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First Permanent Molar Extraction — ORE Part 1 MCQ

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HardPaediatric DentistryFirst Permanent Molar ExtractionORE Part 1

A 7-year-old child has a lower first permanent molar with extensive caries and a poor long-term prognosis. There is no pain, swelling or infection, so the tooth can be stabilised temporarily. A panoramic radiograph confirms an unerupted lower second permanent molar and early mineralisation at its root bifurcation. To optimise spontaneous space closure, when should the lower first permanent molar be extracted?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — At 8–10 years, while the second molar is still developing

**A is correct.** In the lower arch, the best interceptive timing is generally **8–10 years**, while the second permanent molar is developing. Early mineralisation at the second-molar root bifurcation is a classical radiographic predictor of favourable eruption and space closure. The absence of pain or infection permits temporary stabilisation until this developmental window is reached. **B** is too early: extraction before age 8 can produce unfavourable drift, tipping and spacing. **C** and **D** are late developmental stages, when spontaneous closure is less predictable. **E** is incorrect because an erupted second molar in occlusion will not migrate mesially in the desired interceptive manner. The current UK guidance also stresses that final planning requires assessment of occlusion, second-molar angulation and third-molar development.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. A Guideline for the Extraction of First Permanent Molars in Children, March 2023, sections “Predictors of successful SPM eruption following interceptive FPM removal” and “Ideal timing of FPM extraction”. https://www.rcseng.ac.uk/-/media/fds/guidance-for-the-extraction-of-first-permanent-molars-in-children.pdf