Sir, your leader Of hearts and heads (BDJ 2009; 207: 605) expresses one of the key elements of what it takes to be a primary care practitioner. The technical rational world expressed by the 'science' of dentistry has to be applied to what Donald Schön describes as the 'swampy lowlands' of professional practice.1 This application of science to the patient in our care is the 'art' of dentistry.

Had I had the good fortune to be at the Glasgow conference, I would have liked to challenge Charan Gill on his stated reliance on 'gut instinct'. Like you, I have real concerns about dentists being inspired to run their professional lives by gut instinct – whether on the clinical or business side of primary care.

I believe that Charan's apparently intuitive decision-making is actually based on some fairly objective and very immediate feedback. His years of experience and reflection have probably created a tacit knowledge of his business, but I would contend his decisions are not based on a whim. This matches the unconscious knowledge that Schön observed as the 'art' of professional practice.

Charan has a couple of factors in his favour in comparison to primary dental care. I would have thought that the success or failure of one of his new ventures (the equivalent of one of our treatment plans?) would be evident very quickly by a number of statistically sound indicators (such as profit/loss or footfall). This direct and accurate feedback means success for Charan can be measured within months. Our treatment plans may take years to demonstrate their effectiveness. And, as you point out, Charan's failure is only a risk for the investor.

Schön found that professional artistry is not something ethereal. We can learn how to balance this heart and head decision making, to be better primary dental care artists. There are a number of ways of achieving this, of which I offer just three.

Firstly, when applying the technical rational 'evidence' of dentistry, we have to understand that no research finding can be applied directly to the problem in front of us. The best we can hope to achieve is practice that is evidence informed. This requires us to develop an evidence base that is as closely related to the practice setting as possible. Ideally, this research should be performed in practice with the direct involvement of the dental team. Evidence derived from the bench will require translational research to ensure its findings are effectively applied.

The relevant reporting of evidence is also key, and I commend the excellent Evidence Based Dentistry journal for pointing readers to the significance of findings to practice. The FGDP journal, Primary Dental Care, is the only practice-based research publication in the world and will become an increasingly valuable source.

Finally, teaching and assessment of the primary care team must develop their skills of artistry in applying the evidence, not just their ability to remember technical rational facts. I would encourage practitioners to seek out courses that teach them to critically appraise the evidence, with exams that test their application; and, for the hardy few, directly involve themselves in practice-based research.

In dentistry's current 'modern world', an entrepreneurial approach to services is clearly being encouraged by many of its leaders, from the BDA to the Department of Health. In the dissolution of old attitudes and systems, the dental profession is becoming very creative in their activities – sometimes bizarrely so. Personally, I am strongly in favour of creating new and better solutions to our many challenges. However, unlike Charan, we also have a professional responsibility to the public to ensure we gather, learn and apply the best available evidence. Ethically, we cannot rely on gut instinct. We have to exercise the skill of professional artistry; to balance the heart and head.