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Thank you for highlighting my 1987 article. While some things have changed others remain the same today, as you have mentioned.
Assessment of caries risk is as important today as it was in 1987, although microbiological tests would not now be part of this, nor would chlorhexidine be used to modify bacterial counts as part of caries control.
In 1987, I wrote ‘although many children are caries free, there are still some with a remarkably high level of disease’. This is certainly true today; caries can be considered a disease of social deprivation. For several years now the Royal College of Surgeons has emphasized that children's hospital admissions due to tooth decay are very high and increasing in some age groups.
In 1987, I commented ‘it is distressing that practitioners in the GDS are not specifically remunerated for preventive items’. This remains to be addressed. As I discussed in 1987, caries control preventive measures are just as much dental treatment as restorative care, and need to be recognized and rewarded as such.
In this respect, of course, things have got even worse with the imposition of the Unit of Dental Activity (UDA) system in England and Wales in 2006, where disease control methods are included with diagnosis and treatment planning for a single UDA. I consider this to be the legacy of a previous dental administration but, in my opinion, it is wrong to the point of being unethical.
In 1987, I concluded that ‘the profession is working in challenging times’. Nothing has changed: practitioners and academics have been criticizing the lack of payment for preventive dentistry for years but politicians and the Chief Dental Officers of England and Wales apparently refuse to do anything about the UDA system and the General Dental Council takes no interest. This is, in my view, also wrong, unethical, and I formally invite the CDOs of England and Wales and the General Dental Council to give Dental Update comments on my opinion for publication in the journal.
I hope that these comments are of value to readers.
