Sir, we note J. P. Murphy's letter regarding the Hall Technique (BDJ 2008; 204: 476). We are uncertain whether this letter is meant to be a serious contribution to the scientific debate on how to manage caries in children, as it seems to mainly consist of recycled arguments from Roberts et al. (BDJ 2006; 200: 600–601), to which we have already responded (BDJ 2006; 201: 249–250). We were pleased to note, however, that environments considered suitable for the Hall Technique have been increased from 'in the field, in developing countries' (sic) to include 'war zones'.

Regarding J. P. Murphy's other comments, most are dealt with in a paper we published last year.1 Nevertheless, we answer them here:

  1. 1

    'This technique could precipitate a maxillary or mandibular cellulitis if the decayed tooth undergoes necrosis'. This is indeed a possible consequence of failing to treat a carious primary tooth. However, sealing in decay as a treatment option in our study gave results which, at two years, were comparable to conventional restorative techniques carried out by specialist paediatric dentists. As detailed in the paper, 19/124 traditionally managed teeth, compared to only 3/124 treated with the Hall Technique, went on to show clinical or radiographic signs of necrosis. These teeth (where almost half of the teeth had caries radiographically over halfway through dentine) were matched clinically and radiographically; the study was split mouth in design and the randomisation was controlled centrally

  2. 2

    'It would be difficult to monitor a tooth after a full coverage SSC was placed with radiographs'. We are at a loss to see how this would be more difficult than for a conventionally placed PMC

  3. 3

    '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.' This may be so but in 2001, Scottish Dental Practice Board records showed that only less than 0.5% of all restorations placed in children's teeth in Scotland were PMCs.2 They are simply not used in the general practice setting in the UK

  4. 4

    'Removal of decay is very simple.' It is not in dispute that the process of removing caries is simple. What is being contested is whether complete caries removal is necessary. Our study would indicate that in the case of the Hall Technique it is not. This agrees with other work much of which has been ignored by the profession for several decades3

  5. 5

    If Dr Murphy really can provide a 'pulpotomy and a PMC in six minutes', all in, then he is more of a technician than we will ever be. However, there is more to clinicianship than speedy delivery. Good clinical care involves providing effective dental treatment which children can cope with, and their dentists can deliver effectively. Our study shows the Hall Technique fulfils these criteria.

We do take exception to the comment that children in the study were 'human guinea pigs ... experimented on by the least experienced of the dental team'. The study had full Ethics Committee approval, complied to the letter with Good Clinical Practice Guidelines and above all, as with all our clinical research, the interests of the patient were held paramount. In addition, the majority of the practitioners in the study were principal GDPs in their practice and the rest were long standing associate GDPs; hardly the least experienced of the dental team! This type of ill-informed, emotive criticism is unhelpful in progressing discussion within the profession, on the management of dental caries in children.