The Prevalence, Severity and Pattern of First Permanent Molars’ Dental Caries in Children Attending A Postgraduate Dental Hospital: A Retrospective Study

@#Introduction: First permanent molars (FPMs) erupt early and their anatomy and location leave them susceptible to dental caries. This study aimed to retrospectively determine the prevalence, severity and pattern of dental caries of FPMs and investigate their relationship if any with demographics and medical health status of the partcipants. Methods: This was a retrospective cross-sectional study. A sample of the digital case notes and radiographs of children aged 5 to 12 years who attended the only postgraduate dental hospital in Dubai were accessed. The recorded data included the children’s demographic variables and the carious status of each FPM as recorded in the notes on the initial assessment. Descriptive and statistical analyses were conducted (P<0.05). Results: A total of 2984 FPMs were obtained from the digital records of 774 children. Their mean age was 8.07 (±2.23) years and only those that met the inclusion criteria were included in the study. The prevalence of dental caries and mean Decayed Missing Filled Surfaces of FPMs, were 42% and 0.3 (±0.04), respectively. The most prevalent decayed surface was the occlusal (29.2%), followed by mesial, buccal, palatal/ lingual, distal surfaces (24.2 %; 6.6 %; 3.1 %; 2.3 %) respectively. Children with medical problems and/or special needs had a significantly higher level of caries in the buccal surfaces (12.3%) (P=0.042). Conclusion: Caries of FPMs in a sample of Dubai children studied was prevalent, especially in those with special healthcare needs, thus indicating a necessity for targeted prevention and treatment focused on these keystone teeth.

Prevalence and Severity of Ectopic Eruption of First Permanent Molars in Pediatric Patients in Makkah, Saudi Arabia.

Background Early detection and management of ectopic eruption (EE) of first permanent molars (FPMs) are crucial to avoid complicated treatments later. Aim This study aimed to assess the prevalence and severity of EE of FPMs among children in Makkah, Saudi Arabia. Methods This retrospective study was based on a radiographic evaluation of 1,008 dental panoramic radiographs performed for children attending the Dental Educational Hospital at Umm Al-Qura University and the Security Forces Hospital in Makkah. Patients' age, sex, tooth location, and severity of EE were assessed. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies.  Results Of the 1,008 reviewed cases, 18 (1.79%) were diagnosed with EE of FPMs. Among the 11 male patients, 81.82% showed severe EE, while 57.14% exhibited moderately severe EE among the seven female patients. The prevalences of EE in the maxilla and mandible were 1.59% and 0.20%, respectively. In contrast, the occurrence of EE of FPMs was similar between the right and left sides. Conclusion In this study, the prevalence of EE of FPMs among children in Makkah was 1.79%. The frequency and severity were both greater in male patients compared to female patients. While significantly more EE of FPMs was observed in the maxilla than in the mandible, there was no significant difference between the right and left sides.

Delayed eruption of permanent maxillary first molars among Saudi children: A cross-sectional study.

Aim: This retrospective cross-sectional study aimed to determine the prevalence of delayed development and eruption of permanent maxillary first molars (U6) and associated dental anomalies in a sample of Saudi children. Material and methods: In total, 10,232 panoramic radiographs from 9,672 patients were screened for delayed U6 eruption. Radiographs showing delayed U6 eruption were further examined for associated dental anomalies. The dental age of participants was estimated using The London Atlas of Human Tooth Development and Eruption. Result: Twenty cases of delayed U6 eruption were found, with a prevalence of 0.2%. Of these patients, 3 and 17 were males and females, respectively; 9 and 11 cases were unilateral and bilateral, respectively. Congenital absence of the adjacent permanent second molar was observed in 8 cases, and the congenital absence of permanent teeth, except the adjacent second permanent molar and third molar, was observed in 6 cases. Peg-shaped lateral incisors were observed in 6 females. No significant associations were observed between delayed U6 eruption and dental anomalies. Overall, the average delayed U6 eruption was 2.3 years for males and 2.8 years for females. Conclusion: Among a sample of Saudi children, the prevalence of delayed U6 eruption was 1 in 483 (0.2%) and five times higher in females. No significant associations were found between delayed U6 eruption and dental anomalies; however, congenital absence of the adjacent permanent second molar was observed in 40% of cases.

