Clinical Assessment & Presentations
Intra-oral Features
Dental pathology
Deep caries and/or restorations can lead to pulp pathology and poor prognosis teeth in a child. These teeth should be considered for extractions if the patient is undergoing comprehensive orthodontic treatment. If the child is still in the mixed dentition, a complete orthodontic examination should be performed before deciding if the tooth should be electively extracted or maintained. In general, the absence of a deep bite or severe malocclusion are indications for early extractions of permanent molars so long as the correct timing and the presence of third molars are confirmed.
Hypomineralisation
Molar-incisor hypomineralisation (MIH) is a relatively common with reports in the literature ranging between 10 to 30% (Jalevik 2010, Kuhnisch et al. 2012). It is a multifactorial condition (causes range from environmental disturbances from 3rd trimester gestation to the first 3 years of life and to genetics – Almuallem and Busuttil-Naudi 2018) which can result in poor prognosis teeth in the severe cases. In severe MIH, extractions of molars may be necessary. Extractions at the correct times with the view of potential orthodontic treatment in the future are recommended (Cobourne et al. 2014).
Malocclusion
The extraction of first permanent molars at too late an age can lead to a collapse in the arch length and a deep bite malocclusion. Such deep bite malocclusions with spacing and a curve of Spee are challenging orthodontic corrections. If the first permanent were ideally maintained until orthodontic treatment, the bite opening and occlusal corrections are generally more predictable.
