There are diverse opinions amongst dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them judge the prognosis.

Objective

To evaluate current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth.

Materials and methods

A service evaluation was undertaken, based on case-records of medically fit children (6-11 years) referred for management of cFPMs. 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 while 19.3% were managed without extraction. More than half of the extraction cases (n=105) had radiographic radiolucencies not exceeding middle third of dentine in the worst affected FPM. At the time of extraction, 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

Management of potentially restorable cFPMs in children is influenced by the local orthodontic guidelines favouring extraction approach.