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Re: Guest Editorial—In Pursuit of Improvement Before Excellence

52A Station Road West, Oxted, Surrey RH8 9EU, UK

Dear Sir,

Professor Stephen Richmond states in his interesting guest editorial that it is well known that a high proportion of orthodontists consistently occupy the `Top 20' earners in dentistry as a whole. He goes on to state that greater use of upper and lower fixed appliances is associated with high earners.

Anecdotal evidence of the quality of treatment of high earners is good and the length of treatment seemed to be similar to the average.

If these high earners are already using multiple dental nurses with expanded duties carrying out much of the treatment under delegation they are distorting the treatment timings of the General Dental Services and flying close to the wind with the General Dental Council. This will ultimately lead to a cut in orthodontic fees and a disincentive for fixed appliance treatment. Orthodontic auxilaries should be properly trained and registered.

An additional source of income would be an 80% patient charge for NHS treatment which would create a more level playing field with the general dentistry budget and encourage more private treatment.

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