The six-year tooth
Introduction
The first permanent molar or six-year tooth is an important tooth in the masticatory function and the balance of the occlusion and the arch, it allows a harmonious fit between the maxilla and the mandible.
It is a symbolic tooth due to its chronology of eruption and its role.
- Special feature of the six-year tooth
- Anatomically:
– Occlusal surface covered with several crevices.
1.2. On the histo-physiological level:
– Immature tooth until the placement of JCD (4 years after eruption),
– Prominent pulp horns,
– Wide, highly permeable dentinal tubules,
– Unfinished roots and widely open apex,
– Important tooth in chewing.
1.3. On the epidemiological level:
– Most threatened by carious lesions in young people, the prevalence has decreased with the rise of fluoride prevention,
Currently 70% of cavities are located in the pits and fis 
The six-year tooth also has the following characteristics:
– The first to erupt,
– Its eruption may go unnoticed,
– Self-cleaning of occlusal surfaces is impossible, its position at the bottom of the oral cavity,
– it has an occlusal plane which is located below the occlusal plane of the temporary molars,
– The occlusal surfaces, due to their particular anatomy, promote plaque retention and increase the risk of caries.
- Six-year tooth therapy
Therapeutic management of the six-year tooth can be done using three approaches:
- Primary prevention: during primary prevention , the onset of the disease must be prevented, “preventing caries”, essentially by acting on the child’s caries risk factors.
- Secondary prevention: in secondary prevention, the disease must be detected early, at the initial stage, in order to prevent its worsening or even cure it.
- Tertiary prevention: we will intervene to prevent recurrences or complications, and combat after-effects (treatment of cavities).
- Primary prevention:
- Intervening before the first signs of the disease appear, it refers to the child’s RCI.
- Refers to certain factors: socio-economic data, child’s eating habits, oral hygiene.
- The risk factor that currently has consensus is the presence of active lesion.
Primary prevention is essentially done by acting on the child’s caries risk factors:
- Education in food hygiene: one of the significant risk factors in children is the dietary factor, so it is necessary to assess eating habits with the child and their parents since diet is a determining factor in the etiology of caries, eating habits play a role in determining the individual caries risk (ICR).
-It is necessary to group food intake around 4 times in a day.
-Drink water after each meal.
-Between these meals, stop snacking.
The six-year tooth
- Use of fluorides: Fluorides have been shown to be effective in preventing dental caries.
Their use, topical and/or systemic, must be modulated according to the caries risk.
Before prescribing fluoride, it is essential to review dietary sources of fluoride (eg, all drinking water sources, beverages consumed, prepared foods, toothpaste) to determine the patient’s true fluoride exposure, and to consider the child’s caries risk.
The optimal prophylactic dose is 0.05 mg fluoride/kg/day for all fluoride intakes combined, subject to an assessment of daily fluoride intake (fluoridated salt, content of drinking water) to prevent overdose.
The six-year tooth
- Preventive sealing of occlusal surfaces: sealing of pits and fissures should not be systematic. The practitioner will decide whether or not to seal the grooves after assessing the child’s individual RCI caries risk and rigorously examining his or her teeth (to estimate the depth of the grooves and their crevices and to detect any possible early carious lesions).
The six-year tooth
The ICDAS classification: Many classifications of carious lesions have emerged, often unidirectional in nature based on location, topography or carious involvement.
In the interests of harmonization, for diagnostic purposes, a consensus was developed by specialists and cariologists resulting in the International Caries Detection and Assessment System ICDAS classification.
This classification, which is a reference in the literature, is based on a visual examination on dry and wet teeth after prophylactic cleaning. It allows the severity of the lesions to be established by defining 7 stages.
- Secondary prevention:
This is the set of means implemented to detect and intercept the first signs of dental caries.
- In the presence of non-cavitary lesions, therapy consists of remineralization with a fluoride gel or varnish with periodic check-ups, without neglecting the correction of risk factors.
- Perform sealing of the grooves even in the absence of cavitary lesions.
- Perform a sealing of the cracked furrows.
- In the presence of cavitary lesions, the therapy meets the criteria of minimal dentistry with tissue saving and reconstruction of the loss of substance.
The six year toothThe six year tooth
- Tertiary prevention:
This involves caries treatment and all restorations.
- In case of significant cavity lesions, restoration is necessary:
- Remove infected dentin, preserve affected dentin, prevent pulp disruption.
- Deposit a Ca(OH)2 or biodentine, CVI.
- Closed or stratified technique in occlusal, open sandwich at the proximal level (better tolerance to cervical humidity).
- In the absence of irreversible pulp symptoms: conservative treatment to promote apexogenesis.
Good oral hygiene is essential to prevent cavities and gum disease.
Regular scaling at the dentist helps remove plaque and maintain a healthy mouth.
Dental implant placement is a long-term solution to replace a missing tooth.
Dental X-rays help diagnose problems that are invisible to the naked eye, such as tooth decay.
The dentist uses local anesthesia to minimize pain during dental treatment.