Sir, in response to J. Stuart Robson's letter, Duty to extract,1 I wholly agree that clinicians have a duty of care to extract a child's tooth when appropriate. Many of us would do so. However, he has seemed to have missed the complete picture. Creating a positive dental experience for a young child is just as important as dealing with the underlying need for extraction. The last thing we want to do is create more dental phobics, particularly when managing the co-operation of a young child. Hence, local anaesthesia alone may not be enough. The use of sedation has its own challenges, especially the use of IV or RA sedation. Not all practices are equipped with this. Sedation is classed as an additional service under current NHS regulations hence GDPs would require separate funding and contractual approval for its use. Parents/carers may not be in a financial position to pay privately for sedation too, especially under the current difficult financial circumstances they may find themselves in. This leaves us with the difficult decision for making a referral and use of antibiotics where appropriately indicated. Not such a clear clinical world is it? Difficult decisions for us GDPs for these difficult times.