Sir, Pine et al.'s paper (BDJ 2006; 200: 45–47) concludes on the filling side of the 'to fill or not to fill' deciduous teeth argument. Only 4.8% of those surveyed (n = 6,964) experienced sepsis. Eleven per cent of those experiencing sepsis were from most deprived backgrounds with 2% from least deprived backgrounds. This supports the work of others in that caries in 5-year-olds is found mainly but not exclusively in deprived populations.1

I totally agree with the authors if the only aim from care is to eliminate sepsis in 5-year-olds. However, as a GDP caring for a socio-demographic profile with large deprived and affluent population sub-groups.2 I fear attempting to fill all deciduous teeth would be counterproductive.

Parents from deprived and affluent backgrounds with caries active 5-year-olds have one thing in common – a particular mindset for childcare that supports caries active oral environments in their children.

The mean dmft for those with dental sepsis is 6.3 suggesting that this group of children would require extensive restorative work. There is a risk that embarking on such treatment would alienate the client group with possible failure to complete treatment thus increasing unsupervised sepsis. This risk, in my experience, is real when attempting such an approach to care although I have no evidence to support this statement.

An alternative behavioural approach to care would be to focus on developing ongoing continuing care with appropriate, realistic, measurable, positive, important, time-related and specific goals.

The primary goal is access and regular attendance so that if sepsis is observed appropriate treatment can be instigated. During continuing care non-verbal communications should communicate self-responsibility for disease inactivity with specific advice as to how to achieve this. There is a danger that filling deciduous teeth in children with disease active oral environments communicates inappropriate responsibility for oral health. That is the belief that it is normal/okay to have disease active oral environments and when disease appears the dentist fills teeth.

Another goal is to engage with adequate numbers of patients from backgrounds reflecting the social profile of the surrounding community. Practice protocols can deploy resources so as to target disease active sub-populations. Such an approach has been reported in the literature.3

Clearly the 'to fill or not to fill' debate is too simplistic to be based on a two-dimensional medical model of health.