[8 years of peer review in the context of accreditation].

In order to maintain the quality of care, dental professionals must be enabled to update their knowledge on a regular basis. This can be achieved by continued education (lectures), but management techniques as well as regulations and legislation also have their influence. None of the aforementioned is equally effective or applicable. In 1998, peer review became a compulsory element of the system of accreditation for Belgian dentists. Peer review is an adaptation to the medical (dental) situation of what is known as a quality circle in management sciences. In contrast to former general opinion, today there is only little evidence of the effect of quality management on the quality level of (dental) care. Even continuous quality improvement experts admit that their expectations have not been met so far. The reason for this might be that quality management mainly focuses on side effects of care rather than on care itself; or that the strict methodology of the quality circle is violated. This article focuses at the methodology of the quality circle, compares with the medical literature and pays attention to the reasons why, at least in Belgium, peer review may not be very successful in improving quality of dental care. This is mainly due to mandatory participation at peer review within the Belgian accreditation system, and unfamiliarity with the methodology of peer review. In order to obtain quality improvement one must take integrated measures that effectively aim at multiple facets of a problem. If as many dentists as possible are to be involved, one has to guarantee a free choice between multiple alternatives in order to keep professional knowledge up to date.