Sir, the article on NICE guideline and current practice of antibiotic prophylaxis for high risk cardiac patients... (BDJ 2012; 213: E5), the editor's summary and commentary (BDJ 2012; 213: 180–181) raise some important issues both for dental foundation and specialty trainees as well as experienced general dental practitioners.

Those best able to provide advice on antibiotic prophylaxis, cross infection control, decontamination and other microbiological matters might be consultants/specialists in oral microbiology. Unfortunately, this specialty is in decline. There are seven on the specialist list, two of whom are in Scotland, one in Wales and one in Northern Ireland. There are currently two consultants in England who are bona fide oral microbiologists. The Department of Health provided funding six years ago for two trainees; of the current trainees, both based in London, one has recently completed training and the other should complete shortly.

This means that there are few experts in oral microbiology in England to provide advice locally, regionally or nationally. In order to take trainees into specialty training, it is important to know that there are likely to be jobs for them on completion of training. Sadly, owing to the lack of trainees, there is a consequent lack of succession planning in the specialty. The Specialty Dental Education Board (SDEB) of the GDC has yet to approve the curriculum and this is in part due to the fact that the Royal College of Pathologists and GMC are reviewing the Infectious Diseases and Medical Microbiology curricula. As the oral microbiology training programme is based on the medical model and requires input from specialists in the latter, it is critical that some consideration is given as to how oral microbiology can, or should, be developed in the future both from a diagnostic point of view and to provide advice. To that end, Professor J. Cowpe, Lead Postgraduate Dean for the Additional Dental Specialties, has established a small working group to review these issues. It would be helpful if there was a wider debate as to whether there is a need for this specialty. Certainly, microbiology is the basis of many important diseases related to the oro-maxillofacial complex, not the least of which is dental caries.

1. Chair COPDEND