To extract or restore compromised first permanent molars?

A new study welcomed by the British Society of Paediatric Dentistry finds that the treatment of compromised first permanent molars (cFPM) 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 the management of cFPM.

Greig, a BSPD member and an NIHR academic clinical fellow, said that he wanted to understand how these teeth are currently managed in the UK.

He explained: ‘The aim of this cross-sectional analysis was to explore the current clinical pathways and attitudes to managing cFPM amongst UK general dental practitioners and specialists in paediatric dentistry.’

Currently, he said, most children with cFPM 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.

Online questionnaire

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.

Greig said that there was a considerable amount of overlap of opinion between the groups.

GDPs and specialists both agreed strongly that cFPM affect children’s quality of life and general health, which is consistent with the literature that highlights the impact that compromised teeth have on children (Sheiham 2005).

But he also found that cFPM are not managed consistently.

There were slight preferences by GDPs to restore and SPDs to extract cFPM in nine and 15-year-olds.

‘This study has highlighted that children with cFPM are being managed, but which approach is the most effective, in terms of patient benefit and costs to the NHS, are 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.’

She said she was optimistic that Managed Clinical Networks for paediatric dentistry would 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,’ she added.



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

Sheiham A. Oral health, general health and quality of life. Bulletin of the World Health Organization 2005;83(9):641-720.



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