Key Points
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Describes the updated national clinical guidelines for the extraction of first permanent molars in children.
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Presents the most up-to-date evidence to support clinical decision-making.
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Informs GDPs who play an important role in managing the developing dentition.
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Educates dentists on the issues that need to be considered when managing first permanent molars of poor prognosis in children.
Abstract
This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children. The first permanent molar is susceptible to chronological enamel defects, molar-incisor hypomineralisation and caries, which may necessitate enforced extraction in the developing dentition. In the right circumstances, the extraction of these teeth can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition. For this reason, elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions. However, a number of factors can influence the decision-making process, including the necessity for a general anaesthetic to allow extraction, potential cooperation with restorative or orthodontic treatment and likely future preventative practice within the family. Moreover, the presence of any underlying malocclusion also needs to be evaluated within the context of extraction planning. The current available evidence has been evaluated and awarded a grade based upon those recommended by the Scottish Intercollegiate Guidelines Network.
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References
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Acknowledgements
The authors acknowledge the contributions of Ros McMullen and Iain Mackie in the preparation of the previous RCS guidelines on first permanent molar extraction. We are also grateful to Professor Nigel Pitts for advice on caries experience and first permanent molars.
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Cobourne, M., Williams, A. & Harrison, M. National clinical guidelines for the extraction of first permanent molars in children. Br Dent J 217, 643–648 (2014). https://doi.org/10.1038/sj.bdj.2014.1053
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DOI: https://doi.org/10.1038/sj.bdj.2014.1053
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