Leading Article: Dentists bite back at slow pace of reform

AT first sight, the idea that a dentist could refuse to treat a child who eats too many sweets may seem outrageous. Children cannot fairly be expected to think prudently about their adult lives; that is their parents' job. To withhold dental treatment is to visit the sins of the fathers on the sons - or in the case that has come to light in Wakefield this week, of the mothers on the daughters. But the draconian action of Mr Sharif Khan, a Yorkshire dentist, illustrates a professional dilemma that is financial as well as medical.

Keeping a good set of teeth, researchers agree, is as much a matter for the patient as for the dentist. The surgery cannot prevent decay in a mouth that is being constantly bombarded with sweetened fizzy drinks, chocolate and other sugary food. It is therefore a crucial part of a dentist's work to help patients and their parents to acquire good habits - and frustrating when they refuse to do so.

Dentists can afford to be blase with adults, for they are paid for each treatment they perform. But when they sign on a new child patient, the Government pays them an 'entry fee' (based on age and the number of fillings in the mouth) and then 'capitation' (a monthly fee based on age). Providing endless fillings to sugar-addicted children actually costs the dentist money. Legally speaking, practitioners are within their rights to 'deregister' patients with bad habits - just as they may deregister those who repeatedly miss appointments, or (with adults) who fail to pay their bills.

Yet it would be disastrous if the Wakefield dentist's policy were to set a precedent for the nation's dental health. The children with the worst mouths tend also to be the poorest; in many cases, if they are turned away, their parents will not take them to another dentist but stop taking them to the dentist altogether. The problem of unhealthy teeth at the bottom of society would thus become self- perpetuating.

One possibility might be to put some dentists on salaries, to preserve the preventive philosophy while removing the temptation to neglect mouths full of fillings. Denmark's system of salaried dentists has been so successful that less is spent on treating decay than on repairing front teeth broken by accidents. But debate on this has been stalled until the Government publishes its Oral Health Strategy, which has been drafted and presented to ministers but still not yet released to the public.