Sir, it was with interest and a degree of disappointment that I read the paper by Patel and Taylor (BDJ 2016:221: 561–564) regarding the late referral of impacted canines.

I have been working part time in general dental practice in Surrey for 35 years. Over the last ten years I have been to numerous postgraduate courses and BDA meetings throughout the region when orthodontic consultants have preached the importance of detecting and not only referring cases of impacted canines but also the benefit of extracting the deciduous canine illustrated by dramatic serial radiographs. I am sure that this is also included in their lectures to F1 (vocational training) courses (indeed in the MOS course that I give each year to an F1 contingent I mention the benefit that can often be had by extraction of the deciduous canine in my section on surgical exposure of ectopic canines!).

I note in the article that much of the blame was placed on specialist orthodontists, probably due to their very long waiting lists. Having said that, I would assume that whilst a child was on the specialist orthodontist's waiting list he or she would still be attending their own general dental practitioner for routine check-ups. In my opinion I consider it is incumbent on a general practitioner who feels that the opportunity for this simple interceptive measure is running out that he or she should carry on and extract the deciduous canine. If they are not sure there is always the opportunity to show the radiograph to a local orthodontic consultant to confirm the treatment plan.

1. London