First Permanent Molar Extraction — ORE Part 1 MCQ

Correct answer: A — Timing is less critical than in the lower arch if the upper second permanent molar is unerupted

**A is correct.** UK guidance states that, in the upper arch, an unerupted second permanent molar will generally drift mesially and achieve a good occlusal position after removal of a compromised first permanent molar. This makes precise timing less critical than in the lower arch, where eruption and occlusal outcomes are more variable. Nevertheless, treatment planning remains individualised and should include radiographic and orthodontic assessment. **B** is wrong because there is no universal age-8 cut-off; age alone must not determine management. **C** is wrong because an erupted second permanent molar does not provide the same interceptive opportunity for mesial migration. **D** is wrong because routine space maintenance is not indicated in every upper-arch case. **E** is wrong because balancing extraction of a sound contralateral first permanent molar is not routinely recommended.

Reference: Royal College of Surgeons of England Faculty of Dental Surgery. A Guideline for the Extraction of First Permanent Molars in Children, sections “General principles of management: upper arch”, “General principles of management: lower arch” and “Ideal timing of FPM extraction”. March 2023. https://www.rcseng.ac.uk/-/media/fds/guidance-for-the-extraction-of-first-permanent-molars-in-children.pdf