Sir, I was saddened to see the letter by Pankhurst et al. (BDJ 2016; 220: 2–3) referring to the previous lack of manpower planning in clinical oral microbiology. As postgraduate dental dean from 1998-2013, and then as the lead dean for the additional dental specialties from 2000-2012 and as Chair of COPDEND 2006-2012, I, along with the postgraduate deans, consistently argued for the need to train specialists in clinical oral microbiology. We obtained some NHS funds from the then CDO England, Professor Bedi, for two training posts, one each in Bristol and London; after some initial problems, the Bristol funding was moved to London. I liaised with the Lead Postgraduate Medical Dean for Microbiology about training, and colleagues in oral microbiology developed a curriculum in collaboration with the Royal College of Pathologists (then responsible for medical microbiology training) that was eventually approved by the GDC Education Committee (I believe this committee no longer exists).

Attempts to obtain funding for further training posts, as the number of Consultants in Oral Microbiology (COMs) depleted to the point that there were only a few COMs remaining in the UK (and that there were few such colleagues to advise the DH or, as then, the PCTs), were frustrated by comments by a senior member of the profession, at national committee level, that we were managing alright without such properly trained colleagues. Even then we knew there were problems developing with antimicrobial resistance and that both medical and dental GPs were over-prescribing antibiotics. This has all been brought into sharp focus recently by statements from the Chief Medical Officer for England, Dame Sally Davies, as we enter a post antibiotic era.

Recruitment into clinical oral microbiology was also an issue because potential trainees (and postgraduate deans) were uncertain whether there would be NHS consultant or senior clinical academic posts for those completing training to apply for. In addition, UK dental schools have had to rely on non-clinical colleagues to provide undergraduate teaching in clinical oral microbiology. Whilst I know that these colleagues do a sterling job, first hand experience of prescribing by clinicians is also very important. Colleagues in the medical and dental specialties who need the advice of clinical oral microbiologists have long since had to make do without. I know from my time in Sheffield, when we had such a specialist, that our clinicians benefitted from such advice.

Training in clinical oral microbiology has required the support and input from colleagues in medical microbiology and virology and, at one time and in a number of places, that was willingly given. During the last few years of my chairmanship of COPDEND, and while therefore sitting on the Postgraduate Medical Deans Committee, I was privy to the discussions on the changes being argued and devised, in conjunction with the GMC, for a new curriculum that would incorporate medical microbiology and virology into the medical training programme for infectious diseases. That new curriculum has now been approved and it does make it more difficult to obtain oral microbiology training. However, with goodwill and helpful colleagues in infectious diseases, we know this can be achieved. Before I retired as postgraduate dean, I had fruitful discussions with local medical colleagues in medical microbiology and virology, about future training in clinical oral microbiology, aided valuably I should say by one of the authors of the recent BDJ letter referred to at the beginning of this correspondence, who was then one of the London trainees.

It should be noted that approximately four years ago the Chair of the Joint Committee for Postgraduate Training in Dentistry (JCPTD), Professor Jon Cowpe, established a small working group with the small cadre of clinical oral microbiologists remaining to see what could be achieved. JCPTD's membership includes representation from all stakeholders involved in dental education and training in the UK. A position paper was produced, which included a series of proposals. This was circulated widely along with discussions with key senior stakeholders in dentistry. Members of the group have continued to try to stimulate support for the specialty but unfortunately despite their best efforts, there continues to be no clear outcome.

I hope that in the light of the letter by Pankhurst et al. and my reply, this might stimulate senior colleagues in the NHS and academia to reconsider how best to take forward the need to train clinical microbiologists for the future.

1. Sheffield