A 14-year-old patient has an impacted mandibular second premolar. What is the next step?

In the case of an impacted mandibular second premolar in a 14-year-old patient, the most appropriate next step is to refer to orthodontics. This referral is crucial for several reasons.

Firstly, at this age, the adolescent's dental and skeletal development is still ongoing, making orthodontic intervention particularly effective. An orthodontist is skilled at evaluating the overall alignment of teeth and the relationship between dental and skeletal structures. They can determine whether the impaction of the second premolar is likely to resolve with the proper guidance from other teeth or if further intervention is necessary.

Additionally, early referral can help in developing a comprehensive treatment plan that may include the use of braces or other orthodontic appliances. These tools can help create space and orientation for the impacted premolar to erupt properly into the dental arch.

Waiting to observe can lead to complications such as root resorption of adjacent teeth or periodontal issues. Similarly, extraction is not typically the first choice in such cases if there's potential for the tooth to erupt properly. Performing a surgical exposure also becomes less relevant if orthodontic treatment can guide the tooth into position more effectively and conservatively.

Thus, referral to orthodontics ensures the best possible outcome for the impacted tooth within the context of the ongoing dental development