under the terms of the new dental contract, treatment of irregularly attending patients with relatively high decay rates is currently unattractive for 'high street' dentists. This issue is addressed in the article and suggestions for change are considered.

DACs were set up at a time when the availability of NHS dental care was diminishing and there was little the Government could do to encourage NHS dentists to accept new patients. Now that we have a new dental contract the situation is quite different. PCTs are able to engage with the local profession in the pursuit of dental services that meet the needs of all those wishing to access NHS care. Given this new flexibility, the role of the DAC should be revisited. It may be that currently short term symptomatic dental care for poorly motivated individuals is not attractive for many 'high street' dentists, but perhaps this problem should be addressed via development of the dental contract, rather than by perpetuating a separate and often expensive alternative service.