The first permanent molar in children
I. Introduction
II. Anatomical reminder
1. The first lower molar
2. The first upper molar
III. Embryology
IV. Caries pathology
1. Enamel immaturity
2. Occlusal anatomy
3. Dentin immaturity
4. Pulp immaturity
V. The different types of caries
1. Progressive caries of grooves, pits and fissures
2. Surface caries
3. Arrested mesial caries of the first molar
VI. Conservative therapy
1. Preventive therapy
1.1 Action on the power supply
1.2. Appropriate oral hygiene
1.3. Reinforcement by adding fluorine
1.4. Prophylactic sealing
2. Curative therapy
VII. Conclusion
I. Introduction
The first molar is the first permanent molar to appear, also called the “6-year tooth.”
Its eruption often goes unnoticed because it is often confused with a temporary tooth.
Due to its location, it is the site of frequent cavities and must be given particular attention when brushing.
It is the key tooth of occlusion, a strategic tooth in the oral cavity, considered the crossroads of all dangers for some.
It is the first permanent tooth in children, it plays a very important role in chewing, it is a pillar tooth of the dental arch.
II Anatomical reminder
1. The first lower molar
It is biradicular, pentacuspid, and has 5 grinding grooves.
The 2 roots are most often curved distally, they are rarely fused, they are flattened.
• The distal root is slightly longer and has one to two canals.
• The mesial root has 2 canals.
2. The first upper molar
It is triradiculate, tetracuspid and has 5 grinding grooves.
The roots are divided into 2 vestibular roots (mesial, distal), and a larger palatine root, their inclination is distal, they are rarely fused, their general appearance is conical.
III. Embryology
The 6-year tooth, as well as the second molar, results from the distal extension of the dental lamina, its eruption occurs between 5 and a half and 6 and a half years when the crown and 2/3 of the roots are formed.
the crown is completed on the external morphological level around 3 to 4 years and root development requires 3 to 4 years after eruption for it to be complete.
IV/ Caries pathology
The diagnosis of a carious lesion in immature permanent teeth is urgent.
It is essential to preserve pulp vitality at all costs (in order to allow root development).
The practitioner should explain to parents and children the factors that contribute to early caries, in the presence of bacterial plaque, poor brushing, and a diet rich in sticky and sugary products.
This early vulnerability of the first permanent molars is due to:
1/ The immaturity of the enamel
In front of this immature enamel, with a porous surface, the plaque adheres strongly to it. The maturation of the enamel takes place during the years following its eruption.
The fact that the tooth is in the process of eruption for several months promotes the retention of plaque on the occlusal surface which is not fully functional during chewing.
2/ Occlusal anatomy
It has numerous cracks, pits and fissures, which are anatomical factors in plaque retention.
3/ Dentin immaturity
Dentin on immature teeth has widely open tubules; which promotes the rapid proliferation of caries once the enamel-dentin junction is crossed.
4/ Pulp immaturity
It is characterized by immature innervation, which contributes to making the young permanent tooth less sensitive to various external stimuli.
V. The different types of caries
1/ Progressive caries of grooves, pits and fissures
This is a very extensible form, which will not only develop in the pulp direction but in width over the entire surface of the enamel to such an extent that the simple occlusal opening identified with the probe confronts us with a good part of the unsupported enamel.
This should prompt the practitioner to undertake careful clinical and radiographic screening which will allow preventive measures to be taken as early as possible.
2/ Surface caries (White spot)
This is carious damage to the enamel with rapid extension to the surface.
It develops in 3 phases:
- An early phase: it appears as a white spot in which the probe catches, (differential element in the differential diagnosis of opacities of the enamel which mineralizes).
- A state phase: the lesion evolves in depth, the enamel is completely
Destroyed, revealing the dentin, at this time, the retention of bacterial plaque is encouraged by the loss of substance.
- The extension of the lesion occurs at the level of the entire vestibular surface, reaching the appearance of a very extensive class V cavity with more or less distinct enamel edges.
3/ Stopped mesial caries of the first molar
It follows progressive caries occurring at the point of contact with the second temporary molar; it appears on the enamel in the form of a brown stain limited to the contact surface without loss of substance.
The temporary loss or fall of the tooth will allow better hygiene of the area and the carious lesion will transform into a stopped lesion.
VI. Conservative therapy
1/ Preventive therapy
Preventive action must address several of these factors:
- Action on food;
- Implementation of appropriate oral hygiene;
- Strengthening teeth by adding fluoride;
- Dental visits and professional preventive acts (Sealants).
1.1. Action on the power supply
All foods that contain carbohydrates are potentially cariogenic.
Our action will focus on:
- Limiting carbohydrate consumption;
- Choosing a balanced diet;
- Avoid repeated intake of sugary drinks, or drinks with a low pH.
1.2. Appropriate oral hygiene
Motivation for children’s oral hygiene with the aim of controlling dental plaque in quantity and quality.
1.3. Reinforcement by adding fluorine “See fluorine course”
1.4. Prophylactic sealing “See sealants course”
2/ Curative therapy
Composite resin remains the material of choice currently for modern dentistry, which is more preventive than curative.
Control of the operating field is the essential key to success in adhesive dentistry and the dam appears to be the means of achieving this.
We will favor the preparation of ultraconservative cavities with preservation of the overhanging marginal ridges and the interproximal enamel contact.
These interventions are carried out using optical aids combined with conventional preparation instruments (microburrs) or innovative ones (sound or ultrasonic abrasive inserts, air abrasion).
- Regarding proximal lesions , conservative cavities all aim to preserve mineralized tissues, and in particular the marginal ridges and the interproximal contact area.
- Regarding cervical lesions, this particular area usually presents carious lesions whose topography and development are related to the situation of the anatomical neck and that of the clinical neck (the free gingiva), as for the other areas of cariosusceptibility, initial lesions related to the accumulation of bacterial plaque can and must imperatively be treated by methods that induce remineralization. When restoration is necessary, minimally invasive treatments are nevertheless preferred to preserve dental tissues, taking advantage of the advantages that bioactive adhesive restorative materials can offer (since the aesthetic requirement is not the main criterion).
The first permanent molar in children
VII Conclusion
- Current pediatric dentistry is fully equipped to offer our children mouths that are practically free of carious lesions with harmoniously implanted teeth.
- It is up to parents to instill sound principles of hygiene and not to wait for a problem to arise before seeking help.
The first permanent molar in children
Untreated cavities can damage the pulp.
Orthodontics aligns teeth and jaws.
Implants replace missing teeth permanently.
Dental floss removes debris between teeth.
A visit to the dentist every 6 months is recommended.
Fixed bridges replace one or more missing teeth.