Space Maintainers
July, 2002

Dear Dr. Mady: My six-year-old son had four baby teeth removed about three months ago in Hamilton. We recently moved to Windsor and our new dentist said that space maintainers should be placed. What are they and do you feel that they are really required?-Sandra new in Windsor.

Dear Sandra: If your child loses a baby tooth early through injury or decay, the other surrounding teeth could shift and occupy part or all of this empty space. This space should be maintained by either the primary tooth or something else that can retain the space so that the permanent tooth can erupt in a proper position.

If your child's adult teeth do not grow in properly, the result is crowded and misaligned teeth. This can lead to difficulty chewing, speaking and may even affect their physical appearance. Also it will dramatically increase the need for orthodontics (braces) and the amount time wearing these appliances.

Most often a baby tooth will stay in place until it is ready to exfoliate on its own at the proper time. This time is usually when the root of the replacement big tooth is two-thirds formed. If an unfortunate situation exists, and primary teeth are lost too early, I often do recommend the placement and cementation of space maintainers. They also promote more normal development of the jawbones and muscles in addition to keeping space for the permanent teeth. They stop teeth from their natural tendency to drift and fill in empty spaces.

Space maintainers are fairly inexpensive and do not require a great amount of time for the doctor or the patient. This preventative measure can be performed in two ways. The non-restorable teeth are extracted and the area is allowed to heal before a impression or mould is taken, or the mould can be made prior to tooth extraction and the maintainer can be inserted immediately on the day of the extraction after the bleeding stops.

They are fabricated from custom formed metal or plastic. The most common is a band-and-loop type which consists of a orthodontic metal band that goes around the tooth behind the empty space soldered to a metal loop that extends against the tooth in front of the empty space. The band is bonded into place with a strong dental cement and it does not come off easily. Sometimes these are made as a bi-lateral type when there is a missing tooth on both sides of the same arch. In this case there are two bands joined by one larch loop that goes around the entire arch usually resting against the front teeth.

Getting used to these is somewhat difficult during the first few days, but later on your child will forget that the maintainer is even there. Your dentist will let you know when it is time for it to be removed and it comes off very easily.

While wearing space maintainers, always make sure that your child avoids hard sticky foods. Regular oral hygiene should always be continued as well as regular dental check-ups. When brushing, extra special attention should be paid to the areas where the bands are placed. Advise your child to never attempt to bend the wire with their tongue or finger or to try and remove the appliance. If you see your adult tooth coming in under the wire, call your dentist immediately for an examination of that specific area.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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