# The Pathology of the First Permanent Molar during the Mixed Dentition Stage--Review
## 3 Results and Discussion
### Pathology of the Dental Hard Tissues
#### 3.2.2 Dental Caries
2020, and [PERSON] 2018, showed that the risk factors associated with the occurrence of caries in FPM are represented by the retentive occlusal morphology, caries antecedents in primary teeth, the experience and educational level of the parents, dietary habits (daily sweets, pastries, soft drinks intake), the frequency of tooth brushing and the presence of MIH syndrome [102; 105]. In a study on the prevalence of Saudi Arabia children, 7-10 years old, the DMFT for FPM increased with age, having values of 1.88, 2.48, 2.88, and 3.04 for 7, 8, 9, and 10 years age groups, respectively [106]. Mandibular FPMs exhibited statistically significant higher Decayed and Filled components of the DMFT index than their maxillary homologues [106]. This was explained by the particular morphology of the occlusal surface of the mandibular molar, with more pits and supplementary grooves which serve as food retentive areas facilitating caries and by the slightly earlier eruption of the mandibular FPM as compared to the maxillary FPM in the majority of the children [106]. The DMFT index was higher among public school children than in private school children, with a statistically significant difference in what concerns the Decayed and Filled component of DMFT between public school and private school children. This aspect highlights the impact of social factors on caries pathology and the lack of access to oral health education, preventive programs, and school dental services for public school children [106]. [PERSON] et al., 2013, investigated FPM caries patterns in 15,611 American Indian and Alaska Native children in kindergarten, first, second, and third grade from 186 schools in 19 states [107]. Results showed that 7% of kindergarten children, 21% of first grade, 31% of second grade, and 38% of third-grade children had decayed, missing, or filled (DMF) FPMs [107]. The largest increase in the prevalence of FPM dental caries was registered between kindergarten and first grade [107]. The mean number of DMF molars ranged from 0.10 in kindergarten children to 0.81 in third-graders [107]. In a 2021 cross-sectional study on a group of 1510 Indian school children, 7-10 years old, [PERSON] et al. determined a prevalence of 47.48% for FPM dental caries [108]. Both prevalences of caries in FPMs and DMFT increased with age. Government school children were more affected than private school children (57.90% vs. 35.71%) [108]. [PERSON] et al., 2017, researched caries prevalence among a group of 17,891 female children aged 6-9 years from public schools in Riyadh, Saudi Arabia [109]. Caries were present in 6338 subjects, representing an overall prevalence of 35.4% [109]. Regarding age distribution of caries lesions, the 8-9-year-old group was the most affected (31.2%, n = 7110), followed by 7-8-year-old children (23.5%, n = 4833) and 6-7 year-olds (16.1%, n = 2370). From the total of 14,313 decayed molars, the highest prevalence was registered in the mandibular FPMs (33%) in comparison to the maxillary FPMs (18.2%) [109]. The decayed FPM counted for 24.6% (n = 14,313) of the total number of examined teeth, and fillings were only found in 1.0% (n = 573) of the FPMs. Only 1.3% of the children presented fissure sealants, demonstrating the underutilization of the procedure in caries prevention in public schools [109]. [PERSON] et al., 2018, studied caries prevalence in a group of 1844 male children from 17 public primary schools in Saudi Arabia aged between 6 and 9 years [90]. In the sample examined, decay was only present in 305 children representing a total prevalence of 16.5%, leaving the other 83.5% of the patients examined (n = 1539) caries free. From a total of 5394 FPMs examined, cavities were found in 574 teeth (10.6%), and only 27 FPMs (0.5%) were treated. Caries on FPM were more prevalent in the mandible (14.4%) than in the maxilla (7.7%).