Sir, I read your editorial in the 8 December issue with similar interest that I read them all, but found your discussion on the appearance of 'British teeth', the potential psychological benefit of good dental appearance and whether cosmetic dentistry should be allowed on the NHS particularly interesting. To help answer the latter question, may I suggest that there might be a clue in examining the questions asked in recent Adult Dental Health Surveys?

In 1988, the question was asked 'Are you happy with the appearance of your teeth?' Readers may be interested in the findings, namely, that the response was 'yes' for 79% of respondents with four or more anterior crowns, 'yes' for 63% of those with one crown (perhaps indicating our difficulty in getting one anterior restoration to blend with the remaining dentition), 76% for those with six sound anterior teeth and 84% for those with six or more teeth on a denture. Reasons for dissatisfaction with appearance were, for dentate adults: colour of teeth (38%), alignment/position (36%), spaces in the mouth (13%) and colour of fillings (11%). I fully expected that these questions would be repeated in the 1998 Survey, but they were not. Knowing that a further survey should be scheduled for 2008, I wrote to the Department of Health in 2007 suggesting that these questions be reinstated. I do not recall receiving a reply, but sufficient to add that these questions on dental appearance were not part of the most recent Adult Dental Health Survey, although the severity of oral impacts on some basic functions of daily life was, at least, assessed.1 You and your readers may draw your own conclusions.