Reader TTS

BDA ACCREDITATION CAUSES CONCERN Sir, — It is with dismay and horror that I read about the concerns linking aspartame with brain cancer. Of equal concern is that the British Dental

Association endorses products containing this potentially harmful material. I hope that they will withdraw their support for any product containing aspartame as soon as possible to separate

the profession from being accused of poisoning patients and possibly causing fatal brain tumours. If there is sufficient doubt in the minds of the researchers then who are we to dismiss

their claims? I do not think that dentists can make such decisions. What is also worrying is that there may be other products presently accredited by the BDA which may with future research

prove hazardous to human health. All the profession does not share the confidence that fluoride is absolutely safe. I personally, am not happy with its widespread use and I would warn my

patients about the possible harmful effects of fluoride use. We should avoid endorsing any products which have controversial health issues associated with them. My view is that accreditation

could be harmful to the reputation of the profession and should be discontinued. Would the BDA be willing it give accreditation to a mercury containing filling? I hope not. J. ROBERTS

ROCHDALE _DR GEOFFREY CRAIG, CHAIRMAN, BDA'S HEALTH AND SCIENCE POLICY GROUP, RESPONDS:_ _ Dr Robert's letter has been passed to me for comment and I am pleased to be able to

respond to both the general points he makes about accreditation and the specific points on aspartame and fluoride._ _In deciding whether or not to accredit the claims made for a product by a

manufacturer, the scientific experts (which include a nutritionist on the BDA's Food and Drink Accreditation Panel) do not make independent toxicological judgements. They follow the

lead of the Ministry of Agriculture, Fisheries and Food and/or the Health Departments for they are the Government agencies responsible for food and product safety._ _The alleged link between

aspartame and brain tumours in 1996 by Olney has been rebutted by the UK National Cancer Institute and the Department of Health. Aspartame is approved for use in foods and drinks under UK

law and the use of non-sugar sweetners to reduce caries is endorsed by the Health Education Authority in The Scientific Basis of Health Education (4th edition)._ _I have noted Dr

Robert's comments on the safety of fluoride. We await the outcome of the systematic review of fluoride presently being carried out for the Department of Health by the University of

York. In the meantime I suggest that no product, naturally occuring or manufactured, is absolutely 100% safe. Potential risks and known benefits have to be weighed against each other,

dosages have to be assessed and judgements made. Once this has been done it is surely right that the Association does not take the easy option of sitting on the fence but takes the action

necessary to promote good oral health._ USE OF TERMINOLOGY QUESTIONED Sir, — The article 'Teaching and assessing ethics and law in the dental curriculum' (_British Dental Journal_

1999, 187: 217–219) and the core curriculum contained therein, whilst of great importance in dealing with areas of dental practice which are a cause of concern, includes materials which are

not in accord with good law in England and Wales. I refer to the use of terminology and in particular that of the phrase 'informed consent'. In an article as influential as this it

is important that the terminology is correct since the concepts discussed will be relied on by practitioners now and in the future. The use of the term 'informed consent' in a

document purporting to deal with consent in the English Legal System is neither good law nor good practice. The English Legal System does not recognise the doctrine of informed consent even

though Lord Scarman attempted to introduce it in his judgment in _Sidaway-v-Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital_. Lord Scarman's judgment in the

House of Lord's was a minority judgment and even though the sentiments expressed there are admirable it is still not good law, being a minority judgment. The failure to recognise

informed consent as good English Law was emphasised at the Third International Congress on Dental Law and Ethics held in London in October 1998. Professor Sheila MacLean, one of the United

Kingdom's foremost authorities on health care law stated in terms which left no room for uncertainty that informed consent was not good law in England and Wales. This was a view that

was not challenged by any of the delegates present. To my personal knowledge this included a number of the authors of the proposed core curriculum. The term informed consent is used

extensively by the likes of Beauchamp and Childress, in _The Principles of Biomedical Ethics,_ 4th Edition. This is an American text where the 'doctrine of informed consent' is

recognised as good law by some, but not all, of the individual states of the USA. Beauchamp and Childress is regarded as, and used as, a standard text in the United Kingdom for biomedical

ethics teaching. However while so doing, allowance has to be made by UK teachers when dealing with concepts of consent, of the differences between the laws of the various states of the USA

and the law of England and Wales. Thus, whilst making general use of such texts as guidelines, English legal standards must be taught, including the use of English terminology. In the

present context, rather than using the terminology concerned with the doctrine of informed consent with all that it conveys for patient management and restrictions imposed on health care

professionals, an Anglicised treatment of consent is called for. A more appropriate phrase for use in England and Wales is 'Informed Decision and Reasoned Consent' though use of

the term 'real consent' is not unknown. I trust that these constructive criticisms will be taken on board by the authors. G. R. THOMAS PONTYPRIDD REPLANTATION A LAST RESORT Sir, —

The technique of extraction retrograde root filling and replantation discussed by J. M. Pilsworth (_British Dental Journal_ 1999 187: 237) was used by the late Mr O. C. Morphy here 60 years

ago. He thought that this technique should only be used as a last resort as he noticed such teeth often became ankylosed. D. J. M. BUDDERY NORFOLK RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Letters. _Br Dent J_ 187, 406 (1999). https://doi.org/10.1038/sj.bdj.4800292 Download citation * Published: 23 October 1999 * Issue Date: 23

October 1999 * DOI: https://doi.org/10.1038/sj.bdj.4800292 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a

shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative