Sir, I am concerned by the conclusions drawn in the research paper by Pine et al. (BDJ 2006; 200: 45–47), which suggest that we should be filling and extracting more deciduous teeth in order to reduce oral sepsis. This does seem to be a rather unsettling idea.

Treatment of the deciduous dentition is problematical and, as the authors state, the evidence for intervention must be weighed against the risks of intervention. No-one, from either side of this argument, has an approach that is going to be successful 100% of the time.

My many years in practice, however, have shown that year on year we are presented with fewer children in pain and fewer children with 'fat faces', and approaches to treatment should reflect these changes.

The old chestnut of 'a chronic abscess can result in damage to the developing permanent tooth' should not worry dentists until proven one way or other. If it happens, how often does it happen, and in what situations? One does see the occasional hypoplastic pre-molar though they are usually second premolars rather than the first premolars one would tend to expect — the first deciduous molars being the ones that abscess more easily. Indeed hypoplastic second premolars can be seen when there has been no caries in the related deciduous molar.

Faced with a 5-year-old with gross caries, I would still prefer to adopt a preventive approach — including the regular application of F varnish and later use of fissure sealants — in an attempt to coax the deciduous dentition along until either the child is older (and less likely to be affected by the procedures), or indeed, as happens in many cases, until the teeth are naturally exfoliated. Some teeth may eventually need extracting but if I can save a 5-year-old child from extraction I would prefer to do so. Many practitioners are also aware that conventional restorations in deep cavities can accelerate abscess formation.

It is the treatment of children as 'individuals' rather than the treatment of teeth that should be paramount — guiding them through their deciduous dentition with minimal discomfort and building on positive non-interventive visits so that they emerge with their permanent dentition, untraumatised and able to cope with whatever future procedures are necessary. Indeed the child I have treated in this way often has to face the daunting task of having four permanent teeth removed, for orthodontic reasons, with local anaesthetic, as their first interventive procedure. I am still amazed at how well they cope.

I am convinced that this preventive orientated/minimally or non-interventive approach can deliver on most occasions. Others obviously feel that an increased level of fillings and extractions is the way forward. I simply find their arguments underwhelming. The fact that from 1 April 2006 interventive treatment now produces UDAs may well see more interventive treatment being undertaken, though it will be unfortunate that the data collected by the new BSA will not be able to tell us what that treatment is.