MIH and compromised permanent first molars. When and which teeth to extract: guidelines / MIH et premières molaires permanentes compromises. Quand et quelles dents extraire : lignes guides

Introduction: The prevalence of molar incisor hypomineralisation (MIH), the degree of severity of experienced molars, their medium-term survival rate are factors that have reintroduced the decision to extract first permanent molars, forced extractions or chosen therapeutic option. Material and method: The author summarizes pedodontic and orthodontic clinical studies in the management of patients with compromised first permanent molars in order to analyze the consequences of single or multiple extractions of these teeth. Results: Firstly, the consequences of extractions of the first permanent molars in the absence of malocclusion are studied. The goal is the establishment of all the teeth without orthodontic treatment. The impact of the age at which the extraction is practiced is a key factor. In a second step, extractions of first permanent molars in the presence of orthodontic anomalies are analyzed to define the optimal therapeutic strategies, the precautions during these treatments, the contraindications. Consultation and good coordination between the generalist dentist / pediatric dentist and orthodontist are the key factors for stable and functional end-of-treatment results and optimized treatment duration. Discussion: Clinical experience and knowledge make it possible to properly select patients qualified for these therapies who obtain multidisciplinary planning and good biomechanical control. Conclusion: By bringing together optimal decision-making conditions, extraction is a therapeutic option that often proves to be superior to a restorative option in providing our patients with the greatest long-term service.

Introduction: La prévalence de l'hypominéralisation molaire incisive (MIH), le degré de sévérité des atteintes molaires, leur taux de survie à moyen terme sont des facteurs qui ont réintroduit la décision d'extraction de premières molaires permanentes, extractions forcées ou option thérapeutique choisie. Matériel et méthode: L'auteur fait la synthèse des études cliniques pédodontiques et orthodontiques dans la prise en charge des patients présentant des premières molaires permanentes compromises afin d'analyser les conséquences des extractions unitaires ou multiples de ces dents. Résultats: Dans un premier temps, les conséquences des extractions des premières molaires permanentes en l'absence de malocclusion sont étudiées. Le but est la mise en place de l'ensemble de la denture sans traitement orthodontique. L'impact de l'âge auquel est pratiquée l'extraction est un facteur clé. Dans un second temps, des extractions de premières molaires permanentes en présence d'anomalies orthodontiques sont analysées permettant de définir les stratégies thérapeutiques optimales, les précautions lors de ces traitements, les contre-indications. La concertation et la bonne coordination entre praticien traitant/pédodontiste et orthodontiste sont les facteurs clés pour des résultats de fin de traitement stables et fonctionnels et une durée de traitement optimisée. Discussion: L'expérience clinique et les connaissances permettent de bien sélectionner les patients éligibles à ces thérapeutiques qui nécessitent une planification pluridisciplinaire et un bon contrôle biomécanique. Conclusion: En réunissant des conditions optimales de décision, extraire est une option thérapeutique qui se révélera souvent supérieure à une option restauratrice pour offrir à nos patients le plus grand service à long terme.

Damaged first permanent molar: how conservative can we be? / Première molaire permanente délabrée : jusqu'où peut-on être conservateur ?

Introduction: It is a fact reported in the literature that the first permanent molar is the most frequently decayed tooth. Our treatment choice is based mainly on two clinical criteria: the degree of coronal decay and the damage to the pulp tissue. In the absence of pulp tissue necrosis, the following therapeutic gradient: indirect pulp capping, direct pulp capping, partial pulpotomy, cameral pulpotomy should be implemented with the objective of maintaining pulp vitality regardless the degree of maturity of the molar. Discussion: In the case of pulp tissue necrosis, if the tooth is immature, stopping root construction and apical closure requires an apexification or endodontic regeneration technique. The prognosis of these necrotic teeth remains uncertain in the medium and long term (risk of fractures). This raises the question of the indication for avulsion of the first permanent molar (FPM). Objectives: The main objectives of this article are to present the means of conservation and their limits. Conclusion: The decision to retain a FPM is based on several criteria, including assessment of pulpal status (which remains problematic, especially on immature permanent teeth) and the feasibility of coronal restoration. The decision to retain or extract a FPM must be the subject of a multidisciplinary discussion between a paediatric dental surgeon and a specialist qualified in dentofacial orthopaedics.

