Local Dental Care - Pediatric Tooth Chart

Tooth Care: Space Maintainers

What happens when a primary (baby) tooth is lost too early? An appliance called a space maintainer will be recommended by your pediatric dentist. The area of the mouth and the age of the child will determine the need for and type of space maintainer.

The primary teeth save the space for the permanent teeth. The 20 primary teeth are replaced by 20 permanent teeth. The six-year molars, twelve-year molars, and wisdom teeth will erupt (come in) in the back of the jaw. The bone will begin to grow around five years of age to make room for these teeth. If a primary tooth is lost before the permanent tooth is ready to erupt, other teeth will drift or tip into the empty space. This may block out the spot for the permanent tooth that replaces the primary tooth. The space maintainer will hold the teeth in their proper position.

Primary teeth may be lost early because of decay, crowding, injury, or improper eruption of the permanent teeth. Most space loss occurs during the first six weeks after the loss of the tooth. This may continue over the next six months. A space maintainer should be placed before this loss occurs. Sometimes, space loss cannot be avoided and your dentist can only attempt to preserve the remaining space.

There are many types of space maintainers, but two are most often used. The band and loop is used to hold the space for one tooth. The lingual arch is used to hold the space for two or more teeth that have been lost from both sides of the jaw.

If a primary molar is prematurely lost and the six-year molar has not yet erupted (come in), the parent must watch closely for the eruption of the six-year molar. This is very important because the six-year molar will rapidly tip or drift forward causing space loss. The teeth that replace the first and second primary molars ordinarily do not erupt until between nine and eleven years of age. The six-year molar must be partially erupted to make the space maintainer for early loss of a second primary molar.

Space maintainers are usually made with orthodontic bands and wires. Two appointments are necessary. During the first dental appointment, an orthodontic band is fitted on the tooth next to the space. An impression is taken. Next, the band is removed from the tooth and placed in the impression. A mold of the teeth is made with the band on the tooth. A laboratory will custom make an appliance to exactly fit the space. During the second appointment, the appliance is cemented in place.

The space maintainer is not removed until the permanent tooth begins to erupt. The parent must be sure to tell the dentist when the permanent tooth is erupting. If the space maintainer is not removed at the proper time, the permanent tooth may come in improperly. Your dentist will inform you of the age when your child's permanent tooth will likely appear. Early tooth loss may cause the permanent tooth to be delayed in its eruption or to erupt earlier than expected.

by Jane A. Soxman, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Management of Injury to Children's Permanent Teeth

Recent studies indicate that 25% of Americans between the ages of 6 and 50 years have experienced traumatic injury to permanent teeth. Ninety percent of traumatized teeth involve the upper incisors. The focus of contemporary treatment of dental traumatic injuries is conservative management of the affected tissues to maximize their excellent healing potential in children. The most important element in this process is the reduction of the time interval between the traumatic episode and the dental treatment. Dental treatment should therefore be sought immediately. It is for this reason that public information on dental trauma management is so critical, particularly in the following three areas.

Coronal Fractures -- Broken Crowns of Teeth

The predominant treatment goal in tooth crown fractures includes protecting the underlying pulp (nerve tissue) within the tooth from bacterial contamination and infection. Additional goals include keeping the adjacent teeth from moving into the space created by the missing tooth portion and restoring the esthetic appearance and function of the traumatized tooth.

Dental treatment of crown fractures involves the following steps. The affected teeth and surrounding soft tissues are cleansed with an antibacterial mouthwash and the exposed dental hard tissues are protected with either an applied protective medicament or an adhesive resin material. These measures provide a seal against bacterial penetration into the porous tooth structure and subsequent infection of the underlying pulp. A resin (plastic) restoration of the lost tooth portion is placed for esthetics and function. In cases where the missing tooth fragment can be found, it can be reattached to the remaining tooth portion with dental adhesives. The treated teeth are then monitored post-operatively for signs of possible infection over a period of several months to a year.

Tooth Displacement Injury -- Loosened or Dislodged Teeth

The predominant treatment goal for displaced teeth focuses on protecting the supporting tissue known as the periodontal ligament from bacterial invasion and subsequent infection resulting from the injury. This tissue surrounds the root of the affected tooth and has the primary function of attaching the tooth to the bone.

Dental treatment includes stabilizing the excessively loosened or displaced tooth by means of short-term splinting. The splinting device consists of an orthodontic brace wire attached to the affected tooth and adjacent teeth with resin adhesive for a one to two-week period. Additional treatment may include esthetic restoration of tooth portions damaged by the injury as previously mentioned, and post-treatment monitoring for signs of healing.

Tooth Avulsion -- Teeth That Have Been Knocked Out

Treatment goals for knocked-out teeth are focused on enhancing periodontal ligament survival. The critical variable is the length of time that the tooth has been out of the mouth without any means of providing hydration and nutrition to the periodontal ligament cells attached to the avulsed root surface. This time length is known as Extra-Oral-Dry-Time (EODT). If the EODT is less than one hour, the chances for periodontal ligament survival is quite good, provided the appropriate management is started immediately.

Dental treatment of avulsion involves minimizing the EODT by immediately replacing the tooth back into the socket or immediately placing it in a transport/storage solution to hydrate and nourish the periodontal ligament cells still attached to the root. The most readily available transport media is cool milk. Special tissue culture fluids are even better, but generally are available only from a dentist, drug stores, or school health clinics. On-site tooth avulsion management includes the following:

1) Rinse the knocked-out tooth under tap water only if there is dirt.

2) Replant the tooth in its socket and keep it held in position, or place it in milk (or culture fluid, if available).

3) Immediately take the child to a pediatric dentist who will stabilize the tooth with splinting devices previously mentioned and provide the necessary treatment of the pulp and the periodontal ligament.

The more we can do to enhance the excellent healing potential of the traumatized tissues in children, the better the outcome.

By Clifton O. Dummett, Jr., DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.