| Baby
teeth (dentists call them primary or deciduous teeth) aren't just for
chewing. Each one also acts as a guide for the permanent tooth that replaces
it. If a primary tooth is lost too early, the permanent tooth loses its
guide and can drift or erupt incorrectly into the mouth. Neighboring
teeth also can move or tilt into the space, so the permanent tooth can't
come in.
Primary teeth can be lost too early for several reasons:
- They can be knocked out in a fall or other accident.
- Extensive decay can require that a primary tooth be extracted.
- Primary teeth can be missing at birth.
- Some diseases or conditions can contribute to early tooth loss.
If your child loses a primary tooth before the permanent tooth is ready
to come in, or if the permanent tooth is missing, your dentist may decide
to use a space maintainer. The maintainer keeps the space open until
the permanent tooth comes in.
Types of Space Maintainers
A space maintainer is made of stainless steel and/or plastic. It can
be removable, or your dentist can cement it in your child's mouth (called
a fixed space maintainer).
A removable space maintainer looks like a retainer. It uses artificial
teeth or acrylic blocks to fill in the space or spaces that need to be
maintained. 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.
There are several kinds of fixed space maintainers. A band-and-loop
maintainer is made of stainless steel wire. The maintainer is held in
place by an orthodontic-type band around an adjacent tooth or a crown
on the tooth. A wire loop attached to the band or crown extends into
the space and touches the tooth on the other side of the space to hold
both teeth in place.
A lower lingual holding arch is used when back teeth are lost on both
sides of the lower jaw. "Lingual" refers to the inside or tongue
side of the teeth. This type of space maintainer uses bands wrapped around
a tooth on either side of the mouth behind the missing teeth. A wire
connected to the bands runs along the inside of the bottom teeth. A lower
lingual holding arch is more stable than two separate band-and-loop space
maintainers.
Another type of fixed space maintainer called a distal shoe appliance
is inserted under the gums. It's used when the tooth in front of an unerupted
6-year molar is lost. Because the 6-year molar (also called the first
permanent molar) has not come in yet, there is no tooth to hold a band-and-loop
space maintainer in place. With a distal shoe appliance, the end of the
metal arm is inserted under the gums and keeps the space from closing.
Distal shoe appliances must be monitored frequently because the incoming
tooth can easily become blocked by the wire. The appliance may require
adjustment to allow the tooth to come in properly. As a result, most
dentists will try to keep the primary tooth in the mouth until the permanent
tooth underneath is ready to come in.
Children missing several teeth can use a partial denture instead
of a space maintainer. For example, children with a congenital disease
called ectodermal dysplasia often are missing multiple primary teeth,
and 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.
Are Space Maintainers Always Necessary?
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 be maintained
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, especially
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 surgically.
If the permanent tooth is about to erupt, your child's dentist may decide
not to place a space maintainer unless space is a critical issue for
orthodontic reasons.
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. However,
the ability to cooperate with the dentist is more important than a child's
age. Young children can get space maintainers if they are able to cooperate
during the process.
Making the Space Maintainer
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. The band is removed
and sent to a dental laboratory with the impressions. The lab creates
the space maintainer and sends it back to your child's dentist, who cements
it in 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, impressions are made and sent
to a lab, which makes the appliance.
Caring for Your Space Maintainer
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 important for your child to brush regularly to keep the gum tissue
healthy. If your child has a fixed space maintainer, he or she needs
to avoid chewy candy and gum, which can loosen the band or get caught
in the wire arm. If the space maintainer becomes dislodged, there is
a risk of swallowing or aspiration (inhaling the object into the lung).
Finally, your child shouldn't push on the space maintainer with his
or her tongue or fingers because that could bend or loosen it.
Follow-Up
Your child's dentist will follow the progress of the incoming permanent
tooth by taking X-rays regularly. When the tooth is ready to erupt, the
space maintainer is removed.
If there is no permanent tooth, the space maintainer will be used until
your child's growth is completed (age 16 to 18), and then a bridge, implant
or removable partial can be placed in the space.
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