Premature baby tooth loss.

- Complications | Dental space maintainers - Applications / Precautions / Costs.

The permanent tooth erupting underneath a baby tooth.

Normal tooth eruption.

Why are a child's primary teeth so important?

One of the key functions that baby teeth perform is acting as placeholders for the set of permanent teeth that will replace them.

If a baby tooth is lost early and adequate steps are not taken to preserve the space it occupied, problems may develop.

Depending on the child's current stage of dental development, this can include the misalignment, or even impaction, of permanent teeth.

Consider this example.

Even loosing a single baby tooth prematurely can result in problems that can be difficult, time consuming and costly to fix later on in life. Consider the following example involving a child's primary second molar.

 
Normal eruption of permanent teeth.

The normal eruption process.

1) How things usually work.

Under normal circumstances, as a child's permanent 2nd bicuspid erupts underneath their primary second molar, its actions causes the root of the baby tooth to gradually resorb (dissolve) away.

This process serves two important functions:

  • It creates an eruption path for the bicuspid to follow that helps to guide it into its proper position.
  • Because the primary second molar is retained in place until the last stages of the eruption process, it acts as a stabilizer that keeps the neighboring teeth in place.
 
Losing a baby tooth can lead to crooked permanent teeth.

Early baby tooth loss can lead to permanent tooth impaction.

2) What happens when a baby tooth is lost too early?

In comparison, if our example child's 2nd primary molar is lost prematurely, its stabilizing influence is lost too.

  • That means the next tooth back (the permanent first molar) may drift or tilt forward. This is a common occurrence.

    This change may also affect the positioning of teeth that bite against the molar, and also those behind it (future or existing).

  • Much less likely, the tooth in front (the 1st permanent bicuspid) may drift backward.
  • As a worst case scenario, the erupting 2nd bicuspid may become impacted (prevented from erupting altogether). This is the case we show in our graphic.

 
A space maintainer holds the space of a lost baby tooth.

A space maintainer holds a lost tooth's space.

3) How a space maintainer can prevent problems.

In those cases where the space resulting from the early loss of a baby tooth is at risk for closing in, a dental space maintainer can be placed (see graphic).

Wearing this type of device will preserve the width of the space formerly occupied by the lost baby tooth. And allow the replacement tooth to continue to erupt in normal fashion.

As a result, wearing this simple type of device can prevent the need for major corrective treatment (such as braces) later on.


 

Space maintainer design.

These appliances are typically metal-band-and-wire devices.

  • The band fits around the anchor tooth (or teeth) the maintainer is cemented on.
  • A bent wire attached to the band(s) rests against the teeth whose current position needs to be stabilized.

When maintaining the space of a single tooth, an appliance's design can be quite basic (like shown in our graphic above).

But in other cases its design may be relatively complex or involved, simply depending on the location of the missing teeth and the availability of teeth on which to anchor it. Besides just fixed (cemented) design, some space maintainers are removable or semi-attached appliances.


Things to know.

1) How long is the maintainer left in place?

A space maintainer is usually removed as soon as the erupting permanent tooth begins to penetrate through the gum tissue.

2) How long will it take for the permanent tooth to erupt?

As a rule of thumb, when a baby tooth is lost prematurely:

  • If less than 50% of the permanent tooth's root has yet formed, its eruption will be delayed. (See our tooth eruption timetable.)
  • If more than 50% root formation has already taken place, its eruption will tend to be accelerated.

3) A space maintainer isn't always needed.

Not all lost baby teeth create a need for a space maintainer. It simply depends on how much time it will take the permanent tooth to erupt. If the dentist feels that the permanent tooth will come into place before any detrimental tooth shifting will take place, then one won't be required.

When making this determination they will consider the current stage of dental development of the patient, as well as evaluate the current status (position, percentage formed, etc...) of the replacement tooth via the use of an x-ray.

As an example, if x-ray evaluation reveals that a substantial portion of the replacement tooth's root has formed, and the tooth is currently positioned right at the crest of the jawbone ridge, placing a space maintainer is probably not required.


How are space maintainers made and placed?

Having a space maintainer made, and then placed, is a simple process.

  1. Your dentist will take a dental impression of your mouth. This way they'll have a copy of the space and neighboring teeth that can be given to their dental laboratory.
  2. The dental lab will create a plaster cast from the impression. They'll then use it as a model on which they'll fabricate your space maintainer.
  3. When it's finished, they'll deliver it to your dentist's office. The fabrication process may take a week or two.
  4. At your appointment, your dentist will slip your appliance into place and check it. They'll adjust its shape and fit as is necessary.
  5. Once they're satisfied, they'll cement it onto your tooth.

The whole placement process is pretty quick and easy. The dentist may do some trimming with their drill, but just on the appliance not you. There shouldn't be any need for an anesthetic.

How are they taken off?

Since it's just cemented in place, removing a space maintainer is usually relatively easy. The dentist might just pull it off, or use their drill to cut it into parts and then remove it. Either way, it should just take a moment or two and no anesthetic should be needed.


What precautions do you need to take when wearing a space maintainer?

Wearing your appliance should be a non-event. But you do need to practice some simple common-sense measures.

  • Eating. - You should be a little bit careful when eating especially hard or crunchy foods. Your space maintainer is only cemented in place. It is possible to dislodge it.
  • Cleaning your teeth. - There are no special instruction needed for cleaning around your appliance other than just be as thorough as you can. In general, a space maintainer will tend to trap food and debris. So, if you don't clean around it thoroughly, a cavity or gum irritation could form.
  • Keep on the lookout. - Take a look at your appliance when it's first put in, and then over the months or years that you wear it keep an eye on things. If something looks different about its position, or the tissues or teeth it involves, let your dentist know.

What should you do if your space maintainer comes off?

If your appliance comes off, put it in a safe place. Then let your dentist's office know so they can make an appointment for you to cement it back on.

  • Don't delay in reporting. When you're not wearing your maintainer, your teeth have the potential to shift.
  • If it will be some time before you can appoint with your dentist, seek their advice. They may suggest that you can help to minimize tooth shifting by carefully wearing your appliance some hours each day.


How much does a space maintainer cost?

Here's a ballpark estimate of what your dentist's fee might be.

$180.00 - $290.00
Small city or town. - Metropolitan area. 

How did we come up with this estimate?

A fixed, unilateral space maintainer.

Notes: The fee range shown would be for what a dentist refers to as a fixed, unilateral space maintainer.

  • This is the type of appliance illustrated in our graphic.
  • It's used to hold the space for one, or possibly more, teeth on just one side of a jaw (upper or lower).
  • This does not include the fee for extracting the baby tooth.

The cost of a fixed, bilateral space maintainer (a single appliance that involves protecting spaces on both sides of a jaw) typically runs on the order of about 50% more.

Does dental insurance cover space maintainers?

Dental plans often do provide benefits for this procedure but some restrictions may apply.

  • Placement may be limited to applications that protect the space associated with lost back teeth, not front ones.
  • There may be an age restriction. For example, this benefit may only be provided for children under the age of 14 years.
  • This procedure may be payable only once per area per lifetime of the patient.

These restrictions aren't universal. You'll simply have to examine the conditions outlined in your policy.

Other things to know.

  • If your space maintainer comes off, expect that your dentist will charge a recementation fee.
  • If your appliance is lost, expect that your dentist will charge you full price for a new one.
 

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