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.

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

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.

Children's Social Perception of Peers' Dento-Facial Condition: A Cross-Sectional Study.

AIMS: This study aimed to compare the participant's perceptions about their peers' dento-facial condition with different incisal appearances (intact, discoloured, fractured, and avulsed incisors). MATERIALS AND METHODS: A cross-sectional study was conducted among schoolchildren of both primary (8-11 years) and secondary (12-14 years) levels. Each participant was asked to judge photographs with one intact and three digitally modified central incisors giving the appearance of a traumatised tooth. Data on perceptions were collected for each condition using 12 attributes (8 positive and 4 negative; scored on a 4 point Likert scale). The positive, negative and total attribute scores were analysed separately by unpaired Student's t-test. Repeated Measures ANOVA and Bonferroni post hoc analysis was also used. RESULTS: A group of 587 children participated in the study. The perception for intact and traumatised incisors about demographic factors is well appreciated. Among the gender delineation, girls showed a significant difference in judgment between discoloured and fractured incisors. In comparison to intact incisors, positive and total attributable scores were found to be significantly higher (P < 0.001), whereas negative attribute scores were significantly lower (P < 0.001) for traumatised incisors. Pairwise comparison showed high significance (p <0.001) between the intact and traumatised incisor conditions. CONCLUSION: The results demonstrated that visible dental trauma influenced the psychosocial judgment given by children towards their peers. This judgment would, in turn, affect their level of acceptance towards such appearances. Therefore, these conditions ought to be redressed as swiftly as possible.CLINICAL SIGNIFICANCE: The primary purpose of this study was to highlight the psychosocial perceptions of children in judging their peers, regarding not only attractiveness but also intelligence, friendliness, confidence, outgoing nature, etc.