Introduction: C'est un fait rapporté dans la littérature : la première molaire permanente est la dent la plus fréquemment délabrée. Notre choix thérapeutique repose principalement sur deux critères cliniques : le degré de délabrement coronaire et l'atteinte du tissu pulpaire. En l'absence de nécrose du tissu pulpaire, le gradient thérapeutique suivant : coiffage pulpaire indirect, coiffage pulpaire direct, pulpotomie partielle, pulpotomie camérale doit être mis en œuvre avec pour objectif de maintenir la vitalité pulpaire quel que soit le degré de maturité de la molaire. Discussion: En cas de nécrose du tissu pulpaire, si la dent est immature, l'arrêt de l'édification radiculaire et de la fermeture apicale requiert une technique d'apexification ou de régénération endodontique. Or le pronostic de ces dents nécrosées reste incertain à moyen et long termes (risque de fractures). Se pose alors la question de l'indication d'avulsion de la première molaire permanente (PMP). Objectifs: Les principaux objectifs de cet article sont de présenter les moyens de conservation et leurs limites. Conclusion: La décision de conservation d'une PMP repose sur plusieurs critères dont l'évaluation du statut pulpaire (qui reste problématique, surtout sur dent permanente immature) et la faisabilité de la restauration coronaire. La décision de conserver ou d'extraire une PMP doit faire l'objet d'une discussion pluridisciplinaire entre chirurgien-dentiste pédiatrique et spécialiste qualifié en orthopédie dento-faciale.

Management Of Ectopic Eruption Of Bilateral Mandibular First Permanent Molars: A Case Report And Literature Review.

Ectopic eruption of the first permanent molars is a local eruption disturbance. The frequency of ectopically erupted first permanent molars is predominant in boys and primarily affects the maxilla. Interceptive treatment for irreversible ectopic eruptions should be initiated early to prevent space loss and the impaction of the second premolars. Herein, we report the case of a six-year-old girl with irreversible ectopic eruption of the bilateral mandibular first permanent molarstreated with a modified lingual arch. The mandibular first permanent molars were successfully distalised after six months of treatment, and one year of follow-up showed a satisfactory outcome. The modified lingual arch satisfies not only the clinical aspects of treatment but also the patient's well-being. However, the lingual arch may disturb tooth eruption in the mixed dentition stage.

COVID-19 Reflections on Restorative Treatments of Permanent First Molars.

BACKGROUND AND AIM: It is important to provide appropriate dental care for newly erupted permanent first molars (PFMs) since they are susceptible to caries. As the coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in the way dental services are provided to patients, the purpose of this study is to examine the procedure records assigned to PFMs of 6-15 year-olds during the pandemic and analyze the restorative material preferences of the residents of public dental hospitals. MATERIALS AND METHODS: Procedure records of patients aged between 6-15 years were extracted from the Public Oral and Dental Health Center, Bursa, Türkiye. All teeth groups except PFMs were excluded, while extracted, survived (restorative/endodontic/prosthetic procedures), and prevented (fissure sealant application) PFMs were analyzed retrospectively. Furthermore, restorative material preferences were analyzed by arch location, cavity surfaces, and dentition types. RESULTS: Strong positive correlation was seen between age and PFM extraction (r=0.973; p<0.001) and age and PFM restorative treatments (r= 0.966; p<0.001); a negative correlation was detected between age and fissure sealants (r= -0.984; p<0,001) performed on PFMs of 8-15-year-olds. Amalgam was most often preferred as the restorative material (p<0.05). CONCLUSION: The distribution of treatments and dental restorations can vary based on many factors, and the pandemic conditions may have changed treatment preferences to favor preventive dentistry. The excess of multi-surface restorations may be related to the delay of treatment applications during COVID-19.

