Sir, the paper by Yip and Smales1 on the subject of diagnosis and treatment planning for caries in practice gives a reader from 'practice' cause for concern. Use is made of data that are not referenced (eg '...was shown in the UK patients who have regular dental care ... are just as likely to require emergency dental treatment as those who visit a dentist regularly' – really? By whom and when and where can I verify the data and read more? – because this is of interest)!

Authoritative statements are presented, with no evidence to support them cf first paragraph on page 218 making statements about restoration replacement. I am familiar with the issues raised and know where to go for further reading and information (Annusavice, Elderton and Christensen – because I have already read around the subject. However, readers who have not are left in the dark).

This is a shame because the paper deals with many aspects of contemporary practice which are of interest to dentists in general practice, but we want to know what the evidence base is and what is 'expert opinion'. This paper does not make that distinction. There is an urgent need for evidence-based papers like this, as we increasingly face patients armed with extensive 'reading off the Internet' – some of which is simply wrong, but a lot is opinion – which we have difficulty finding research for or against, because we are so busy simply doing the work! A lot of the statements made in this paper simply either reinforce or contradict current professional dogma, without providing us with the tools for making our own minds up on the validity (or otherwise) of what is presented.

Professor Roger Smales and Dr Kevin Yip respond: We acknowledge that there are ever-increasing numbers of dental journals and published articles on many topics relevant to dental practice that busy practitioners have difficulties in finding time to read. However, the reading lists in the present series are not intended to reference every statement made in the eight chapters selected from the 19 chapters in the textbook A clinical guide to oral diagnosis and treatment planning, but to provide some pertinent material as a starting point for those readers who may wish to explore the topics included in more depth. The book chapters are not intended to be critical reviews of each and every topic mentioned. Where possible, the reading lists have included relevant review articles, clinical guidelines, long-term clinical studies, articles or sources from recognised authorities (several of which Dr Maidment has mentioned) and more recent articles. Many evidence-based reviews on topics of interest to practitioners (and patients) are available at the Cochrane Oral Health Group Reviews (www.ohg.cochrane.org/reviews.html) – as was mentioned in Newsome P, Smales R, Yip K. Oral diagnosis and treatment planning: part 1. Introduction. Br Dent J 2012; 213: 15–19. We hope that such evidence-based reviews will also assist practitioners to move out of the dark!

More specifically, various articles have explored associations between the frequency of patients' attendances and the dental treatments received. Several studies have found that regular attendees have more restorations (mostly replacement restorations) placed because of disease experience and unsatisfactory restorations than do irregular attendees.2,3,4 The average number of restorations placed also increased significantly with a change in dentist.3 The lowest survival of restorations was strongly and directly related to the shortest median frequency of attendances, due possibly to the higher occurrence of dental problems in the most frequent attendees.5 A three-year study of dentate adults aged less than 35 years at baseline also found that similar percentages of 'dentally successful' people (56%) expected to retain teeth beyond the age of 65, and of 'dentally unsuccessful' people (57%) expected to lose all teeth by the age of 45, had sought General Dental Service care.6 And, one other clinical study involving 677 children who attended 50 general dental practitioners on a regular basis reported that similar percentages of deciduous molars having either unrestored caries (18.8%) or a history of restorative care (17.0%) were extracted because of pain or sepsis.7 An Australian dental hospital study of 301 adults found that, although 62% claimed to have seen a dentist during the past 12 months, overall 86% attended because of a dental problem – usually toothache, broken teeth and lost fillings and denture problems.8 Another Australian private general practitioners' study of 497 adults found that although 64% had attended during the prior 12-month period, overall 54% were now attending because of dental problems.9 All of these studies indicate that receiving regular restorative care does not necessarily result in fewer dental problems and, in the latter two clinical studies, the patients also required more periodontal and restorative treatments than just for their immediate dental problems. The reasons for this situation are largely conjectural, such as regular attendees (who retain more teeth) receive more restorations and complex restorative treatments10 and, therefore, are also more likely to have increased dental maintenance problems. Finally, most of the statements and supporting references relevant to the mentioned first paragraph on page 112 of Part 5 are contained in additional articles by Elderton.10,11,12,13