Sir, as a practising wet fingered paediatric dentist I have considered the 'Hall' technique regarding placement of preformed stainless steel crowns (SSC) and entombing decay on deciduous teeth. My main concern with the 'Hall' procedure is that this technique could precipitate a maxillary or mandibular cellulitis if the decayed tooth undergoes necrosis. It would be difficult to monitor a tooth after a full coverage SSC was placed with radiographs. I have seen severe infection occur post-op when similar compromised paediatric dentistry was performed on a child who had less than stellar cooperation in the dental chair.

Nevertheless, the 'Hall' procedure could possibly serve a need in an area where little or no access to a dentist for the foreseeable future is the state of affairs. For example, in a war zone, or on a mission service in a remote area, I could justify the 'Hall' technique on deciduous teeth. I do not see the need for this procedure in the every day practice of paediatric dentistry.

The administration of infiltration local anaesthesia with mesial, distal, and occlusal preparation of the deciduous tooth for a preformed SSC is a very straightforward affair. Deciduous teeth cut like butter if a coarse diamond is used for the preparation. Removal of decay is very simple. Use of inhalation sedation and topical anaesthesia helps even the most recalcitrant of youngsters allow care to be delivered effectively.

If the decay penetrates the pulp, a pulpotomy is done forthwith. It takes approximately six minutes to perform a stainless steel crown and a pulpotomy for an experienced practitioner. If the practitioner cannot perform the procedure efficiently, the child should be transferred to a practitioner who can.

Children are the most sophisticated of patients. They require finesse and an art of delivery of care that supersedes even the most discriminating of adult patients. Children are not human guinea pigs to be experimented on by the least experienced of the dental team. Rather, it should be the most senior and experienced partner who cares for the child patient. They know what doesn't work!

Thank you for allowing me to express my concerns.