Children's baby teeth are an ever changing thing, sometimes being lost for no apparent reason. When they come out prematurely, sometimes this can cause problems.
After all, if a primary tooth is lost too early, the permanent tooth loses its guide and can drift or erupt incorrectly into the mouth. The ones surrounding it can also move or tilt into the space, so the permanent tooth cannot come in properly.
If your child loses a primary baby one before the permanent is ready to come in, or if the permanent one is missing, your dentist may decide to use a space maintainer. The maintainer keeps the space open until the permanent is able to erupt through.
A space maintainer is made of stainless steel, or sometimes plastic. It can be removable, or your dentist can cement it in your child's mouth, making it a fixed piece.
A removable space maintainer looks like a simple retainer. It uses 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 a few different varieties of fixed pieces. 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 which is on top. A wire loop attached to the band or crown extends into the space and touches the enamel on the other side of the space to hold both of them stable.
A lower lingual holding arch is also used in some cases. This may be utilized when canines are lost on both sides of the lower jaw.
The term Lingual means that it is on the tongue side of your mouth. This type of space maintainer uses bands wrapped around on either side of the mouth behind the empty spot.
There is another type called a distal shoe appliance. It is inserted directly under your gums, and is used when the tooth in front of a permanent molar comes out.
When it is gone, there is no enamel 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.
It must be monitored frequently because the incoming permanent can easily become blocked by the wire. The appliance may require adjustment to make sure everything comes in properly.
Children who are missing several baby molars can use a partial denture instead of a space maintainer. For example, children with a congenital disease which causes them to lose several teeth often have nothing to replace them with, and need a sort of removable denture to transition them into adulthood.
At that point, they can use a dental implants, a bridge, or continue to use a partial denture. If you are going to use a maintainer, they are custom-made by a dentist or orthodontist.
For a fixed one, a metal band is placed around the area, or next to the space, and impressions are made. The band is removed and sent to a laboratory with the impressions.
The lab creates the piece, and sends it back to your child's dentist, who cements it in place at a second office visit. Sometimes, it can be made in the office in a single visit without impressions.
To help it to last, you must be sure to maintain it as carefully as you can. It may feel unusual or strange at first, but after a few days, your child probably will forget about it.
It is important for your child to brush regularly, to keep the gum tissue healthy. If your child has a fixed one, he or she needs to avoid chewy candy and gum, which can loosen the band or get stuck in the wire arm.
Your child's dentist will follow the progress of the incoming enamel, by taking X-rays regularly. When the permanent one is ready to erupt, the piece is removed.
Talk to your dentist about if this is the right option for your child. If it is, begin the process right away before it is too late.