Exempt from insight

The parody of NHS patients being ungrateful, ignorant and audacious in their demands is a poor reflection upon those who hold this view. It seems to be an all too common perception that NHS patients should be grateful for whatever treatment they receive. These views are evident in articles such as 'Give a Mouse a Cookie' (The Dentist, April 2012) with claims of being a tongue-in-cheek jest and an assertion of the right to freedom of expression. Views such as these are in fact plainly insulting to patients, dentists and all those who devote time and considerable skill to the profession. There seems to be a misunderstanding demonstrated by some dental professionals that NHS patients, especially those who are exempt, are not deserving of the treatment that they are entitled to.

The idea that NHS dentistry is an unwinnable struggle against oral disease is perpetuated throughout the profession. As a student, I was once told by a nurse not to pursue any interest in periodontology because "they never get better". Again, anyone with a knowledge of the disease process and has seen enough patients will know that periodontitis is often well managed in those who improve their oral hygiene. Disease rates are decreasing and dentistry is moving towards a new chapter where conditions such as tooth wear are more of a concern to an ageing population than caries. Caries is a social disease, with the majority of individuals at high caries risk being of the lower socio-economic groups. This is well-known to be due to poor diet and oral hygiene routines. Caries will most likely be prevalent at higher levels in these patient groups for many more years, but advances in the public's health knowledge and interventions such as fluoride toothpaste go a long way to reducing these inequalities. The idea that the festering mouth is related to social deprivation has not always been so; in comparatively recent times it was a sign of affluence as sugar was a luxury commodity, that only the rich could afford to consume with the frequency required to develop caries.