The Hall Crown (Paediatric SSC) Notes Template
Nosht
Published by Nosht Limited
Placing a Hall crown over an undiagnosed irreversibly inflamed pulp leads to pulpectomy or extraction in months — and a complaint. Below is a template for UK paediatric clinicians to paste into their PMS, with pulp vitality assessment built in.
Why this Hall crown (paediatric) template wins
- Pulp vitality assessment recorded — without this, the Hall crown may be sealed over an inflamed pulp requiring later pulpectomy or extraction.
- Parent consent specifically covers bite change and silver aesthetics — defends against later complaints.
- Separator visit documented — proves the space creation step happened.
- GIC cement + lot number — MDR + traceability.
- SDCEP-aligned first-line — defensible against "you should have drilled the filling" criticisms (you followed UK evidence).
The template (paste into your PMS notes field)
Paste the Hall crown (paediatric) template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.
TOOTH: [FDI — primary molar — typically D or E] DENTITION: Primary INDICATION (SDCEP): [Cavitated carious lesion in primary molar / 1-2 years from anticipated exfoliation / not requiring pulpal therapy] PRE-OP ASSESSMENT: - Symptoms: [Asymptomatic / mild transient sensitivity / NO spontaneous pain (would contraindicate)] - Clinical: [Cavitated lesion / no sinus / no mobility / no swelling] - Radiograph: [BW reviewed — caries extent in dentine but no PA radiolucency / no internal resorption] - Pulp vitality: [Probable vital — based on absence of symptoms + radiographic appearance / sensibility testing usually not feasible in young child] PARENT CONSENT (Hall technique explained): - Procedure: Preformed stainless steel crown sealed over primary molar without LA or caries removal - Bite change: TEMPORARY bite opening (~1mm) for 2-4 weeks then settles via tooth movement - Open contact: Mesial/distal contact will be tight then settles - Aesthetics: Silver crown — visible in mouth - Alternative: Conventional restoration (drill + filling under LA), extraction, no Tx Parent understands and consents. SEPARATOR VISIT (if needed): [Date — elastomeric separator placed mesial and distal to selected tooth to create space for crown] CROWN SELECTION: - Brand: [3M ESPE / NuSmile preformed crowns] - Size: [Tried-in, fits snugly without binding] - Verified: [Snug fit, snaps onto tooth with finger pressure, crown extends below gingival margin] CEMENTATION: - Cement: [GIC — RelyX Luting+ / Fuji I / Ketac Cem] - Cement lot number: [Recorded] - Crown seated: [Patient bites on cotton roll / wooden stick — finger pressure 2 minutes] - Excess cement removed: [At gel state with explorer + floss interproximal] POST-CEMENTATION: - Occlusion: [Bite slightly open as expected — parent and child reassured] - Crown margins: [Sealed and intact] POST-OP ADVICE: Bite will feel different for 2-4 weeks then settles naturally. Crown stays until natural exfoliation (~age 11-12 for D and E). Brush as normal — fluoride toothpaste. Contact if crown dislodges, swelling, severe pain, or sinus develops. RECALL: 6 months for review of crown integrity + further preventive care.
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What good looks like — a worked example
The same Hall crown (paediatric) template, completed for a realistic case.
TOOTH: ULD (FDI 64) — primary upper first molar DENTITION: Primary INDICATION (SDCEP): Cavitated occlusal-distal caries ULD. Anticipated exfoliation 3-4 years (current age 8). SDCEP first-line for primary molar caries not requiring pulpal therapy. PRE-OP ASSESSMENT: - Symptoms: Asymptomatic. No spontaneous pain. Mum reports no complaints from child. - Clinical: Cavitated occlusal-distal lesion. No sinus tract. No mobility. No swelling. No abscess. - Radiograph: BW reviewed — caries extends to pulpal third of dentine but no PA radiolucency. No internal or external resorption. Permanent successor developing normally. - Pulp vitality: Probable vital — absence of spontaneous pain and radiographic features of irreversible pulpitis. Sensibility testing not feasible in 8-year-old. PARENT CONSENT: Hall technique explained — preformed stainless steel crown sealed over ULD without LA or drilling. Bite change explained (1mm opening temporarily, settles 2-4 weeks). Silver appearance acknowledged (mum agrees — primary tooth, will exfoliate). Alternative options discussed: conventional restoration with LA + drilling (child anxious, declined), extraction (loss of space, unnecessary given Hall option), no Tx (caries progression risk). Mum consents to Hall crown. SEPARATOR VISIT: 1 week ago — elastomeric separators placed mesial and distal to ULD. Today separators removed (still present). CROWN SELECTION: - Brand: 3M ESPE stainless steel crown - Size: 4 (after try-in — size 3 too small, size 5 too large) - Verified: Snug fit, snaps onto tooth with firm finger pressure, crown extends 1-1.5mm subgingivally on all aspects. CEMENTATION: - Cement: Fuji I GIC (GC) - Cement lot number: [F1-2026-03-456] - Crown seated: Child bit firmly on cotton roll for 2 minutes under finger pressure to ensure complete seating. - Excess cement removed: At gel state (~3 min) with explorer. Floss passed interproximally to remove subgingival excess. POST-CEMENTATION: - Occlusion: Bite slightly open as expected (Hall technique). Parent and child reassured this is temporary and bite will settle within 2-4 weeks via natural tooth movement. - Crown margins: Sealed and intact circumferentially. POST-OP ADVICE: Bite will feel different for 2-4 weeks then settles. Crown stays until ULD exfoliates naturally (around age 11-12). Brush as normal — continue fluoride 1450 ppm. Mum given written information. Contact if crown dislodges, persistent swelling, severe pain, or sinus tract develops (all would indicate pulpal involvement requiring further treatment). RECALL: 6 months for review of crown integrity + further preventive care + continued caries risk management.
