Sir, Arianne Matlin and Damien Walmsley (BDJ 2010; 209: 261) correctly highlight the common risk factor approach as being the strategy which is roundly accepted as the prime strategy of choice in the development and implementation of dental public health interventions. The voices extolling this approach have been evident for many years,1,2,3,4 however, the question remains as to the proficiency with which (if at all) this approach has been taught at an undergraduate level and whether dentists and dental teams subsequently feel empowered to use this in primary care settings. Crucial for dental teams is the use of expertise and resources based within dental public health/oral health promotion, which requires ongoing clinical engagement. Making this relationship more robust where lacking should improve the quality of oral health promotion disseminated by dental teams in primary care.

The BDA's call for commissioners to understand the needs of prisoners is a principle worth dwelling on with a broader perspective. In order to appropriately and effectively develop public health interventions for most 'difficult to reach' communities or populations, understanding them has to be the crux. Too often as clinicians we look at and treat our patients through our own vision of the world with our own cultural values. To understand a population, a community, a member of the public, is to be able to look at an aspect of their life, in this case health, through their own value systems. Doing this enables us to best provide effective interventions that may have a greater impact.4 The ability of a clinician to be culturally competent whether in public health or any other clinical field will help improve the responsiveness of patients to their interventions. The depth of understanding of cultural competence needs to be brought into the undergraduate curriculum. After graduation and in PCT land, tick box exercises in cultural awareness are too common and often a totally inadequately substitute for cultural competence. For clinicians informing commissioning decisions, cultural competence must be a fundamental cog helping them interpret local conditions.