One of the most challenging scenarios for dentists treating school-aged children is how effectively treat hypoplastic first permanent molars. Hypoplastic and hypomineralized first permanent molars are a frequent dental finding in children. Studies have reported that approximately one in five 7-13 year olds have at least on hypoplastic fist permanent molar. The exact causes of these dental enamel defects are not always obvious from a thorough dental examination or medical/dental history. A number of systemic and genetic conditions have been associated with dental enamel hypoplasia of the first permanent molar, including trauma, ingestion of high levels of fluoride and amelogensis imperfect. The first permanent molar calcify from around birth to 2.5 years of age and therefore any interruption to the tooth at this time frame can potentially result in dental enamel hypoplasia.

Size, shape and location of dental enamel defects can vary greatly which in many cases leaves the tooth impossible to fill with conventional richmond hill dental fillings. Many dentists fine themselves spinning their wheels with conventional fillings such as composite restorations that fail on hypoplastic permanent molars. The ideal dental treatment modality for these teeth should aim at reliably restoring lost and weakened tooth structure, alleviating pain or sensitivity, and maintain occlusion.

Full coverage-restorations or dental crowns are the treatment of choice for moderate to severely hypoplastic permanent molars with stainless steel dental crowns being recommended treatment for children. Stainless steel dental crowns are simple restorations to place, and if properly adapted and cemented to the prepared tooth they can be reliable restorations for many years. Although in many cases stainless steel dental crowns can last well into adult years, the ideal treatment is to replace them with a cast metal or porcelain-fused-to metal dental crown when the patient stops growing.

If single or multiple teeth are extensively involved, or are deem unsalable the timely extraction may be considered. If extraction is to be considered, the optimal age for doing so is between 8.5 and 10.5 years. This will allow for the second molar to drift into the space of the lost first molar. Extraction of these teeth should be done in consultation with an orthodontist or paediatric dentist.