Clinical status and assessment of caries on first permanent molars in a group of 6- to 13-year-old Tunisian school children.

AIM: The present survey aimed to highlight the clinical status of first permanent molars (FPMs) among a group of children aged between 6 and 13 years in public primary schools in Tunisia and to determine the association between FPMs' dental caries, gingival bleeding, malocclusion, dental fluorosis, and enamel defects. MATERIALS AND METHODS: The survey involved a cross-sectional study based on a dental examination conducted in public primary schools in Monastir Tunisia. A dental caries assessment was performed on FPMs using the International Caries Detection and Assessment System classification; the number of carious lesions in permanent and temporary dentition was established using the decayed/missing/filled teeth (DMFT) index. The Gingival Index and the Dental Aesthetic Index were used to determine the occurrence of gingival bleeding and malocclusions. Dean's index and the modified Development Defects of Enamel index were used to define the enamel defects. The χ2 test was used to assess the difference between more than two groups, and the level of statistical significance was set at .05%. RESULTS: A total of 545 children and 2080 FPMs were examined. The prevalence of dental caries in FPMs was recorded to be 35.8%. The overall mean DMFT index of the study population was 1.62 and the mean DMFT index was 1.41. The proportion of carious FPMs increased significantly with the age of the children (p < .05). The mandibular first permanent molar presented higher caries prevalence than its maxillary counterpart (p < .05). The presence of surfaces affected by molar incisor hypomineralization was recorded in 4.3% and the presence of surfaces affected by fluorosis was recorded in 4.6% of FPMs. No association was reported between FPMs' dental caries, gingival bleeding, malocclusion, and enamel defects (p > .05). CONCLUSION: Although the prevalence of caries in FPMs was considered moderate, health promotion programs should be implemented on a large scale to decrease the prevalence of dental caries among school children.

Cone beam computed tomography study on the root and root canal morphology of mandibular first permanent molars in a Tibetan population / 口腔疾病防治

Objective @#To investigate and analyze the root and root canal morphology of mandibular first molars (MFMs) in the Tibetan population using cone-beam computed tomography (CBCT) and to provide references for clinical root canal treatment in the Tibetan population. @*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. CBCT imaging data of 300 mandibular first molars from 300 Tibetan patients were included. Patient age, the number of roots in mandibular first molars were recorded. The morphology and incidence of mesial root and mesial root canals and the morphology and incidence of distal root and distal root canals were statistically analyzed by Vertucci classification. @*Results @#There were 198 double-root teeth and 102 three-root teeth in the 300 mandibular first permanent molars. Among the three-rooted molars, 1 case had mesiolingual roots, and the rest had distolingual roots. The incidence rate of the distolingual root was 33.7%(101/300). The most common root canal configuration was Vertucci Ⅳ 65.7% (197/300), followed by Vertucci Ⅱ 20.3% (61/300) in the mesial roots. The overall incidence of middle mesial canals (MMCs) was 6% (18/300), with the highest incidence of MMCs in the 20-40 year-old group at 9% (9/100). The distal roots canals of single-distal-rooted mandibular first molars were mainly Vertucci Ⅰ 66.8% (133/199), followed by Vertucci Ⅱ 14.6% (29/199) and Vertucci Ⅳ 11.6% (23/199). For the mandibular first permanent molars with two distal roots, 96% (97/101) of the distal buccal roots and 100% (101/101) of the distal lingual roots were Vertucci Ⅰ root canals. @*Conclusion@# The root and root canal morphology of mandibular first permanent molars in a Tibetan population is complex and variable. Approximately one-third of patients have distolingual roots, and clinicians should carefully explore the root canals under the guidance of CBCT.

