What happens when a primary (baby) tooth is lost too early? An appliance called a space maintainer will be recommended by your dentist. The area of the mouth and the age of the child will determine the need for and type of space maintainer.
The primary teeth save the space for the permanent teeth. The 20 primary
teeth are replaced by 20 permanent teeth. The six-year molars, twelve-year molars, and wisdom teeth will erupt (come in) in the back of the jaw. The bone will begin to grow around five years of age to make room for these teeth. If a primary tooth is lost before the permanent tooth is ready to erupt, other teeth will drift or tip into the empty space. This may block out the spot for the permanent tooth that replaces the primary tooth. The space maintainer will hold the teeth in their proper position.
Primary teeth may be lost early because of decay, crowding, injury, or
improper eruption of the permanent teeth. Most space loss occurs during the
first six weeks after the loss of the tooth. This may continue over the next six
months. A space maintainer should be placed before this loss occurs. Sometimes,
space loss cannot be avoided and your dentist can only attempt to preserve the
remaining space.
There are many types of space maintainers, but two are most often used. The band and loop is used to hold the space for one tooth. The lingual arch is used to hold the space for two or more teeth that have been lost from both sides of the jaw.
If a primary molar is prematurely lost and the six-year molar has not yet
erupted (come in), the parent must watch closely for the eruption of the
six-year molar. This is very important because the six-year molar will rapidly
tip or drift forward causing space loss. The teeth that replace the first and
second primary molars ordinarily do not erupt until between nine and eleven
years of age. The six-year molar must be partially erupted to make the space
maintainer for early loss of a second primary molar.
Space maintainers are usually made with orthodontic bands and wires. Two
appointments are necessary. During the first appointment, an orthodontic band is
fitted on the tooth next to the space. An impression is taken. Next, the band is
removed from the tooth and placed in the impression. A mold of the teeth is made
with the band on the tooth. A laboratory will custom make an appliance to
exactly fit the space. During the second appointment, the appliance is cemented
in place.
The space maintainer is not removed until the permanent tooth begins to
erupt. The parent must be sure to tell the dentist when the permanent tooth is
erupting. If the space maintainer is not removed at the proper time, the
permanent tooth may come in improperly. Your dentist will inform you of the age when your child's permanent tooth will likely appear. Early tooth loss may cause the permanent tooth to be delayed in its eruption or to erupt earlier than expected.
by Jane A. Soxman, DDS
