Sanghvi R, Cant A, de Almeida Neves A, Hosey M T, Banerjee A, Pennington M. Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis. Community Dent Oral Epidemiol 2023; 51: 755-766.

Extract or not?

Options for the management of compromised (by caries or enamel hypomineralisation) first permanent molar teeth (cFPM) in children are preventive only, restorative (which may include root canal treatment) or timely extraction. In the modelling used in this paper, patients at age eight years either had the cFPM extracted (with the assumption that the space would close) or restored, with a series of restorative scenarios envisaged, leading to possible extraction and replacement or left as a space. Survival data/failure rates for the various treatment options were estimated from published research. Financial costs were obtained from NHS remuneration data, company prices and expert opinion.

Making a number of assumptions (eg no implants or bridges until age 18 years, no endodontic re-treatment) and continuing modelling for a tooth life span of 62 years, this simulation concluded that extraction of 1 or 2 cFPMs under general anaesthetic (GA) was never cost-effective. Extraction of 4 cFPMs under GA or 1 under local anaesthetic was more cost-effective than retention. Retention of 4 molars was cost-effective but involves a value judgement and ongoing cost to the patient/provider.