Sir, I feel I must reply to the paper on An audit of referral practice for patients with impacted palatal canines and the impact of referral guidelines (BDJ 2006; 200: 493–496) by Drs Hassan and Nute.

The article states that a prospective two extra audits undertaken at Basildon and Southend hospitals between September 2001 and September 2003 suggested that patients who are regular attendees with unerupted palatal canine teeth should be referred by the age of 12 years. Surely this is far too late for any simple interventive treatment to be initiated other than as was mentioned in the paper, normally surgical removal or surgical exposure.

When I was at dental school in the mid-1970s at Leeds, the late John Wigglesworth always insisted that radiographs should be taken by the age of nine years to determine the likelihood of possible impaction and perhaps commence such interventive measures as described in the paper.