Fifteen years ago when the expenditure on the National Health Service was 2600 million pounds annually, an economic survey of the then more common procedures carried out by oral and maxillofacial surgeons in the UK was undertaken. After three reorganisations of the NHS with a fourth pending the overall cost has escalated to 21.6 billion pounds. The specialty has also seen significant change with a broader spectrum of work being carried out and a greater proportion of major cases being undertaken. The paper shows how previously costed procedures have changed; for example with increasing use of day care facilities and internal fixation techniques, before moving on to consider costings for the more advanced operations now being carried out on a regular basis. In an era of resource management with progressive stringency of funding in the acute sector it has been suggested that some procedures are uneconomical and others possibly should not take high priority. Under these circumstances it has become especially important to justify all facets of practice of the specialty and this aspect is considered in terms of the cost to the National Health Service, the quality of life of the patient and the cost to the economy as a whole in Social Security benefits and loss of productivity.