Sir, we read with interest the letter Another hiccup by S. Laverick of Dundee (BDJ 2009; 206: 509), a consultant oral and maxillofacial surgeon, with reference to having to pay registration fees to both the GDC and GMC. Given that oral and maxillofacial surgery includes some aspects of dentistry and that only registered dentists can carry out the practice of dentistry it follows then that de-registration with the GDC might restrict this practice. For example, it is accepted that removal of a tooth is a maxillofacial procedure, but the decision as to whether a tooth needs removal or can be restored is clearly a dental decision.

Much of the routine day to day care of patients in 'maxfac' units can be delegated to dentally registered junior and middle grade staff, but those individuals work under the authority of a named consultant and unless the consultant is appropriately registered it would be inappropriate for him/her to assume responsibility for those patients; the non-consultant staff would have to act as independent practitioners; this is not in line with current hospital practice where patients are under the care and responsibility of a named consultant. Furthermore, dental care professionals can take prescriptions for treatment only from registered dentists, therefore de-registration from the GDC could limit the range of treatments available in specialist units and also limit employment of DCPs within hospital practice. One can imagine a scenario where a general dental practitioner refers a patient to his/her local hospital only to have the referral returned on the grounds that the consultant cannot accept responsibility for the case; similarly a patient who sustains traumatic injuries may not be able to benefit from temporary restoration of any damaged teeth but could have a fractured mandible reduced and fixed.

If the British Association of Oral and Maxillofacial Surgeons wish to advise their fellows to de-register with the GDC then perhaps they would consider making a case for the appointment of more consultants in oral surgery to care for those patients for whom maxfac consultants could potentially no longer assume responsibility?