Caries status and related factors among 12-year-old children in Yangpu District， Shanghai / 上海预防医学

ObjectiveTo investigate the prevalence and risk factors of dental caries and its related influencing factors in 12-year-old children in Yangpu District， Shanghai， and to provide relevant data support for the formulation of oral health policies and measures for children. MethodsIn 2021， 839 12-year-old children were randomly selected from five ordinary junior high schools in Yangpu District. The investigation included an oral health examination and a questionnaire survey on factors related to dental caries. Logistic regression analysis was used to analyze the influencing factors of dental caries. ResultsAmong the 839 participants， data from 830 were included. Among them， 426 were male （51.3%） and 404 were female （48.7%）. Of the 830 children， 203 had dental caries， resulting in a caries prevalence of 24.46%， a caries supplemental filling ratio of 32.6%， and a DMFT of 0.63. Multivariate logistic regression analysis revealed that a mother’s education level of college or above （OR=0.849，95% CI： 0.732‒0.984）， brushing teeth twice a day （OR=0.827，95%CI： 0.703‒0.973）， and the caregiver brushing teeth twice a day （OR=0.843， 95%CI： 0.726‒0.983） were effective factors in reducing the caries rate. Factors associated with childhood dental caries included consuming sweets ≥1 time per day （OR=1.397，95%CI： 1.197‒1.342） and female gender （OR=1.482，95%CI： 1.347‒1.671）. ConclusionThe prevalence of dental caries among 12-year-old children in Yangpu District is 24.46%. Gender， maternal education， the frequency of children's toothbrushing， the frequency of sweet consumption， and the caregiver’s toothbrushing frequency are the main factors affecting the prevalence of dental caries in children.

Caries prevalence of the first permanent molar and associated factors among second-grade students in Xiangyun of Yunnan, China: A cross-sectional study.

Purpose: This study aimed to explore the caries prevalence of the first permanent molar (FPM) and the associated factors among second-grade students in Xiangyun of Yunnan, China. Materials and methods: A cross-sectional survey was conducted in Xiangcheng Town, Xiangyun County, China, from September to November 2020. The methodology recommended by WHO was used for the dental examination. All the parents were required to complete a questionnaire to collect information on children's family background, dietary habits, oral health behaviors and parental oral health-related knowledge. The tests of significance used were the chi-square test. The association between dental caries prevalence and its associated factors was investigated using logistic regression analysis. Statistical significance was set at P < 0.05. Results: Data of 1,295 second graders consisting of 665 males and 630 females were analyzed. The caries prevalence of FPM was 47.6%, and the mean DMFT was 1.11 ± 1.394 in this sample. Among all the children with caries, the filling rate is meager, 2.6%. There were statistically significant differences in the caries prevalence of FPM among age groups. No significant difference existed between the sexes. Logistic regression analysis showed that the most significantly associated factors were: consuming desserts at least once a day, no fluoride varnish application experience, worse parental perception of children's oral health status, and incorrect parental knowledge of whether decayed primary teeth need treatment. Conclusion: Caries prevalence of FPM among second-grade schoolchildren in Xiangyun was considerably higher than the average prevalence nationwide in China. As China aims to reduce dental caries to <25% of 12-year-old children in 2030, the local government of remote regions like Xiangyun needs to do much more to achieve this goal. Results of this study could provide a framework for ongoing and future public oral health programs and policy planning in Xiangyun, with particular attention to early preventive and therapeutic measures.

Outcomes of root canal treatment of first permanent molars among children in Jeddah, Saudi Arabia: A retrospective cohort study.

Objectives: The first permanent molar (FPM) is considered the tooth most susceptible to caries, as it is the first permanent tooth to erupt in the oral cavity, making it susceptible to environmental conditions that may appear as caries, hypoplasia, or hypomineralization. Several treatment options are available for managing deep caries, including root canal treatment (RCT). However, there is a lack of data on the success and failure rates of RCT in FPM among children. This study aimed to determine the success and failure rates of RCT in FPM among children and related factors. Methods: This retrospective cohort study was conducted at three major centers in Jeddah, Saudi Arabia. Children aged 9-18 years who underwent an RCT between 2010 and 2019 were included. Clinical and radiographic examinations were also performed. Results: Based on the loose criteria, most of the evaluated teeth (79.6%) were successfully treated. The treatment failed in only 20.4% of participants. Older patients and teeth with acceptable restoration quality had an increased success rate compared to younger patients and teeth with unacceptable restoration quality. A shorter time lapse between treatment and assessment resulted in a lower success rate compared to a longer time lapse. Based on strict criteria, 72.9% of the patients were successfully treated. The use of a microscope and teeth with acceptable restoration quality resulted in an increased success rate compared to teeth treated without the microscope and with unacceptable restoration quality. Conclusions: The success rate of this procedure was high. Several factors, including older age, acceptable restoration quality, and the use of a microscope, increase the probability of success.

