Sir, the opinions expressed in the BDJ (Vol 223 No. 10) by A. Al Hassan,1 a young graduate, Martin Kelleher,2 an older graduate, and indeed yourself3 were extremely interesting. I sympathised with the views of A. Al Hassan and fully appreciated his real concerns for dentistry and our younger colleagues practising in the climate of fear leading them to practise defensive dentistry. However, being of an 'age', I have lived and practised through the past analysed by Martin Kelleher and wholeheartedly agree with his analysis of the state we are in; we are all in this together.

The profession is demoralised and has been emasculated by successive 'regimes' of governments and regulatory organisations like the GDC. I have never heard the GDC make any comment about regulatory changes, especially when they are not in the interest of our patients. The GDC is an arm of the government and not independent.

The many crazy schemes under the 'item of service' were used to try to direct our clinical behaviour regardless of the benefit to our patients but purely to satisfy the Treasury.

'Item for service' certainly had its problems but it was so much better than the UDA system. It could have been improved to the benefit of patients and dentists. Barry Cockcroft, the CDO who oversaw the introduction of the present UDA system, said all the dentists were complaining about IOS, but as I pointed out to him, those in private practice who had the choice of whatever system they wanted basically used fee per item.

I despair at the damage UDAs have done to the dental health of the nation after great strides had been made in retaining dentitions through advances in operative techniques and prevention over many years. The damage also to the morale of the profession has been enormous.

Not everything that was done in the past was perfect but, I know from my own 'inadequate' practice, folk retained their teeth including some slightly sub-optimal root filled teeth for over the 30 plus years that I treated them for. We did molar root treatments, difficult extractions and anything we could to help patients and it generally worked. We did not have the fear of litigation from avaricious legal teams and patients were grateful for our efforts.

There is a dental world of 'swings and roundabouts', but in that playground world there is also a 'slide' and that is where I feel the dental health of our patients and the health of our dental colleagues has gone down.

The GDC are supposed to protect patients but they have been totally negligent in allowing successive governments to 'abuse' them and then have blamed the dental profession when systems have failed. They are an organisation not fit for purpose and should at least have the complement of members like it used to have: more active dental practitioners voted on by the profession. We pay for it... 'no taxation without representation!!'

I am very grateful for both our colleagues for identifying what all of us really know, but have, unfortunately allowed to happen.