Sir,- It is a matter of profound regret to me that in spite of reading 'Does the dental profession know how to care for the primary dentition?' (BDJ 2003, 195: 301) three times that I remain at a complete loss to understand what is being suggested.

However I am certain of one thing. To suggest that High Street dentists treating the deciduous dentition are at risk if they do not follow BSPD policy in respect of a comprehensive restorative approach because expert specialists in paediatric dentistry think otherwise is totally misleading. The authors go on to suggest that non-intervention is seen by many paediatric specialists as complacency, or at worst, neglect.

Thank goodness neglect is still decided by the courts who allow High Street practitioners treating the primary dentition to be judged by their peers and not by paediatric specialists, or worse still, consultants in Dental Public Health.

The authors of the paper K. M. Milsom, M. Tickle and D. King respond: The main purpose of writing the opinion paper was to call for more high quality research to be undertaken in the field of paediatric dentistry and the authors agree that GDPs are likely to find the BSPD guidelines a somewhat challenging document. In particular the BSPD statement that stainless steel crowns are the 'restoration of choice'1 for the primary molars with two surface caries is difficult to accept, given the available evidence.

However, in the event of a GDP being challenged over his care of the primary dentition, it is unlikely that a peer of the GDP will be called, but rather it is more likely that a paediatric specialist will be asked to give his/her opinion. The British Society of Paediatric Dentists is very clear what constitutes optimal restorative care and will judge the performance of the GDP accordingly. We have to ask ourselves whether the guidance, produced by specialists in paediatric dentistry is a reasonable benchmark against which to judge the performance of High Street dentists.