Compliance: the medico-legal angle
- SDCEP Prevention and Management of Dental Caries in Children (3rd ed, 2025) — Hall technique is first-line for primary molar carious lesions without pulpal therapy needed.
- BSPD guidance — non-invasive paediatric caries management.
- Montgomery — parental consent including bite change and aesthetics is required.
- MDR 2017 — GIC cement is a regulated medical device; lot traceability.
Common documentation mistakes
- Hall crown placed over irreversibly inflamed pulp — leads to pain, abscess, extraction within months. Vitality assessment is critical.
- No separator visit when space is tight — crown won't seat or seats over food, causes proximal caries on adjacent tooth.
- Parent not warned about bite change — child eats unusually for days, parent panics.
- No lot number for cement — MDR breach.
- Routine 6-monthly recall without caries risk management of the underlying causes — caries continues to develop elsewhere.
Sources
- Montgomery v Lanarkshire Health Board (UK Supreme Court, 2015, UKSC 11) (accessed 18 October 2026)
- SDCEP: Prevention and Management of Dental Caries in Children (3rd edition, February 2025) (accessed 18 October 2026)
Frequently asked questions
Why Hall crown instead of conventional filling?
Conventional filling: LA, drilling, child anxiety, may need stainless steel crown anyway if cavity large. Hall: no LA, no drilling, immediate seal, evidence-based 80%+ 5-year success per SDCEP. Faster, less traumatic, comparable or better outcomes for primary molars not needing pulpal therapy. SDCEP first-line.
How do I assess pulp vitality in a young child?
Clinical proxies: absence of spontaneous pain, no swelling, no sinus, no mobility, no PA radiolucency. Sensibility testing (cold, EPT) usually not reliable or feasible in young children. Document the clinical assessment + radiographic appearance.
Do I always need a separator?
No — sometimes the crown seats without one. Try the crown first; if interproximal binding prevents complete seating, place separator and return in 1 week. Document either way.
What if the bite change is too much?
Reassure parent — primary teeth and growing alveolar bone adapt within 2-4 weeks. If after 4-6 weeks the bite remains uncomfortable, review. Adjustment of crown occlusal surface is occasionally needed but usually not required.
Can I do Hall on a permanent tooth?
No — Hall technique is specifically for primary molars (D and E). For permanent molars with cavitated caries, conventional restoration or pulp therapy is needed. Hall principles (sealing biofilm) inform some adult techniques (e.g. ART — atraumatic restorative technique) but the Hall crown itself is paediatric.
What if the Hall crown fails?
Failure modes: crown dislodgement (re-cement), pulpitis/abscess (pulpectomy or extraction), proximal caries on adjacent tooth (treat separately). 5-year success ~80% per SDCEP — failures usually present as pain or swelling within months if pulp was inflamed at placement.
Guides that cover this
- Dental Therapist New Graduate UK Guide
- Paediatric Dental Doses (UK): Antibiotics, Analgesics and Local Anaesthetic by Age and Weight
Patient leaflets for this treatment
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Nosht
Published by Nosht Limited
Nosht Limited makes structured clinical note templates for UK dental professionals. Articles refer to guidance from the GDC, CGDent, BSP, SDCEP and NICE. Check the current version of a source before relying on it.