A service evaluation on the management of first permanent molar under intravenous sedation in children

Abstract

Background: The First Permanent Molar (FPM) is the most important tooth in the jaw. Currently, FPMs are the teeth most commonly affected by caries or enamel defects in young children. Therefore, clear guidance regarding the management and prognosis of FPMs is essential to save the sixes. Aims: Report on the cohort of patients undergoing FPM management under intravenous sedation (IVS) and the caries severity of restored and extracted FPMs in children in two UK hospitals from January 2016 to December 2020. Methods: A service evaluation was conducted based on retrospective case note records of children aged 8 to 16 with FPMs managed by IVS. Radiographic evaluation of the lesion severity was scored based on the ICDAS scoring system (Intra/inter-rater kappa 0.82/0.92). Results: Sixty children had the management of at least one FPMs at King's College London Hospitals. Their average age was 13.7 years, and 68 percent of the children were females. The majority of children (49/60) had an extraction of at least one FPM. Caries with a poor prognosis were the primary cause, and the worst affected FPMs extracted in each child, the radiographic radiolucency reached into the inner 1/3 of dentine (9/49) and to the pulp (38/49). Twenty-six of the forty-nine had two FPMs extracted, followed by (15/49) who had one FPM extracted. For those children who had restored FPMs, the worst affected FPMs restored the lesion radiographically was in the middle 1/3 of the dentine (4/11). Conclusion: The majority of referred children under IVS at King's College London Hospitals, namely Guys's and St Thomas' and King's College Hospital NHS Trusts, had an extraction of FPMs. Where less than a quarter of children had a minimally invasive restoration. However, extensive caries were the main reason for extracting the first permanent molar. Radiographically, the lesion reached the pulp in more than half of cases. Apparently, IVS could be a beneficial pharmacological aide for the FPMs extraction with poor prognosis as they attend late to the departments with high caries risk.