Early Tooth Loss

Most people are born with two sets of teeth; the primary or baby teeth begin to erupt as early as six months and continue to erupt until three and a half years of age. As your child grows and develops, she will lose her baby teeth and new permanent teeth will take their place.  The first permanent teeth to erupt may be either the lower first molars (which do not have primary predecessors) or the lower front teeth, which replace the lower front baby teeth.  When primary teeth are lost prematurely, it is important to see an orthodontist to prevent any long term issues that may inhibit the eruption of other permanent teeth in the future.

Reasons for premature tooth loss.

1. Decay – this can be prevented by regular brushing and home care and visiting your dentist for regular check ups.
2. Injuries including accidents or sports related injuries to the mouth – this can be prevented by wearing outhguards, helmets and other protective equipment.

What happens if my child looses a baby tooth too early.

We often see patients who lose their primary or baby teeth too soon.  This posses a risk for the developing teeth because the adjacent teeth can move and block the space for the permanent teeth to erupt, making future orthodontic treatment longer and more complicated.

When we see a patient with early tooth loss, where the teeth have not yet shifted, we usually recommend space maintainers to prevent the adjacent teeth from shifting and blocking the space of the erupting tooth.

Space maintainers:

Band and Loop Appliance

A band and loop appliance is often used when there is early tooth loss of a single baby tooth on one side of the mouth.  A ring is fastened to an adult molar which has a loop that traverses across the extraction space and lightly touches the closest baby tooth.  This ensures that the molar does not move forward to block the space where the adult premolar will eventually erupt.  Once the adult tooth grows in, the band and loop appliance is removed.

Nance Appliance

A Nance appliance is used in patients who have two or more missing primary teeth on both sides of the upper jaw.  In this case, two rings are fastened on the adult molars with a loop closely traversing the roof of the mouth.  The only part that is in contact with the palate is a small acrylic button that prevents the upper molars from moving forward into the extraction space.  Once the permanent teeth erupt, the appliance is removed.

Holding Arch

A holding arch is used in patients who have two or more missing teeth in the lower jaw.  The appliance is fabricated so that the rings are attached to a wire that sits against the back of the lower front teeth.  These teeth prevent the shifting of the molars forward and maintain the space until the permanent teeth are ready to erupt.

Indications for a lower lingual holding arch to create space for adult teeth to erupt.

In certain cases, when there is significant crowding in the lower jaw, Dr. Virdee will recommend the use of this appliance to allow mother nature to passively create space for the crowding that is present.  This is one of the best ways to conserve and create space naturally without initiating active orthodontic treatment.  It works because the baby molars are usually larger than the adult teeth that replace them.  Normally, when the baby molars fall out and the adult premolars erupt, the permanent first molars (the six year molars) will drift forward to “eat up” the residual space.  When a holding arch is inserted before the baby molars fall out however, the residual space is maintained because the six year molars can’t drift forward.  As a result, we can use this space to relieve the crowding that may be present in the bottom jaw.  Sometimes, using this appliance can mean the difference between extraction and non-extraction treatment.

What if a baby tooth is lost early and there is no space for the eruption of the permanent teeth.

We often see many cases where there has been early loss of baby teeth.  The permanent teeth then drift forward and prevent future eruption of the adult teeth at the site of tooth loss.  In this case, we may use early intervention with either a removable appliance or a fixed appliance to help move the molars back to their original position.  Once this is completed, we will then insert a space maintainer until the adult tooth erupts, limiting long, complicated treatment in the future or even unnecessary extractions of adult teeth.