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The year is 2145. The government of the day is onto its 14th Prime Minister since being elected. The Health and Social Care Secretary has just returned from a stint on Love Island, while all four Chief Dental Officers of England, Wales, Scotland Northern Ireland are being yelled at by Bear Grylls on an island for unsuccessfully attempting to surgically put the mouth back in the body. There are urgent calls for dental contract reform. The postponed 2019 inquiry into dentistry is finally back on the agenda - mainly to ask what is this thing they call 'dentistry' and whether it's worth resurrecting it.

Without the prospect of science and being cryogenically frozen, unfortunately we won't be around to find out if this vision comes to fruition. A shame, I hear you all cry. I know, but it's worth assessing which of these is most and least likely to happen.

First of all, most. Some strong contenders, but my bet is on a call for dental contract reform. After all, it's now 2023, and there have been calls for urgent contract reform since 2006. In that time, there's a portion of the population that were born, turned teenagers, learned to drive and are about to go to university. I know from personal experience those 17 years have seen enough major life events for one lifetime.

In the very first issue of BDJ In Practice back in January 2015, one news item drew my attention. The piece, entitled 'Early contract findings support blended remuneration' opens with 'The Department of Health England conducted an 'engagement exercise' with dental-contract reform between June to August 2014. The exercise precedes, and is designed to inform, development of the next stage of reform.'1

That's a full eight years ago. Must have been some engagement exercise. Alas, in January 2022, the BDA condemned the 'insufficient support offered to over 100 pioneering practices in England', describing them as being thrown under the bus and being forced back to work under historic models of care. In July 2022, they went on to adopt 'a neutral position on the new package of changes, neither endorsing nor rejecting what it characterises as modest and marginal fixes to the widely discredited NHS dental contract'.

For how much longer will dental contract reform be a topic of discussion? Some practitioners will have practised under nothing but the BDA calling for changes by the time they hang up their tools.

The answer to this invariably lies within considering which of the events and scenarios in the opening paragraph is least likely to happen: dentistry being on the agenda.

Throughout 2022, I felt like I may as well have invited Chair of the BDA, Eddie Crouch, and Chair of the GDPC, Shawn Charlwood, around for breakfast, given how often they were on the TV talking about dentistry and the need for urgent reform. We even had the rather surreal experience of Crouch being invited onto GMB to set the record straight after one of its presenters, Richard Madeley, offered what Crouch called a 'grotesque misrepresentation of a crisis facing millions of patients'. It is one of a number of occasions the BDA has had to step in and urge a correction of the record in recent times.

While dentistry may be a topic of discussion over a morning coffee, it seems for those operating within Westminster, that's about as much as they can stomach. Repeated calls for 'urgent contract reform' align with 'dentistry on its last legs' and other end-of-days like metaphors really highlights just how important dentistry is to decision-makers. It isn't.

The recently announced parliamentary inquiry into access to NHS dentistry - the first since the 2019 iteration was cut short by the snap general election - 'offers hope to millions of patients left with no options', Charlwood said in a statement. As always, it is the hope that kills. How many times have we heard politicians, committees and reports state the dental contract is unfit for purpose, or that urgent reforms are needed? Even as far back as September 2022 - a long time in politics, even by today's standards - over 60 cross-party MPs called on then PM Truss to act with 'urgency and ambition' on the access crisis.

Dentistry is not not being discussed. It is not something politicians can say they're unaware of. The only conclusion is that calls are falling on deaf ears. For what reason is anyone's guess, but the metaphorical shrug of the shoulders after acknowledging the problems within the system do no favours. On the current trajectory, by 2145, and judging by the BDA's tone, NHS dentistry will be a thing of the past, consigned to history. Perhaps that's what the government wants - their refusal to invest at levels required to bring dentistry back to pre-pandemic levels borders on the criminal, let alone get ahead of the problems COVID-19 caused.

With little evidence ministers are ready to honour any pledges on reform, I would not hold your breath on the inquiry being anything other than a show pony. That's what the track record points to, and 2145 me - at a grand old age of 161 - would take no joy from being proven right. Alas, there's perhaps more chance I'll be alive to witness this than there is seeing a dentistry inquiry bearing any fruit whatsoever. â—†