Space Maintainers for Premature Tooth Loss

Most children get their first full set of baby teeth by around 3 years old, according to the American Dental Association. These primary teeth enable them to eat their first solid foods and serve an important function as placeholders for permanent teeth. When baby teeth are lost prematurely or permanent teeth are late in erupting, dentists may recommend space maintainers to support the child's mouth until the gaps are filled with permanent teeth.

Why Maintainers Are Needed

Children lose baby teeth earlier than expected for several reasons. Some experience trauma to the mouth, such as from accidents like tripping or getting whacked in the mouth by a ball. Others develop early childhood cavities, known as "baby bottle tooth decay." This often happens when babies fall asleep at either breast or bottle, or walk around with a bottle for extended periods of time. The sugar content in the milk causes enamel to decay, which may result in tooth loss. Occasionally, some primary teeth may be absent because of a genetic condition. It's unusual for children to suffer from oral infections severe enough to cause tooth loss, although it's not impossible.

When to Consider Space Maintainers

Regardless of why a child has missing primary teeth, it's important to consider space maintainers to ensure he or she develops permanent teeth in correct locations. If one primary tooth is missing for more than a short period, the child risks other teeth becoming loose because they aren't properly supported. When this happens, the loose teeth can move into the spaces intended for other teeth. This affects permanent teeth when they erupt by guiding them into incorrect positions. If your child loses primary teeth to make way shortly for permanent ones, it might not be necessary to fit maintainers. If permanent teeth are some time away, however, consult with your dentist to determine whether maintainers are a suitable option.

Types of Appliances

Space maintainers come in two types: removable and fixed. Removable devices are made of acrylic and use artificial teeth or blocks of dental material to hold open the spaces. This device works better in an older child, who can remove the appliance to clean and care for it. Partial dentures are suitable removable maintainers for children with several missing teeth.

Fixed maintainers are attached with dental cement to teeth beside the gap. These are more suitable for young children or those who have lost a back tooth. Unilateral maintainers are fixed on one side, while bilateral appliances are fixed on both sides. They can be fitted on the upper or lower jaw to maintain space for front or back teeth. The device your dentist recommends depends on the number and location of missing teeth.

According to the Journal of the California Dental Association, types of fixed appliances include:

  • Band-and-loop device. Composed of stainless steel wire, it is held in place by orthodontic bands that allow the permanent tooth to erupt without blocking it. It is used when one or more baby molars are lost in one dental arch.
  • Lingual holding arch. This is used to maintain space for lower back teeth on both sides.
  • Transpalatal arch. A transpalatal arch is fitted on the upper jaw to preserve space on both sides of the dental arch and held in place by wire fastened around the adjoining teeth.
  • Distal shoe appliance. This fixed appliance is fitted over the baby first molar and will maintain the space for the first permanent molar once the tooth is lost.

These appliances are custom-made to fit each child. In most instances, the dentist takes impressions of the patient's mouth, which are sent to a dental laboratory to manufacture the device. Space maintainers are typically made from acrylic, with loops or bands made from stainless steel wires to hold them in position.

Oral Care for Appliances

It takes time for a child to adapt to wearing a device. During this time the dentist keeps an eye on oral hygiene, jaw growth and progression of the permanent teeth. The maintainer needs adjustment periodically and requires immediate attention if it gets damaged.

The child will have to brush daily with a fluoride-based product like Colgate Kids Cavity Protection toothpaste, which is extra gentle on tooth enamel and comes in a fun bubble fruit flavor that kids will love. He or she will need to avoid chewing gum, biting hard candy and fruits, and pushing or pulling the device with fingers or other objects.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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  • Swish with water before brushing – instruct your child to rinse with water after eating. This will loosen food that may be caught in the braces, then brush thoroughly.
  • Floss once a day – each night help your child floss. Flossing helps loosen food debris and plaque at and under the gum line that would otherwise harden into tartar. It can also help reach the nooks and crannies in the teeth that might be difficult to reach with a toothbrush.
  • Use a fluoride rinse – after brushing and before bed have your child rinse with fluoride rinse to help keep teeth strong and healthy
  • Dental visits every six months – take your child to the dentist for a checkup and cleaning every six months. The dentist can point out areas that need more attention, and help make sure you're keeping your child’s teeth healthy and clean.