Management of compromised first permanent molars in a cohort of UK paediatric patients referred to hospital‐based services

Abstract

Background There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis. Aim To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth. Design A service evaluation was undertaken, based on case records of medically fit children (6‐11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post‐eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter‐rater kappa 0.96/0.82). Results From 349 records screened over a 4‐month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst‐affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs. Conclusion Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia.

Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis

“…Another UK‐based study that evaluated hospital management of cFPM in children found that 81% ( n = 201) had extraction of at least one cFPM. Of this extraction cohort, 97.5% or extractions were completed under GA 5 . Clinical protocols have been published supporting the timely removal of cFPMs to promote natural space closure in certain clinical situations, whilst highlighting the importance of systematic assessment and multidisciplinary input 6,7 …”

“…(n = 201) had extraction of at least one cFPM. Of this extraction cohort, 97.5% or extractions were completed under GA. 5 Clinical protocols have been published supporting the timely removal of cFPMs to promote natural space closure in certain clinical situations, whilst highlighting the importance of systematic assessment and multidisciplinary input. 6,7 The costs and longer-term outcomes of retaining or extracting cFPMs are likely to differ markedly.…”