The impact of the loss of first permanent molars on the duration of treatment in patients treated with orthodontic space closure and without skeletal anchorage.

BACKGROUND: This study aims to evaluate the impact of the loss of permanent molars on the duration of orthodontic treatment for space closure and without skeletal anchorage. METHODS: Records at the beginning (T0) and the end (T1) of orthodontic treatment were selected retrospectively. Patients were divided into two groups: loss of molar (n = 19) and control, without loss (n = 24). The impact of loss on treatment time was assessed using multiple linear regression adjusted for the number of absences, bonding failures, age, sex, PAR index at T0 and T1 at p<0.05. Treatment time was also evaluated by the number of losses and which arches were involved (upper, lower). The systematic and random errors for the PAR index were verified using the intraclass correlation coefficient (ICC) and the Dahlberg formula, respectively. RESULTS: A small random error (1.51) and excellent replicability (ICC = 99.6) were observed. Overall average treatment time was 22.5 months (± 7.95) for the group without loss and 44.7 months (± 17.3) with a loss. Treatment time was longer in cases where there was a higher number of missing molars and when both arches were involved. In addition to the loss (ß = 4.25, p < 0.001), the number of missed appointments (ß = 2.88, p < 0.001) had a significant effect and increased treatment time. Bonding failures, gender, age, and PAR index at T0 and T1 were not significantly associated with treatment time in the multivariate model (p > 0.05). CONCLUSION: Loss of the first permanent molar has a negative impact on orthodontic treatment time in cases of space closure. The treatment time is longer when there are more tooth losses and arches involved. Treatment time also increases with greater numbers of missed clinical appointments.

Automatic segmentation and detection of ectopic eruption of first permanent molars on panoramic radiographs based on nnU-Net.

AIM: The purpose of this research was to present an artificial intelligence (AI) model, which can automatically segment and detect ectopic eruption of first permanent molars (EMMs) in early mixed dentition on panoramic radiographs using the no-new-Net (nnU-Net) model. DESIGN: A total of 438 EMMs obtained from 285 panoramic radiographs were included in this study. An AI model based on nnU-Net was trained to segment and detect EMMs. The performance of the model was evaluated by the intersection over union (IoU), precision, F1-score, accuracy and FROC. Furthermore, the detecting performance of nnU-Net was compared with that of three dentists with different years of experience using the McNemar chi-squared test. The reliability of different dentists was evaluated by intraclass correlation coefficients (ICCs). RESULTS: The nnU-Net yielded an IoU of 0.834, a precision of 0.845, an F1-score of 0.902 and an accuracy of 0.990, whereas the dentists yielded a mean IoU of 0.530, a mean precision of 0.539, a mean F1-score of 0.699 and a mean accuracy of 0.811. The ICC of different dentists was 0.776. The statistical analysis of the McNemar chi-squared test showed that the nnU-Net results were statistically significant and superior to those of dentists (p < .05). CONCLUSION: This study validated an AI model based on nnU-Net for automatically segmenting and detecting EMMs more consistently and accurately on panoramic radiography.

Knowledge, Attitude and Clinical Practice of Dentists about Extraction of First Permanent Molars.

