Premature loss of deciduous teeth might decrease the alveolar arch length, endangering the eruption of posterior teeth. On the other hand, early intervention can preserve the space necessary for the eruption of permanent teeth.
Premature loss of deciduous teeth in children should be categorized into anterior (incisors and canines) and posterior (molars) teeth.
Premolar Loss of Anterior Teeth
Anterior teeth are predominantly lost due to trauma and dental caries. Traumas to anterior deciduous teeth are prevalent because children are developing essential motor skills. In addition, despite efforts to improve preventive care, dental caries still results in the loss of anterior teeth. The lost anterior teeth are usually replaced for four reasons: function, speech (articulation), esthetic, and maintaining space. The last item is less important than the others. There is insufficient evidence to support the idea that the early loss or extraction of anterior teeth results in space loss in the anterior segment of the jaw.
Although poor masticatory function, too, has been suggested as a reason for replacing anterior deciduous teeth, in such cases, nutritional problems have not been documented, and if the child has a proper diet, he or she will continue to grow and develop normally. In addition, if the child acquires speech and articulation skills before the extraction or loss of the anterior teeth, losing the anterior teeth is not important because any articulation problems will be transient and will resolve after the eruption of permanent anterior teeth. It appears that the most valid reason for replacing anterior deciduous teeth is the esthetic appearance. Some children feel discomfort due to the loss of anterior teeth. However, parents are more worried about their children’s esthetic appearance. In this context, if parents are not interested in replacing their children’s lost anterior deciduous teeth, the best choice is no treatment and no use of space maintainers.
Premature Loss of Deciduous Posterior and Molar Teeth
Extracting deciduous molar teeth might result in the loss of space. The posterior teeth move forward toward the space created by the extraction of the tooth, occupying some of this space. In addition, it has been reported that the teeth anterior to the lost molar tooth move backward. Therefore, the loss of space or decrease in the arch length might occur from both sides.
An important consideration: If the interdental (interproximal) cavities due to dental caries are not treated and the interproximal contacts are lost, space loss and decreased arch length might occur even without tooth extraction.
Therapeutic Measures to Prevent a Decrease in the Arch length and Loss of Space
- Maintaining space begins with a proper restoration. Proper and timely restoration of interdental caries and establishing ideal interdental contacts prevent the loss of space.
- If it is necessary to extract a tooth due to infection or severe dental caries, and the permanent tooth will erupt after a long time, a space maintainer should be used.
Different Types of Space Maintainers
Space maintainers are designed as fixed unilateral, fixed bilateral, removable unilateral, or removable bilateral. They have different names, including band and loop, distal shoe, lingual arch, etc.
Considerations on the Use of Space Maintainers for the Parents and Children
- After the space maintainer is fabricated and placed in the child’s oral cavity, the child might need a few days to adapt to it. During the initial days, the child might not feel comfortable with the appliance; however, he/she will adapt to it in a few days.
- The possibility of dental caries and decalcification of the enamel is higher than normal due to the presence of a foreign body in the oral cavity. Therefore, the patient’s oral hygiene and regular toothbrushing become more important. The dentist should provide proper education for the child and parents about how to clean the space maintainer to preserve the gingival health and prevent dental plaque formation. In this context, the correct toothbrushing technique and dental floss use should be taught to the child.
- Fixed space maintainers are bonded to the teeth adjacent to the edentulous area with a special cement (similar to glue). Therefore, the space maintainer should not be manipulated to prevent its loosening and detachment. The child should be given sufficient instructions to avoid exerting pressure on the appliance with his/her finger or tongue or pulling or displacing it. It is recommended that the child avoid eating rigid or sticky foodstuff, chewing gums, or eating candies because they might dislodge the space maintainer; it is also possible for foodstuff or debris to become lodged between the wires or the components of space maintainers.
- If removable space maintainers are used, they should be removed from the oral cavity during main meals. Then they should be cleaned with a toothbrush and return to the oral cavity after cleaning the teeth.
- The dentist should be contacted immediately in case of any problems, such as space maintainer fracture or oral cavity mucosal ulcers.
- Dental visits and examinations are necessary regularly every 4-6 months so that the dentist can check the space maintainer and the health of the teeth.
- When the permanent tooth begins to erupt and emerge in the oral cavity, a dental visit becomes necessary to have the appliance removed by the dentist.
