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.
Primary or deciduous 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
Types of Space Maintainers
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.
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.
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 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.
Making the Space Maintainer
Each space maintainer is custom-made by a pediatric 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 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.
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.
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 clean the space maintainer every 6 months and 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.