The permanent teeth most vulnerable to decay in childhood and adolescence are the permanent molars. Caries most commonly develops at just two sites on permanent molars: at the base of pits and fissures, and on the proximal surfaces, just below the contact point. Both these sites present challenges to the clinician in terms of caries diagnosis and caries management.
Children may present with first permanent molars with advanced caries. In addition, approximately 15% of children will be affected by molar incisor hypomineralisation (MIH) to some degree. If a first permanent molar is assessed as having a poor life-time prognosis (whether from caries or MIH), and the second permanent molar second permanent molar is not yet erupted, then it may be in the child’s best long term interests to extract the first permanent molar, allowing the second permanent molars to erupt into its place.