PURPOSE: The extraction of permanent first molar (PFM) teeth with poor prognosis allows the build of a new-and-ideal occlusion with the spontaneous movement of the healthy second and third molars by taking advantage of the patient's development. This study aimed to evaluate dentists' knowledge level about controlled tooth extractions and determine their information needs. STUDY DESIGN: The survey, consisting of 9 questions about balance and compensation extractions, was prepared on Google Forms and sent via email to dentists. RESULTS: The questionnaire was sent to 3137 dentists and 472 (15.04%) of them answered. While deciding on PFM extraction, the rate of those who checked the presence of permanent 3rd molar tooth was found to be 64.4%. Although 79% of pedodontists stated that they knew about balance extractions, only 60.9% of them apply it in the clinic. After maxillary PFM extraction, the rate of oral and maxillofacial surgeons who think that "mandibular PFM over-erupt" was 92.8%, and the rate of orthodontists was 68.7%. 87.1% of the participants stated that they needed more information about controlled extractions. CLINICAL SIGNIFICANCE: It is possible to raise awareness, encourage the common and follow-up of correct clinical practices, and avoid complications; by adding controlled extractions to the undergraduate education program.

Design of a Knowledge Evaluation Questionnaire for Dental Specialists on Preservation and Extraction Indications of the First Permanent Molars.

Statement of the Problem: The first permanent molar (FPM) teeth are the most important elements of mastication and are crucial in the improvement of functionally proper occlusion. However, in childhood, these teeth are most susceptible to caries. The loss of an FPM in a child can cause changes in the dental arches. These changes can occur throughout a person's life. In such cases, the dentists and dental specialists need to decide whether to preserve or extract the FPM. Purpose: This study aimed to evaluate the extent of knowledge of dental specialists in Shiraz (Iran) on clinical guidelines for the preservation and extraction indications of FPMs. Materials and Method: The authors developed a dedicated questionnaire for the purpose of knowledge evaluation. A total of 6 orthodontists and 15 dental specialists, respectively confirmed the validity and reliability of the questionnaire. The 19-item questionnaire covered topics such as demographic data, preservation criteria for FPM teeth, and indications for FPM extraction. The survey was carried out across six dental disciplines in Shiraz (Iran) during July-August 2018. The data were analyzed using the SPSS software (version 22.0) with the dependent sample t test and one-way ANOVA. p Value< 0.05 was considered statistically significant. Results: Out of 89 dental specialists, 64 participants (53% male, 47% female) completed the questionnaire. The mean knowledge score for all participants was 10.09±3.93 (maximum of 19). The level of knowledge had a significant and inverse correlation with age (p< 0.001) and years of experience (p= 0.017). It also had a significant relationship with dental specialization (p< 0.001). Conclusion: The overall level of knowledge of the specialists was insufficient, except for the pedodontists and orthodontists. A re-education training program for dental specialists is strongly recommended.

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

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.

Children's dental treatment requirements of first permanent molars with poor prognosis.

OBJECTIVES: This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements. MATERIALS AND METHODS: Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis. RESULTS: The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (rs = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (rs = - 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p < 0.01) with the presence of DDC (rs = 0.50) and apical lesion (rs = 0.34). Susceptibility to DDC and apical lesions was significantly higher at mandible than maxilla (p < 0.01). The correlation was significant between DMFT values and apical lesion presence (p < 0.01). CONCLUSION: The ratio of FPMs with poor prognosis was found high in the study group. Treatment requirements of FPMs increased with age, and pulp interventions often took part in the majority. This study successfully concluded that higher DMFT values were correlated with the presence of DDC and apical lesion. CLINICAL RELEVANCE: FPMs with poor prognosis demonstrate a risk factor for apical lesion presence.

Management of Severely Aberrant Permanent First Molars in Molar Root-Incisor Malformation Patients: Case Series and a Guideline.

Recently, a new type of dental anomaly, a molar-incisor malformation or molar root-incisor malformation (MRIM), was recognized. The disease phenotype is now relatively well characterized; however, its etiology and disease-mechanism need to be elucidated. The affected teeth do not respond well to conventional treatment because of severe malformation and an unusual root structure. In this study, we present the treatment of MRIM cases with the extraction of severely aberrant permanent first molars (PFMs) and suggest that the PFM extractions are performed when it is clear that third molars will develop. The purpose of this report was primarily to present amendments to the guidelines for the treatment of patients with MRIM.