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Admin DXD
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from Singapore asked a question

What is your advise on teeth extraction for molar incisor hypomineralization?

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Dental

For kid, 8 yrs old with sever incisor hypominalization problem on their 1st molar both top and bottom (bottom 2 have done the with silver capping) but top already not in good condition and filler came off :

i) Is it a must to extract all the 4 at the same time since the 2nd molar is ready under GA?

ii) Any painless way to extract one at a time?

Kindly advise.

Many Thanks

DOCTOR’S ANSWER (2)

Dear Margaret;

It is very sad for the patient (and the dentist) when first molar teeth have to be extracted. These teeth are extremely important to ensure a proper bite when the child is older.  However there are certain times when extraction is better than keeping the tooth.

I normally suggest that prior to extractions, it is best to consult the orthodontist for an opinion too. This is because once the teeth are extracted, the orthodontist may need to plan for the second molar teeth eruption and also to treat any issues with crowding or bite problems earlier on. The orthodontist may also need to assess your child’s jaw bone growth.

Good luck!

Consult Doctor
0 496 views 0 Doctors agree 26 Jan 2018

Hi Margaret,

Thank you for your question.

I suppose the dentist who is attending to your child recommended the extractions based on the fact that the breakdown on the teeth is severe (as you have also described), which may cause more problems for your child in the long run.

They probably timed the extraction of the 1st molar with the growth sequence of the 2nd molar in the hope that the 2nd molar would be able to drift into and occupy the space left behind after extraction.

Is it a must to extract all the 4 at the same time since the 2nd molar is ready under GA? Any painless way to extract one at a time?

It is definitely not a must to extract all 4 under GA at one time. You can do it chairside, however local anasthetic is required (i.e. injection). If your child is able to cope with the numbing jabs and extractions whilst fully conscious and aware, then that is of course a viable alternative.

However more often than not, dental extraction is a traumatic experience, even to adults. Thus if you think that your child may not be able to cope with chairside extractions (bearing in mind he probably needs to return on 4 separate visits for each tooth extraction), then I would suggest GA to extract all 4 at once.

Hope this helps!

Consult Doctor
0 496 views 0 Doctors agree 26 Jan 2018
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