Sir, Professor Sheiham's editorial (BDJ 2005; 199: 187) gives an interesting perspective on the feminisation of dentistry and the current dental manpower problems. However he does not seem to recognise a major cause of these problems and his solutions will result in negligible improvements in patient health care.

There are many causes, but I believe the most important factor in our failure to deliver dental care to the patients of the UK is the obscene manpower wastage. Females form 60% of current dental graduates and currently account for 34% of dentists [this will rise to over 50% in a few years]. The respected Government funded Seward Report into working patterns of female dentists revealed that not only are females under represented in working hours [more than half work only two days a week], they are also under represented in practice ownership, involvement in postgraduate training and policy-making bodies. This has serious ramifications for high street dentistry and as more males retire there will be nobody to take practices over.

Current undergraduate selection processes are mainly based on 'A' level grades but there are many other important selection criteria that are seemingly ignored. If 90% of dental graduates were male then the manpower problem would be well on the way to being solved and importantly at no extra cost. Dentists are amongst the most expensive graduates to train, [I believe it is in the region of £250K each] and yet simply training extra female dentists at this huge cost will, in my view, do little to solve the problem. When I have simply asked these questions at BDA conferences, angry females shout me down and our BDA representatives have looked embarrassed and quickly changed the subject.

When equal opportunities clash head on with health care needs it creates an impossible problem. Of course there are very good reasons for female working patterns but it must be stated categorically that this developing trend accounts for a significant part of the current shortage of dentists. I do not begin to know how to overcome these barriers but we cannot hide any more because quite rightly, the public will not stand for it. The time has come when we need strong leadership and be prepared to 'walk the talk' instead of timid climb-downs.

I feel I must express these arguable politically incorrect views but for years I have been predicting these problems and was never taken seriously by short-term political dictum. The BDA is complacently presiding over what is fast becoming an absolute scandal as is illustrated by national headlines when a new NHS practice opens. Patients are being denied basic health care and we are failing to face up to this worsening scenario; it cannot last. The current management strategy is creating an inevitable and severe professional crisis.