Hall technique reviewed

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. bdj@bda.org. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.

Sir, we read with interest the recent publication by Roberts et al.¹ We recently surveyed a group of dentists to establish what experience they had in using Hall Technique preformed metal crowns (HTPMC) and any perceived barriers to their use. Of the 90 respondents (70 foundation/core training dentists [DFT/DCT]; 20 GDPs, 3–44 years post-qualification), over 80% had been trained in the use of HTPMC; however, only 16% had placed one in the previous 12 months. Emerging themes regarding limited use related to limited availability of crowns/funding and limited level of confidence/experience with the technique. Roberts et al.,¹ also cited this latter factor.

In our study only 40% of DFT/DCTs reported they had access to PMCs. This is disheartening given PMC placement is part of the foundation training curriculum and a requirement for completion of foundation training.² HTPMC call upon practitioners to seal in caries where traditionally it was removed,³ a concept that requires confidence and skill in a different approach. In our survey, some were unclear about 'how much decay to remove' which demonstrated a lack of familiarity with HTPMC.

Cost was another barrier that emerged from our survey. Respondents felt that the current Units of Dental Activity at Band 2 in England and Wales did little to encourage use of the technique. In Scotland, where a fee-per-item system remains, the number of PMCs placed almost quadrupled between 2005-6 and 2015-16, rising from 2,746 to 10,711.⁴ A recent study indicated a mean positive cost difference of £45.20 in favour of HTPMC when compared to conventional caries management.⁵

In conclusion, both Roberts et al.¹ and our survey, in different practitioner groups, suggest similar barriers to HTPMC use across the dental fraternity. Issues relating to further training, PMC availability and funding need to be addressed to ensure that patients can receive evidence-based management for carious primary molars in all settings.