A space maintainer can save a child's dental health. Typically children lose a baby tooth when a permanent tooth is ready to erupt. The pressure from the permanent tooth pushes out the baby tooth. Sometimes however children lose baby teeth too early due to decay or injury. When this happens the other baby teeth may shift in order to fill the gap. By the time the permanent tooth for which the gap was meant is finally ready to erupt its place in the mouth has shrunk or been filled. As a result this permanent tooth will create a crooked and/or crowded smile. Crooked and/or crowded teeth in turn can lead to difficulty speaking and trouble chewing. Misaligned teeth are more difficult to clean so the child is put at a greater risk for tooth decay. Eventually crooked and/or crowded teeth will bring about a need for orthodontic treatment. In some cases there is no room left in the jaw for the permanent tooth to erupt at all.
Dentists can stop this shift ahead of time with the use of a space maintainer. A space maintainer holds open the hole left by a lost tooth by keeping the teeth beside the spot in place. The space maintainer can consist of a metal band separating the two teeth or of a temporary crown attached to a tooth beside the empty space. The dentist will remove the space maintainer once the permanent tooth has begun to erupt.
Patients can choose from several different types of space maintainers. Band-and-loop maintainers are made of stainless steel wire. To apply a band-and-loop maintainer the dentist creates a mold of the child's mouth then sends this mold off to a laboratory where the space maintainer is made. The dentist cements the metal band around the tooth behind the empty space. Then he or she places a loop or brace over the empty space and rests this loop or brace against the tooth in front of the empty space. A band-and-loop maintainer can also be attached using a crown on one of the adjacent teeth.
It is also possible to use a removable space maintainer consisting of an artificial tooth. Removable space maintainers ideal for filling highly visible gaps should only be used by older children who can properly care for them.
If teeth are lost on both sides of the lower jaw the child can wear a lower lingual holding arch. A wire connected to bands wrapped around a tooth on either side of the mouth behind the missing teeth runs along the inside of the bottom teeth. Lower lingual holding arches are a preferable option over two separate band-and-loop maintainers as the arches can better distribute biting and chewing.
Another option is a distal shoe appliance which is used when there is no tooth behind the missing tooth for the band-and-loop maintainer to sit upon. The end of the metal arm is inserted underneath the gum instead. However the incoming tooth can become stuck in the jawbone or emerge crooked. For this reason most dentists will try to keep the primary tooth in the mouth until the permanent tooth underneath is ready to erupt.
Following the application of a space maintainer the child must visit his or her dentist every six months to check the condition of the device (and of the rest of the teeth). The child should avoid sticky foods such as candy gum or popcorn that might accidentally yank the maintainer out of place. He or she should also ensure that the wires around the empty space are cleaned properly every night.
Space maintainers can also be helpful for adults waiting for teeth to erupt.