Sir, the FGDP Selection for Dental Radiography guidelines1 state that 95% of digital radiographs should be diagnostically acceptable (DA) allowing for 5% being unacceptable.

Whilst this may be feasible in general practice, working in special care dentistry poses its own challenges. Many of the patients have additional needs. Thus, taking radiographs is extremely challenging particularly if the aim is for 95% of them to be of acceptable quality.

This is particularly true of lateral obliques. These are the ‘last resort' radiographs taken for the patients with the poorest cooperation, often with a carer/family member clinically holding the patient to help with quality of the radiograph. These radiographs are of great use when it comes to planning a general anaesthetic.2

A recent audit in our service looked at a sample of OPGs and lateral obliques taken over a one-year period. The percentage of diagnostically acceptable lateral obliques was 80%. This is lower than the FGDP guidelines; however, given the patient factors we would argue this is acceptable.

When setting standards for audit, it is important to recognise that standards need to be achievable as well as aspirational, across the dental specialities. This is particularly true for special care dentistry where the patients may struggle with cooperation.