Minimally invasive judgement calls: managing compromised first permanent molars in children

• Published in: British dental journal Vol. 229; no. 7; pp. 459 - 465
• Main Authors: Alkhalaf, Reem, Neves, Aline de Almeida, Banerjee, Avijit, Hosey, Marie Therese
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2020; Nature Publishing Group
• Subjects: Anesthesia; Child; Child, Preschool; Children; Clinical; Dental Caries - therapy; Dental Restoration, Permanent; Dentistry; Dentition; Dentition, Permanent; Humans; Longevity; Medical prognosis; Molar - diagnostic imaging; Molars; Morbidity; Oral cavity; Prognosis; Teeth
• ISSN: 0007-0610; 1476-5373
• DOI: 10.1038/s41415-020-2154-x

This paper aims to update the reader on how minimally invasive (MI) techniques may be used to improve the longevity of carious or defective/compromised first permanent molars (cFPMs) in young children. Clinical and radiographic diagnosis and the prognostic factors will be discussed in view of recent studies showing that these teeth can be kept in function and have an improved prognosis as the child gets older. Clinical protocols for their care, based on the latest evidence and techniques for MI restorations, together with longevity information of possible restorative options, are described. This paper also explores the rationale behind enforced extractions and related morbidity, in order to help oral healthcare practitioners to determine the optimal management of these key elements in the dentition for the benefit of the patients. Key points Dental practitioners treating young children frequently face cavitated carious or hypomineralised first permanent molars in their clinical practice. The use of improved minimally invasive techniques and materials, such as high-viscosity glass ionomers, may improve the prognosis of compromised first permanent molars in young children and reduce the need for extractions under general anaesthesia. Compromised first permanent molars may be able to survive longer in the oral cavity of young children, postponing definitive restorative treatment for later in life.