Sir,- I was very pleased to read the article on guidelines for referring children for extraction under general anaesthetic (British Dental Journal 2003 194: 557) and note that orthodontic extractions of sound teeth under general anaesthesia can only be justified for intellectually impaired patients. I would like to suggest adding the extraction of all four first molars for orthodontic reasons for a patient below the age of 11 to the list of those eligible for general anaesthesia.