|Space Maintainers for Premature Tooth Loss|
Baby teeth aren't just for chewing. Each one also acts as a guide for the eruption of the permanent tooth that replaces it. If a baby tooth is lost too early, the permanent tooth loses its guide. It can drift or erupt into the wrong position in the mouth. Neighboring teeth also can move or tilt into the space. This means that there may not be enough space for the permanent tooth to come in.
Dentists call baby teeth primary or deciduous teeth. Primary teeth can be lost too early for several reasons:
- They can be knocked out in a fall or other accident.
- They may need to be extracted because of severe decay that causes infection.
- They may be missing at birth.
- Some diseases or conditions can lead to early tooth loss.
Space maintainers may be used:
- If a primary tooth is lost before the permanent tooth is ready to come in
- If a permanent tooth is missing
The maintainer keeps the space open until the permanent tooth comes in.
A space maintainer is made of stainless steel and/or plastic. It can be removable. Some space maintainers are cemented onto the teeth on either side of the space in the child's mouth. This is called a fixed space maintainer.
There are several types of fixed space maintainers. What type is used will depend on how many teeth are lost and where the space is located.
A removable space maintainer looks like a retainer. It uses artificial teeth or plastic blocks to fill in the space or spaces that need to stay open. This type of space maintainer often is used when the space is obvious to other people. Removable space maintainers work well in older children who can reliably follow directions about caring for this appliance.
For children missing several teeth, a removable partial denture may be used instead of a space maintainer. For example, children with a congenital disease called ectodermal dysplasia often are missing multiple primary teeth. There are no permanent teeth to replace them. A child with this condition will use a removable denture into adulthood. After that, the child can receive dental implants or a bridge or continue to use a partial denture to replace the missing teeth.
Not every tooth that is lost too early requires a space maintainer. If one of the four upper front teeth is lost early, the space will stay open on its own until the permanent tooth comes in.
If you do not take your child to the dentist regularly — at least every six months — a space maintainer can cause problems. This especially can occur if your child does not brush well. The gum tissue in the space can grow over the wire arm, increasing the risk of infection. If that happens, your child's dentist may have to remove the gum tissue by surgery.
If the permanent tooth is about to erupt, the dentist may decide not to use a space maintainer unless your child needs braces and space is a critical issue.
Some children may not be able to cooperate during the process of making the space maintainer. Others may be at risk of injury if the space maintainer comes loose or breaks. These include children with diseases that affect how they breathe or swallow, and children who are very young. The ability to cooperate with the dentist is more important than a child's age. Most young children can have space maintainers placed, if needed. Most of them are able to cooperate during the process.
Each space maintainer is custom-made by a dentist or orthodontist.
For a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made. Impressions are made with a soft material that tastes like toothpaste. It sets into a gel around the teeth and is easily removed from the mouth. This allows the dental laboratory to make a copy of the teeth to use in making the space maintainer. The band is also removed and sent to the dental laboratory with the impressions. The lab creates the space maintainer and sends it back to your child's dentist. He or she cements it into place at a second office visit. Sometimes, a space maintainer can be made in the office in a single visit without impressions.
To make a removable space maintainer, the dentist first makes impressions. They are sent to a lab, which makes the appliance.
The space maintainer may feel unusual at first. But after a few days, your child probably will forget about it. A removable space maintainer with replacement teeth can affect speech until your child gets used to it.
It's very important for your child to brush regularly to keep the gum tissue healthy. A child with a fixed space maintainer needs to avoid hard or sticky foods and chewy candy and gum. They can loosen the band or get caught in the wire arm. If the space maintainer comes loose, there is a risk of swallowing or inhaling it into the lung.
Be sure to clean your removable space maintainer daily. This can help to prevent problems such as bad breath or gum inflammation.
Finally, your child shouldn't push on the space maintainer with his or her tongue or fingers. That could bend or loosen it.
Your child's dentist will take X-rays regularly to follow the progress of the incoming permanent. When the tooth is ready to erupt, the space maintainer is removed.
If a permanent tooth is missing, the space maintainer will be used until your child's growth is completed (age 16 to 18). Then a dentist will place a bridge, implant or removable partial denture in the space.