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Space Maintenance
Q: Why do children lose their baby teeth?
A: A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place.
Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed
because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer
to prevent future space loss and dental problems.
Q: Why all the fuss? Baby teeth fall out eventually on their own!
A: Baby teeth are important to your child's present and future dental health. They encourage normal development
of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember:
Some baby teeth are not replaced until a child is 12 or 14 years old.
Q: How does a lost baby tooth cause problems for permanent teeth?
A: If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw
may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in
the jaw for the permanent teeth. So, permanent teeth are crowded and come in crooked. If left untreated, the
condition may require extensive orthodontic treatment.
Q: What are space maintainers?
A: Space maintainers are appliances made of metal or plastic that are custom fit to your child's mouth. They are
small and unobtrusive in appearance. Most children easily adjust to them after the first few days.
Q: How does a space maintainer help?
A: Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing
movement until the permanent tooth takes its natural position in the jaw. It's more affordable -- and easier on your
child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic
treatment.
Q: What special care do space maintainers need?
A: Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second,
don't tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious
brushing and flossing. Fourth, continue regular dental visits.
Q: What is malocclusion?
Malocclusion is the improper positioning of the teeth and jaws. It is a variation of normal growth and development
which can affect the bite, the ability to clean teeth properly, gum tissue health, jaw growth, speech development
and appearance.
Q: What causes malocclusion?
Both heredity and environmental factors can play a role in developing malocclusions. The shape and size of the
face, jaws and teeth are determined mostly by inheritance. Environmental factors can also have a large impact and
these are the types of problems which the pediatric dentist is well trained to manage.
Q: How long does it take to treat a malocclusion?
Every child is unique and must be treated individually. The pediatric dentist will provide an estimate of the length
of time required prior to initiating treatment. In complex malocclusions the treatment may be divided into several
phases which are scheduled to coincide with the child's particular pattern of growth and development.
Q: Is it necessary to remove healthy teeth to correct a malocclusion?
Carefully controlled removal of selected primary teeth may be necessary to guide the permanent teeth into proper
position. This procedure requires frequent monitoring over a period of time and usually in combination with the
use of some type of appliance. The removal of permanent teeth depends specifically upon the circumstances for
that particular child. There are some malocclusions which cannot be treated successfully without removing
permanent teeth and there are other situations where permanent teeth should definitely not be removed. This is a
decision which must be made very carefully after thoroughly evaluating all of the diagnostic materials available for
that patient.
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Q: What information does the pediatric dentist need to evaluate a developing malocclusion?
The complexity of each child's individual problem will dictate the extent of examination and diagnostic procedures.
Following a thorough clinical examination with a review of past medical and dental history, impressions of the
teeth are taken from which plaster models are made. These study models provide a baseline reference of the current
relationship of the teeth and jaws and also provide a method to monitor the progress of any treatment. Photographs
of the face and teeth also provide a record of the child's facial appearance prior to treatment. Several types of Xrays may be needed to properly diagnose a developing malocclusion. Most commonly used are a panoramic X-ray,
which shows all the upper and lower teeth in biting position as well as any teeth still developing within the jaws,
and a lateral X-ray of the entire head, known as a cephalometric X-ray which shows the relationship of the teeth
and jaws to the face and skull.
Q: What types of appliances are used to correct malocclusion?
There are two basic types of tooth movement appliances, removable and fixed. Removable appliances are made of
wires and plastic and can be removed from the mouth by the patient. Some fit the upper and lower teeth at the same
time. Their success is totally dependent on the patient's compliance in wearing the appliance exactly as instructed
by the pediatric dentist. An advantage of removable appliances is that they are easy to keep clean. Fixed appliances
are what we know as "braces." Because this type of appliance is attached directly to the teeth, there is better control
of tooth movement. However, cooperation from the patient in maintaining scrupulous oral hygiene while wearing
fixed appliances is essential in preventing cavities in areas where food collects easily around these appliances.
Early Orthodontic Care
It's never too early to keep an eye on your child's oral development. Your pediatric dentist can identify
malocclusion -- crowded or crooked teeth or bite problems -- and actively intervene to guide the teeth as they
emerge in the mouth. Orthodontic treatment early can prevent more extensive treatment later.
Q: What causes crowded teeth and other orthodontic problems?
A: Malocclusion is often inherited. Orthodontic problems also are caused by dental injuries, the early loss of
primary teeth or such habits a thumb sucking, fingernail biting, or lip biting. Your pediatric dentist can help your
child avoid oral habits that may create orthodontic problems.
