Should you extract or restore compromised first permanent molars?
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- Published: Friday, 22 February 2019 08:10
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A new study1 welcomed by the British Society of Paediatric Dentistry (BSPD) finds that the treatment of compromised first permanent molars in young people varies considerably across the UK. A research team led by Greig Taylor of Newcastle University, identifies the need for clear guidance for their management.
Greig, a BSPD member and an NIHR academic clinical fellow, explained that he wanted to understand how these teeth are currently managed in the UK. “The aim of this cross-sectional analysis was to explore the current clinical pathways and attitudes to managing compromised first molars amongst UK general dental practitioners and specialists in paediatric dentistry.”
Currently, he said, most children with such problems will initially present to their general dental practitioner but the decision on whether to treat or to refer is challenging. At present, there are no guidelines as to whether a specialist in paediatric dentistry (SPDs) or a general dental practitioner (GDPs) should manage these teeth.
An online questionnaire was developed and a random sample of 552 GDPs from England and Scotland and 236 UK GDC registered specialists in paediatric dentistry (SPDs) were invited to take part. The specialist feedback was acquired through the use of BSPD’s database.
There was a considerable amount of overlap of opinion between the groups, he said. GDPs and specialists both agreed strongly that compromised first molars affect children’s quality of life and general health, which is consistent with the literature that highlights the impact that such teeth2 have on children.
But he also found that these molar teeth are not managed consistently. There were slight preferences by GDPs to restore and SPDs to extract them in 9- and 15-year-olds. “This study has highlighted that children with (compromised first molars) are being managed, but which approach is the most effective, in terms of patient benefit and costs to the NHS, is still unknown.”
Claire Stevens, spokesperson for BSPD, said: “What we are seeing is that by and large dentists in primary care are undertaking complex treatments to save compromised teeth. However, there are times when a decision needs to be taken as to whether a referral to a specialist or an extraction may be more appropriate.
“I am optimistic that Managed Clinical Networks for paediatric dentistry will help to bring clarification on this important clinical issue. MCNs are all about different professional groups working together and cFPMs are a perfect example of a topic which needs clear referral protocols. BSPD is very grateful to Greig and his team for carrying out this research and we were delighted to help facilitate it by sending out questionnaires.”
1 Taylor, G. D., Pearce, K. F. and Vernazza, C. R. (2019), Management of compromised first permanent molars in children: Cross‐Sectional analysis of attitudes of UK general dental practitioners and specialists in paediatric dentistry. Int J Paediatr Dent. Accepted Author Manuscript. doi:10.1111/ipd.12469
2Sheiham A. Oral health, general health and quality of life. Bulletin of the World Health Organization 2005;83(9):641-720.
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