Sir,- It is incredible that the authors do not mention the word 'prevention' even once in a two-and-a-half page article concerning 'how to the care for the primary dentition' (BDJ 2003; 195: 301).

It appears that, in drawing battle lines over the care of the primary dentition, the authors have chosen the wrong opponent (specialists in paediatric dentistry) on the wrong battleground (restorative treatment decisions for deciduous teeth). The authors state in paragraph two 'The records show that nearly half of the (regularly attending) children (48 per cent) had experienced at least one episode of pain...' and in paragraph four they say 'It would appear that GDPs have learned experientially how to deal with the problem of caries in the primary dentition.... This approach is largely successful...'

In the words of John McEnroe 'You cannot be serious!' - half of the children experienced pain and this is 'largely successful'?! Surely the opponent here is the disease caries. The battleground should be the way in which (and how much) dentists are paid to deal with the disease in terms of primary, secondary and tertiary prevention (restorations being but one part of the latter).

The authors of the paper K. M. Milsom, M. Tickle and D. King respond: It is disappointing that the respondent sees the dental care of children as a 'battleground'. The authors feel that their research raises valid questions about the optimal approach to the dental care of children and they seek a rational debate on the matter.

The BDJ article drew the attention of the reader specifically to differences in restorative approach between the British Society of Paediatric Dentistry and 50 general dental practitioners in the north west of England. Despite there being very clear differences, in the hands of GDPs, 80 per cent of carious primary molars exfoliate without causing pain. It is difficult to argue that this is not success.

Almost half of the children in the study experienced dental pain. Given that all the children had two surface molar caries, it is perhaps surprising that the figure was not higher. Disappointingly, increased restorative care did not reduce pain experience. The logic of this observation must be that effective prevention of caries is the optimal approach and the authors wholeheartedly support this position. 1