Surprising advice

  • Ray King
  • Published 2006 in British Dental Journal


Opportunistic and reprehensible Sir, the article by Macluskey, Slevin, Curran and Nesbitt (BDJ 2005; 199: 671-675) raised more questions than it answered. Having stated within the introductory paragraphs that the usual referral centre currently is the nearest ‘District General Hospital’, the paper then went on to review the differences between a teaching hospital in Scotland and a specialist surgical dental practice in Northern Ireland! The first identified flaw is that there is no evidence whatsoever that the pattern of referral of patients with third molar disease was in any way comparable between the two centres. By definition, dental teaching hospitals with oral and maxillofacial surgery units tend to attract a referral of more complex cases whereas, by their own admission, the surgical dental practice surveyed attracted over 30% of patients for third molar surgery who required only ‘simple extractions’. Even if it is accepted that the case mix was not too disparate, the second question is the degree of discrimination being exercised in submitting patients to surgery. The dental hospital consultation process resulted in more than a quarter of the 50 patients examined being advised that they did not require a surgical procedure. In contrast the practice submitted every one of their 250 patients to a surgical episode. It also seems remarkable that a dental hospital should choose to put 42% of their patients through local anaesthetic treatments compared to only 30% in the surgical dental practice, whereas 70% of the surgical dental practice patients are subject to local anaesthetic with IV sedation – for which, in that setting, an additional fee is payable. Finally, the surgical dental practice is to be commended upon the 0% complication rate which was achieved. However it is interesting that within the hospital setting where all surgical practitioners are subject to peer review and continuous peer scrutiny, the comparable morbidity was 13%. As a group of practitioners of oral and maxillofacial surgery, involved both in individual practice, National Health Service district general and teaching hospital practice, as well as in the teaching of undergraduates and postgraduates, we find the balance of this paper suspect and are concerned that it has been independently reviewed and accepted as a scientific analysis. The suggestion that a practice such as this could be a more proper place to train students is patently opportunistic and professionally reprehensible. N. Ali, J. Carter, L. Cheng, K. Coghlan, P. Hardee, S. Holmes, I. Hutchinson London doi: 10.1038/sj.bdj.4813433

DOI: 10.1038/sj.bdj.4813445

Cite this paper

@article{King2006SurprisingA, title={Surprising advice}, author={Ray King}, journal={British Dental Journal}, year={2006}, volume={200}, pages={363-363} }