As a former practising NHS and private dentist, and now an archaeological scientist focusing on teeth, it concerns me that we are still fixated on brushing as a means of preventing tooth decay in children, with Labour saying it would roll out supervised toothbrushing in schools for three- to five-year-olds (Pliers, abscesses and agonising pain: Britain’s dental crisis – as seen from A&E, 30 January). Tooth decay is caused by the presence of sugar in the mouth, and prevention must focus on the frequency of sugar intake. Confining sugars (whether refined or those considered natural, such as in fruit juices and honey) to main mealtimes would have a much greater effect than any amount of brushing. We archaeologists in England refer to the period when refined sugar was unavailable to most of the population as BC: Before Cadbury’s. Dr Julia Beaumont Bingley, Bradford The agonising state of dentistry points clearly to where the current trajectory of the NHS is leading for all services: two-tier provision, where the ability to pay will come to determine access to good care. The tragic lack of ambition in Labour’s restorative proposals (700,000 more appointments, supervised brushing in schools – no more than a sticking plaster) would have Nye Bevan resigning once again, were he still in the fight for universal care. In addition to a new dental contract, what we need now is a bold commitment to a publicly provided NHS (including abolition of dental charges) and an end to private involvement; an NHS funded to succeed, not defunded to fail; respect and decent pay and conditions for all health workers; reinvestment in public health and an onslaught on health inequalities; and a rebuilt, restored and expanded service fit for the pandemic era. This is not only necessary to support a strong economy but will add huge value to people’s lives. Dr John Puntis Co-chair, Keep Our NHS Public; retired consultant paediatrician The recent article on access to emergency dental care in Britain is manifestly not about Britain but about England. In Scotland, access to routine care is similarly constrained by the post‑pandemic, post-Brexit shortage of dentists, but emergency and urgent NHS care is available to all, including at weekends. School nurses and dentists in England may perceive an increased prevalence of dental decay in children, but the evidence in Scotland, from the annual national dental inspection programme, is that the anticipated increase in dental caries (tooth decay) did not materialise. However, the proportion of decay that had been treated has declined. Dental extraction remains the single most common reason for small children to be admitted to hospital across the UK, but that is a significant improvement on the situation 30 years ago, when admission for paediatric dental extractions exceeded all other reasons combined. Morag Curnow Caputh, Perth and Kinross Before the creation of the NHS, all dentistry was private. The only treatment affordable for many people was to have all their teeth out. I have seen an article in a professional magazine from about 90 years ago, which estimated that at that time 40% of the population had no teeth. Alasdair Gibson Ledbury, Herefordshire