Radiological Evaluation of Permanent First Molars in Turkish Adolescents: a Retrospective Study

Background As keystone components of the permanent dentition, first molars are fundamental for maintaining occlusal stability and arch integrity. The observed disparities in caries prevalence and extraction rates between arches underscore the need for targeted preventive protocols. Strengthening oral health education and improving oral health literacy among adolescents, parents, and caregivers can reduce caries formation and prevent premature tooth loss. This cross-sectional study aimed to systematically evaluate the clinical status of permanent first molars (categorized as healthy, decayed, filled, root canal treated, or extracted) in adolescents aged 12–18 years, and, quantitatively analyze their anatomical distribution patterns across maxillary/mandibular arches and right/left quadrants. Methods A total of 1.674 panoramic radiographs were retrospectively analyzed. The number of healthy, decayed, filled, root canal treated, and extracted first molars was recorded and categorized based on their location in the jaw and quadrant. Results Maxillary permanent first molars (M1 and M2) were mostly healthy, while mandibular permanent first molars (M3 and M4) were more frequently extracted, with statistical significance (p < 0.05). No gender-based differences were observed (p > 0.05). Conclusions This study reveals significant deficiencies in current preventive and therapeutic approaches for first molars during adolescence. The high extraction rates, particularly in mandibular molars, underscore the urgent need for evidence-based interventions including professional fluoride varnishes and pit-and-fissure sealants. Additionally, raising awareness about oral health among children and their families is essential for better long-term dental outcomes. Trial registration The study was retrospectively registered.