Milk teeth are not just for chewing. Each one holds a place for the adult tooth developing underneath it. When a milk tooth falls out naturally, the adult tooth is ready to come through within weeks or months. When one is lost early, because of decay or an injury, the teeth on either side can tip and drift into the gap. By the time the adult tooth is ready, its space may have shrunk or vanished.
What happens without one
- The adult tooth may come in crooked, to one side of the arch, or not at all (impacted, meaning stuck under the gum).
- The bite can shift, and the centre line of the teeth may move.
- Problems that a small appliance could have prevented can turn into longer, costlier orthodontic treatment later.
Types of space maintainer
- Band and loop: the most common. A stainless steel band is cemented on a tooth next to the gap, with a wire loop resting against the tooth on the other side. Used when one back tooth is lost.
- Lingual arch or palatal appliance: a wire running along the inside of the teeth, fixed to the molars on both sides, when several teeth are lost.
- Distal shoe: a special design for when the second milk molar is lost before the first permanent molar has come through.
- Removable maintainers: plastic plates, sometimes with artificial teeth. These suit older, reliable children and can replace front teeth for appearance, but they only work if worn.
Does your child actually need one?
Not always. The dentist will consider:
- Which tooth was lost. Early loss of milk molars, especially the second milk molar, is the main concern. Losing a milk front tooth early usually does not cause much space loss once the milk canines are in, so a maintainer is rarely needed there.
- How soon the adult tooth will arrive. An X-ray shows how developed the adult tooth is. If it is about to erupt, a maintainer may not be worth it.
- Whether the adult tooth exists. Some children are born without certain adult teeth.
- Existing crowding, and whether space has already been lost.
Timing matters: most space loss happens in the first few months after a tooth is removed. If your child has had a back milk tooth taken out, ask about a space maintainer at the same visit or soon after.
Living with one
- Avoid sticky toffees, chikki and chewing gum, which can pull the band off.
- Brush carefully around the band; food collects under the wire.
- Bring your child for reviews every few months. A loose band, a wire digging into the gum, or an adult tooth erupting under the loop all need attention.
- The maintainer comes off once the adult tooth starts coming through. It is not meant to stay forever.
What goes wrong is usually simple: a band comes loose and needs recementing, or reviews are missed and the appliance stays on too long. If it comes off, keep it and call the clinic rather than leaving it out for weeks.
Our MDS Pedodontics and Orthodontics departments can assess whether your child needs one. Space maintainers are not on our published online fee list, so the cost is explained after examination. See also our page on impacted teeth.
