Through discussion of the findings of a national study of general dental practitioners this paper explores the beliefs, values and practices of dentists, the factors that influence their decisions to practise in the public and/or private sectors, and their experiences of making the transition towards increased private practice. In examining particularly their ideological beliefs, attitudes to business and entrepreneurial behaviour, it considers the appropriateness in sociological thinking of the division between perspectives which have perceived professional behaviour as primarily motivated by economic self-interest and occupational control, and those which have considered professional behaviour to be characterised by altruistic values and a public-spirited concern for patient welfare.

Background-Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in the general dental service. The study reported here attempted to fill this gap. Objectives-To identify the criteria the public and users adopt in evaluating the quality of general dental care, and to identify the extent and nature of perceived concerns with general dental care. Design-Postal questionnaires were sent to random samples of adults living in an inner city area (I) and semi-rural area (R) in southern England. Fifty six per cent (1499) in area R and 48% (1388) in area I completed the questionnaire after four mailings. Follow up face-to-face interviews were done with a purposive subsample (n=50) of responders from the postal survey. Main measures-Public/user views about quality of dental care were measured through groups of questions about the importance of and satisfaction with diVerent aspects of dental care (access/ availability including cost; facilities; technical skills; and interpersonal care) and a scale (Dentsat) measuring general satisfaction was constructed from questions on diVerent aspects of care. Results-Evaluation of quality of general dental care from the users' point of view hinges on perceived technical skills, particularly pain management. Major dissatisfaction stems from concerns about costs of dental care and privatisation. Conclusions-The criteria adopted by the public/users to assess general dental care are similar to other areas of health care, apart from the priority placed on technical skills and pain management. However, the major source of decline in satisfaction with the quality of general dental care is the barrier to access created by the rising cost of dental care and the increasing involvement of dentists in private practice. This evidence suggests that the public and users find the drift towards private practice and away from NHS practice a major source of concern.

This article applies Le Grand's distinction between knightly and knavish motivations to the behaviour of dentists in choosing whether to treat patients on the NHS or privately. Using national quantitative and discursive surveys, it shows that dentists' notions of their own interests centre on independent small-business entrepreneurship and their professional culture defines patient interest in terms of access to clinically autonomous practice based on a restorative paradigm. Government attempts to promote preventive dentistry in the context of the weakening in dentists' bargaining position as general dental health improves and the determination of the profession to protect high remuneration have led to conflict. Both knavish and knightly motives (understood from the perspective of dentists' professional culture) lead dentists to exit from the NHS. Any analysis of ‘robust’ policies, designed to accommodate both motivations, must take into account social factors such as professional cultures which influence how practitioners understand their own interests and those of their clients.

The shift in the balance of NHS and private dental care reflects the interests and preferences of dentists rather than of the public. It suggests, however, that a continued shift towards private practice is a trend that the public will not find acceptable, which might limit the extent of expansion of private practice.

Dentists may have patients who develop Huntington's disease in later life, so this paper will help them consider the longer term effects of this disease and help in planning dental care.