Sir, I read Dr Dobson's letter (BDJ 2012; 212: 206) with interest and with resignation. I think he is probably saying nothing new. The medical and dental non-consultant anaesthetists providing dental general anaesthesia (GA) in 1998 would agree, I am sure, that this was less stressful than sedation. I personally found intubation anaesthesia was the least stressful. I would agree that the GDC obsession with GA being dangerous and therefore banning it was and still is irrational and I am certain it was a politically motivated decision.

The GDC of course, able to dispense with the tedium of evidence and ignore the patient and their need for properly trained professionals who think pain and anxiety/physiology control matter during dental treatment, stopped GA in the dental surgery in 1998. Their concern probably being the then increasing numbers of deaths in clinics run by a particular doctor, who has subsequently died. They apparently ignored the evidence that trained anaesthetists had very low death rates (calculated to be approx 1:750,000 for the dentally qualified by Brett and Jack1). In all the time I had access to coroners' reports relating to dental GA deaths, all except one were probably preventable where advice and recommendations (usually regarding monitors) were ignored. The one death I would have said was unavoidable back then was an odd allergic response but even so a prominent anaesthetist of the day said an aggressive approach could have worked. I know anaesthetic colleagues were horrified that a BDS was enough of a qualification to perform GA and that no postgraduate training existed after the Wylie and Seward Hospital training SHO posts stopped.

Once again the anaesthetic community observe dentists now using sedative drugs, in most cases expertly I'm certain, where there is no mandatory training, registrable qualification or postgraduate specialty and audit, despite years of discussion and astonishingly deaf ears, and are expressing concern. I don't know where to place the blame for dentistry's shameful lack of interest in this aspect of patient care. Is it not time for the GDC to be replaced or enhanced with a competent body that places patients' needs above all, sticks to evidence-based decisions and organises/enables postgraduate training in anaesthesia and all aspects of it including local and sedation the way doctors and vets do?

Incidentally, I can understand the GDC attitude of the day. I rang the Royal College of Anaesthetists in 1998 to ask what its view was regarding the competence of dental 'non-consultant' anaesthetists. I was told by a very senior member, very aggressively amongst other derogatory comments, that 'we don't need dentists anymore'. What a pity. It would seem that the UK BDS is heading toward a technical rather than clinical qualification. I hope I am wrong but I am glad to be retiring.