Oral health Treating refugees Sir, the article titled Personal account: A drop of dentistry in the jungle (BDJ 2016; 220: 160–163) highlighted the appalling conditions in the refugee camps set up in Calais as well as providing us an insight into the poor oral health status of many of the camp’s residents. As dental students this motivated us to make the journey from Cardif to Calais with a team of qualifed medical and dental professionals with the aim of providing dental aid. As we arrived by the camp, the mood in the car subtly shifed to a tense silence as we saw smoke masking the entrance. With many media outlets reporting that the camp was in the process of being completely demolished, all residents having been cleared, news of fres and riots spreading, there was an unspoken anxiety about what we might encounter. Entering the ‘jungle’ was almost dream-like: the blazed periphery gave us a view into the vast landscape which once had many thousands living in such horrid conditions. Contrary to media reports we drove past hundreds of residents until we came to a halt somewhere in the depths of the camp, where nearby, teenage boys were playing a game of volleyball. We decided the best way to maximise patient treatment would be to set up a basic triage system equipped with three plastic chairs we spotted by a nearby tent. As students, our duties involved distributing toothbrushes and tooth- pastes, providing oral hygiene instructions, helping to efectively maintain the triage system and mixing GIC or Kalzinol. Te clinicians treated over 100 cases of acute dental emergencies, with many patients in pain from toothache that they had been sufering from for weeks. Te majority of dental treatment involved excavating and temporising large carious lesions; however, we also came across complicated and uncomplicated crown fractures in children caused by trauma whilst playing. A young lad with acute necrotising ulcerative gingivitis also presented but we could only provide treatment with local measures by carrying out hand scaling and oral hygiene instructions. Te most perplexing case we encountered all day was a lady with her buccal maxillary gingivae coloured dark blue but with no obvious signs of pathology; however, afer eventually fnding a translator we were reassured it was a cultural practice of tattooing the gums! Te reality of the poor oral hygiene levels amongst the camp was now fully understood as almost every patient presented with carious lesions with resulting pain. It was heart-breaking knowing we could only provide a limited amount of treatment. Besides the dentistry, it was touching to connect with the stories of struggle and sacrifce of the camp’s residents, many of whom were feeing from war and persecution. As the Calais camp has now been demolished, we hope our friends have now been reallocated to better living conditions and are provided with the very basic human needs we all require. We would urge all dental professionals to partake in such charitable causes and ofer their skills in the service of humanity. S. M. Hussain, H. Sheikh, A. Amir, A. Al Hassan, by email DOI: 10.1038/sj.bdj.2017.843 Unsupported conclusions Sir, we read the article entitled Motivational interviewing in general dental practice: A review of the evidence by E. J. Kay, D. Vascott, A. Hocking, and H. Nield (Br Dent J 2016; 221: 785-791), which presents a systematised review of the evidence in relation to motiva- tional interviewing (MI) in dental practice. Tis approach to changing oral health behaviours and habits is an emerging and signifcant theme. Considering their proposed objective, the authors concluded that the MI technique has the potential to beneft patients with poor oral hygiene and suggested that MI training for oral healthcare professionals can be added to the established set of practices. However, we observed that only two of the eight articles included are intervention studies that use the MI-based approach specifcally to treat patients with periodontal disease. 1,2 Of the remaining studies, one addresses the cost-efectiveness of the intervention 3 without analysing clinical results as the main outcome. Another study 4 claimed to apply an MI-based approach, but according to the methods described it does not fall under the assump- tions and techniques described by Miller and Rollnick. 5 Tree articles did not use MI-based approaches, 6-8 and one is a qualitative study 9 that only describes the approach used by dental hygienists. Lastly, one study is not cited in the references, making it impossible to determine whether the intervention involved MI or not. Te evidence found by the authors does not support the conclusions, neither regarding better oral health among patients, since the studies included did not synthesise sufcient and adequate evidence for this conclusion, nor professional training, given that none of the articles assessed this aspect for oral health teams. Moreover, we believe that MI is not centred solely on providing additional skills and techniques for clinical practice, as proposed by the authors. MI involves changing professional attitudes and conduct to establish a dialogue about change, promoting self-efcacy and helping patients change their unhealthy oral health behaviours. It is important for readers to understand that MI is a specifc approach, with assumptions and techniques described by Miller and Rollnick, and should not be confused with other behavioural approaches. 10 Tere is more robust evidence available to understand the Letters to the editor COMMENT Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. Email bdj@bda.org. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A ‘Readers’ Comments’ section appears at the end of the full text of each letter online. BRITISH DENTAL JOURNAL | VOLUME 223 NO. 7 | OCTOBER 13 2017 463 UPFRONT OfficialjournaloftheBritishDentalAssociation.