Sir, you have recently published two papers which aim to reduce the risk of wrong tooth extraction. This is rightly classified as a never event.

However, I would suggest far more restorable teeth are needlessly extracted than good teeth are extracted in error.

This is primarily caused by system failure in that an extraction and a root canal treatment attract the same NHS fee so a practice will make a profit on an extraction and a loss on a root canal treatment. Whilst very few dentists will deliberately extract a tooth they know is restorable, the economics will cloud the judgement of all but the most saintly of dentists.

There is also plenty of anecdotal evidence of restorable teeth being removed in order to place implants. This could be due to relative lack of knowledge as well as economic reasons.

In the case of the wrong site extraction a dentist has a duty of candour and must report himself to the authorities, subjecting himself to further investigation. In the case of extracting restorable teeth we can seemingly happily bury our collective heads in the sand.

1. London