Children as they grow, achieve multiple milestones starting from smile, walk and talk and from the dental perspective , getting the first tooth and the remaining teeth. As a child reaches the 6 years mark the baby tooth start shaking heralding another milestone in the development of the child. Many a times the happy phase of natural tooth loss is overshadowed by dental problems like dental decay, trauma, etc causing the child to lose a tooth before its actual shedding time.
NORMAL CYCLE OF SHEDDING : (FIG 1)
When a milk tooth is lost, it is soon replaced by the permanent teeth that was pushing itself upwards by dissolving the roots of its primary predecessor, as the movement increases, the primary tooth is shed and replaced by a new permanent tooth.
ABNORMAL CYCLE OF TOOTH LOSS:
When a tooth has to be removed because of unchecked and untreatable tooth decay or due to any traumatic injury then the cycle takes a different turn. Usually if the permanent successors are in the phase to erupt then it doesn’t create a problem, but if the teeth are lost immaturely i.e. before the permanent successors are ready to erupt then it is a cause for concern.
Figure 2: Abnormal cycle of tooth loss
PROBLEMS WITH EARLY TOOTH LOSS:
Though there are many problems that may arise due to early tooth loss like unpleasant smile, tongue thrusting habits etc but the major concern is LOSS OF SPACE for the permanent successors.
Picture 1 shows inadequate space (shown in circle) for eruption of two permanent teeth
If a tooth has been lost prematurely then it is advisable to visit a Pediatric Dentist/ Pedodontist who may evaluate the condition and treat it appropriately using SPACE MAINTAINERS. These are appliances which save the space for the permanent teeth.
TYPES OF SPACE MAINTAINERS:
REMOVABLE: are acrylic plates with extensions and at times containing artificial teeth. They are like the removable dentures which can be removed and inserted by the patients. In children this is not much preferred as they may not co operate in wearing the appliance.
FIXED: These are made up of stainless steel with each appliance having a wire component and a metal band to be inserted around the teeth. Multiple types are fabricated with different combinations as per the needs of the patients. These are cemented onto the teeth and cannot be removed by the child. Once the teeth start erupting the dentist will remove the appliance.
Frequently asked questions:
1. Will it be uncomfortable?
The child will feel a little uncomfortable for a few days but will get accustomed to it.
2. Will it cause any problems to the permanent teeth?
It definitely won’t cause any harm to the permanent teeth but will save the space for the permanent teeth.
3.Won’t my child swallow it?
The appliance is fabricated based on the measurement of the child’s teeth and then cemented onto the teeth. So there are very less chances of it getting dislocated and children are very sensitive to things in their mouth and usually do not swallow anything just like that.
4. Is it expensive?
The one time cost that you have to pay is far less as compared to the treatment that your child will have to undergo if she has lost space for the eruption of permanent successors
5.Where can I get it done?
Space maintainers are provided by a Pediatric Dentist and you can visit any Pediatric dentist to get it done.
6. How frequently do I have to visit the dentist after this treatment?
Irrespective of whether you are undergoing any treatment or not it is advisable to visit your dentist every six months. In case your child has been given a space maintainer then you have to check it regularly at home and visit the dentist if the teeth for which the space is being maintained starts erupting or if the appliance is causing any problem like loosening, breakage etc.
Dr. Parajeeta Dikshit is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at Kantipur Dental College teaching hospital and research center Basundhara , Kathmandu and Consultant Pediatric Dentist at Smile Square Dental Care Center, Maharajgunj, Kathmandu.
*Figure 1 and 2 illustrated by Dr. Sonila Maskey, Dental surgeon, Kantipur Dental college teaching hospital and research center.