Sir, as clinicians at King's College Hospital and Board members of Dental Trauma UK we read the recent paper on avulsed permanent teeth with great interest and were a little surprised by the comments made subsequently by letter.1,2

In the letter the authors mention a number of aspects of the management of dental trauma and in particular the use of orthodontic brackets for splinting traumatised teeth.2 Unfortunately, their notion that orthodontic brackets may be better than composite and wire splints for repositioning avulsed teeth is definitely not our experience, nor is it evidence based.

The letter asserts that the use of orthodontic brackets is the 'first choice' for both adult and paediatric patients in secondary care. We would disagree strongly with this, especially when considering the guidance in the dental trauma guide that the authors cited. In our opinion, orthodontic brackets are tricky to use especially by non-orthodontic specialists and most primary care practitioners are unlikely to have them readily at hand. Their suggestion that composite is 'tricky' to place in these situations is an odd one bearing in mind that most practitioners would find bonding to the buccal surfaces of anterior teeth, isolated with cotton wool and gauze, relatively straightforward.

Dental Trauma UK have published a video on quick and easy splinting using wire and composite which can be viewed at https://vimeo.com/137957560.

It is our opinion that primary care dentists have the necessary skills to effectively bond composite to tooth tissue. What they may lack is the experience and skills to diagnose and manage acute dental trauma. This was evident in the Kenny et al. study which revealed a need for appropriate postgraduate training in managing dental trauma in children; unfortunately this is likely to translate to an equal or possibly greater need in the adult patient.3 With this in mind we feel that a sensible way forward would be to introduce management of dental trauma as a core subject similar to medical emergencies. In this way dentists could be updated annually thereby going some way to improve their knowledge, skills and confidence.

Dental Trauma UK (www.dentaltrauma.co.uk) is a charity aiming to improve the management of dental trauma by raising awareness in the general public on what to do if a tooth is avulsed as well as educating dentists in the management of all of the other types of dental trauma.