Q: Why is early orthodontic care important?
A: Early orthodontics can enhance your child's smile, but the benefits far surpass appearance. Pediatric
orthodontics can straighten crooked teeth, guide erupting teeth into position, correct bite problems, even prevent
the need for tooth extractions. Straight teeth are easier to keep clean and less susceptible to tooth decay and gum
disease.
Q: What is early orthodontic treatment like?
A: Different orthodontic appliances work in different ways to benefit your child's dental health. Some are fixed;
others are removable. Your pediatric dentist will explain which appliance is best for your child, what the treatment
can do, and how long it will take.
Q: What care is recommended during orthodontic treatment?
A: As with any dental treatment, the more a child cooperates, the better the results. First, careful brushing and
flossing keep the appliance and your child's health in top shape. (Removable appliances should be brushed each
time the teeth are brushed.) Second, regular dental check-ups -- besides orthodontic appointments -- protect your
child from tooth decay and gum disease. Third, prompt contact with your pediatric dentist when an appliance
breaks will keep orthodontic treatment on-time and on-track.
Q: Can my child speak, eat, and play normally?
A: Your child can eat a normal diet except sticky foods (gum, caramels) and large, hard foods (peanuts, ice chips,
popcorn). Some appliances alter speech, but most children adapt quickly and speak clearly within a day or two.
Generally, children can safely run, jump, swim, and play with an orthodontic appliance. Check with your pediatric
dentist for specific advise on your child's activities.
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Braces and Orthodontics
Frequently Asked Questions (FAQ)
 At what age can people have orthodontic treatment?
 What causes orthodontic problems?
 How are orthodontic problems corrected?
 Are there less noticeable braces?
 How long will treatment take?
At what age can people have orthodontic treatment?
The biological process involved in moving teeth is the same at any age. Children and adults can both benefit from
orthodontics. It is recommended that every child receive an orthodontic evaluation by age seven. Treatment may take a little
longer for adults. Because an adult's facial bones are no longer growing, certain corrections may not be accomplished with
braces alone.
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What causes orthodontic problems?
An orthodontic problem is called a malocclusion, meaning "bad bite." Some examples of causes of malocclusion are crowded
teeth, extra teeth, missing teeth or jaws that are out of alignment. Most malocclusions are inherited, although some can be
acquired. Acquired malocclusions can be caused by accidents, early or late loss of baby teeth, or sucking of the thumb or
fingers for a prolonged period of time.
How are orthodontic problems corrected?
First, pretreatment records are made. These records are important tools for the dentist to use in making an accurate diagnosis.
They include medical/dental history, clinical examination, plaster study models of teeth, photos of your face and teeth and xrays of your mouth and head. This information will be used to decide on the best treatment.
A custom treatment plan is outlined for each patient. The specific treatment appliance best suited to correct the patient's
orthodontic problem is constructed. There are a variety of different orthodontic appliances that may be used.
When the orthodontic appliances are in place, this is considered the "active treatment" phase. Appliances are adjusted
periodically so that the teeth are moved correctly and efficiently.
The time required for orthodontic treatment varies from person to person. An important factor in how long a patient wears
braces is how well the patient cooperates during treatment — for example, by following instructions to wear rubber bands or
head gear.
After active treatment is completed, the "retention" phase begins. A patient will need to wear a retainer so that the teeth stay
in their new positions. For severe orthodontic problems, surgery may be recommended.
Are there less noticeable braces?
Today's braces are generally less noticeable than those of the past. Brackets, the part of the braces that hold the wires, are
bonded to the front of the teeth. These brackets can be metal, clear, or tooth-colored. Wires that are used for braces today are
also less noticeable. In some cases, brackets may be put on the back of the teeth (lingual appliances). Modern wires are also
less noticeable than their predecessors. Today's wires are made of "space age" materials that exert a steady, gentle pressure
on the teeth, making the tooth-moving process faster and more comfortable for patients.
How long will treatment take?
Although the average treatment time is about 24 months, this varies with individual patients. Usually, adult treatment takes a
little longer than a child's treatment. Other things to keep in mind are the severity of the problem, the health of the teeth,
gums and supporting bone and how closely the patient follows instructions. While orthodontic treatment requires a time
commitment, most people feel the benefits are well worth the time invested.
Contact Information
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Consumer Questions E-mail: [email protected]
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