Sir, we thank Dr Renton for her considered commentary (BDJ 2010; 209: 36–37) on our published article (BDJ 2010; 209: E1). There is a paucity of data on the subject of complications in relation to third molar surgery and the numbers of patients included in this study are as large as any in recent times. It is a pity that this paper was viewed in isolation, as many of the points that were raised on study design, level of supervision and surgical difficulty were dealt with in previous papers published by our group.

We are disappointed that this discussion has been hijacked into a debate on academic oral surgery versus oral and maxillofacial surgery. Third molar surgery is an integral part of training in oral and maxillofacial surgery as well as academic oral surgery and any attempt to differentiate between the two in terms of training or supervision is a politically driven speculation.

We recognise that these views do not reflect all dentists or academic oral surgeons who work very effectively in teams with oral and maxillofacial or head and neck surgeons. We agree that academic oral surgery is a growing speciality but realise that oral maxillofacial/head and neck surgeons as yet still provide the bulk of general anaesthetic operative third molar surgery. Many of these difficult cases may present with medical complications which may be better dealt with by specialists with training to recognise and deal with these problems. These are also the specialists to whom cases are referred when serious untoward events occur; to think otherwise may be disingenuous and raise medico-legal expenses. The risk of alienating our dental practice and oral and maxillofacial/head and neck colleagues does not serve the interests of patients, multidisciplinary teams or the NHS. We firmly believe in the multidisciplinary management of patients with no one speciality having provenance. Patients should be at the heart of all our actions, not speciality or self interest.

Despite the thought that this surgical training should occur in just the academic oral surgery setting, on analysis the same difficulties in training would arise. Similar problems also manifest in ENT treatments or any discipline that does not allow simultaneous direct visual access by trainer and trainee. We would be interested in the training methods indicated by the commentator so that this practice could be shared and disseminated for the benefit of all.

In summary, the patient's best interests come first. Working in a team of dentists, academic oral surgeons, oral and maxillofacial and head and neck surgeons would enable providing the best care and optimal medical/surgical managements of postoperative complications.