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Inside Dentistry
July 2015
Volume 11, Issue 7

6. Would dentists who treat children using the Hall Technique also use it for their own children or young extended family members who develop caries lesions in primary molars? Would they use the method for a child of a dentist, physician, microbiologist, or an attorney?

7. What about ethical, financial, and medico-legal implications of the Hall method? How can a dentist ethically charge or accept a stainless steel crown fee knowing that worthy, proven care for the child not only wasn’t attempted or achieved, but rather was purposely avoided? We recognize that dentists use various means to provide “interim” (ie, “temporary” or “sedative”) restorations for urgent care in certain cases, such as in military settings or emergency care visits. However, the Hall Technique is not characterized by its proponents as “interim,” and there is no separate third-party billing code for crowns placed with this technique.

We cannot imagine third-party dental insurance carriers willing to send payment checks for dentists voluntarily abrogating their responsibility to treat children in a proven, acceptable manner that has been known for more than half a century as the standard of care. How would a dentist explain the Hall Technique when an insurance carrier initiates an audit of patient records? In addition, we wonder how dentists can explain to parents about the inevitable failures when a compromised technique was purposely used knowing that infected tissue was hidden rather than removed prior to crown placement. Medico-legal implications and ethical concerns have yet to be addressed by Hall Technique proponents.

Our Responsibility

We were glad that the Ludwig et al study6 was published, because it exposes the Hall method for scrutiny by dentists in the United States. This is not the first technique, and most assuredly won’t be the last, that was introduced as a way to provide dental treatment in an expedient manner. One recalls the enthusiasm with which the Sargenti endodontic filling method was embraced to make things easier for the dentist. To what end?

We also sincerely hope that publication of the Ludwig et al study and this Viewpoint essay launch a serious soul-searching evaluation of what we do for children, what measures of success we use, and how serious we are about teaching the principles of excellent restorative dentistry in our schools and in the scientific literature of dentistry. It is paramount we remember that attached to that primary molar is an innocent, vulnerable young person whose parents are trusting us to know the science and art of what we are doing, and to do the right thing for their child.

 

About the Authors

Theodore P. Croll, DDS
Affiliate Professor, Department of Pediatric Dentistry
University of Washington School of Dentistry
Adjunct Professor, Pediatric Dentistry
University of Texas Health Science Center at San Antonio
Private Practice, Pediatric Dentistry
Doylestown, Pennsylvania

Constance M. Killian, DMD
Adjunct Associate Professor of Pediatric Dentistry
University of Pennsylvania
Private Practice, Pediatric Dentistry
Doylestown, Pennsylvania

Richard J. Simonsen, DDS, MS
Dean, College of Dental Medicine
University of Sharjah
United Arab Emirates

 

References

1. Croll TP. Preformed stainless steel crowns: an update. Compend Contin Educ Dent. 1999;20(2):89-106.

2. The Hall Technique: A minimal intervention, child centred approach to managing the carious primary molar brochure. University of Dundee website. http://dentistry.dundee.ac.uk/sites/dentistry.dundee.ac.uk/files/3M_93C%20HallTechGuide2191110.pdf. Accessed May 22, 2015.

3. Innes NP, Stirrups DR, Evans DJ, et al. A novel technique using preformed metal crowns for managing carious primary molars in general practice - a retrospective analysis. Br Dent J. 2006;200(8):451-454.

4. Innes NP, Evans DJ, Stirrups DR. The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health. 2007;7:18.

5. Innes NP, Evans DJ, Stirrups DR. Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res. 2011;90(12):1405-1410.

6. Ludwig KH, Fontana M, Vinson LA, et al. The success of stainless steel crowns placed with the Hall technique: a retrospective study. J Am Dent Assoc. 2014;145 (12):1248-1253.

7. Dean C. Wholly untested. Br Dent J. 2006;201(2):68-69.

8. Nainar SM. Success of Hall technique crowns questioned. Pediatr Dent. 2012;34(2):103.

9. Evans DJP, Southwick CAP, Foley JI, et al. The Hall technique: a pilot trial of a novel use of preformed metal crowns for managing carious primary teeth. University of Dundee website. www.app.dundee.ac. uk/tuith/Articles/rt03.htm. Accessed May 22, 2015.

10. Croll TP, Epstein DW, Castaldi CR. Marginal adaptation of stainless steel crowns. Pediatr Dent. 2003;25(3):249-252.

11. Webber DL. Gingival health following placement of stainless steel crowns. ASDC J Dent Child. 1974;41(3)186-189.

12. Myers DR. A clinical study of the response of the gingival tissue surrounding stainless steel crowns. ASDC J Dent Child. 1975;42(4):281-284.

13. Handelman SL, Buonocore MG, Heseck DJ. A preliminary report on the effect of fissure sealant on bacteria in dental caries. J Prosthet Dent. 1972;27(4): 390-392.

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