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How A Space Maintainer Will Look In Your Child’s Mouth
A few months ago, I wrote an article detailing why it would be necessary for a child to get a space maintainer. A space maintainer is commonly referred to as simply a spacer.
In the picture to the left, you can see how the lower teeth of a six year old child might appear with a missing baby tooth -- the first molar. Let's say that this kid didn't brush his teeth a lot and ended up needing his first molar extracted because of a large cavity that couldn't be fixed.
If the dentist simply removed that tooth and sent the child home, that kid's permanent tooth would probably never come in!
Under normal circumstances, all of the teeth in the mouth exert pressure on each other, which holds them in their proper position. When a tooth is lost, the teeth next to the lost tooth will move into the lost space since the lost tooth can no longer exert its pressure on the adjacent teeth. Also, the teeth above the lost tooth will erupt a little more to fill in the space below.
The picture below shows what happens if a space maintainer is not placed after a baby tooth gets extracted.
When a tooth is lost, the teeth around it are eager to fill in the empty space
Why Teeth Move
Many people wonder why teeth want to move to fill in the gap when a neighboring tooth is extracted. Here's an analogy to illustrate why teeth move.
Let's say there's a giant crowd of people waiting in line for the chance to read the latest article on Oral Answers. Now suppose that one person decides he's sick and tired of waiting and decides to leave. When he leaves, there is a small opening in the crowd where he used to be excitedly waiting. Does the crowd leave that space open? No! The people that were waiting right next to the space where that guy used to be waiting move to fill it in the empty space that he left behind.
That's pretty much how it works in the mouth. When there's an empty space, teeth move to fill it in.
A Space Maintainer Maintains The Old Space
A space maintainer will conserve the space left by the extracted tooth. That way, when the permanent tooth starts to grow into the mouth, there will be lots of room for it to fit in perfectly.
Here's a space maintainer that I made during my pediatric dentistry lab earlier this year.
Here is a top view of a band and loop space maintainer.
Here's another view:
A side view of a space maintainer. This is how the space maintainer would look if you were sitting on the inside of your child's cheek.
Conclusion
If a space maintainer is not used, the jaw may never grow to its full potential and consequently it might not have room for all of the permanent teeth, necessitating the removal of some teeth along with orthodontic treatment (braces).
Do you have any questions or comments about space maintainers (spacers)? Leave them in the comments below and I'll get back with you!
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Hi, I'm Tom. I'm currently a 4th year dental student in the USA. I started this blog to help people take better care of their teeth. You can 
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Great post. Especially the analogy about the crowd fillng in the open space. Gald to see you blogging about dentistry. I think your writing style will serve you well as it speaks much as I try to write, as if you are speaking to a patient. By the way you can make a Band and "L" by using only one solder joint--works quite well and is easy and fast to make while the patient is waiting in the chair. I solder one side, clip it about 2 inches long, bring it to the patient, try it on measure and bend it into an L shape, clipping off the excess. So it looks just like the band and loop but without one side missing. (usually the lingual part)
When I was in dental school, I had no time (and no money) to blog or do pretty much anything else other than school. Of course, there was no such thing as the internet then. Good luck, and as was once said: "Blog on Wayne,-- Blog on Garth."
Hi Dr. Brandon - Thanks for the kind words! It's a struggle to fit everything in, but I look forward to blogging - it's relaxing and fun to be able to learn about different aspects of dentistry that real people have questions about.
That sounds like a much more efficient method of making a band and loop spacer. I imagine that it would probably be a lot easier for the child to eat and keep the area clean with that design. I guess you don't learn everything in dental school
my daughter just got removed 4 tooths 2 fronts and 2 in the back that had cavities
the front were behind the old baby tooths so they had to remove them for the new ones to align properly
the back ones had bad cavities so they had to remove them completely and the dentist said she will need a spacer on each side but the dentist visit was so bad almost traumatizing for her that i cant find a way to convence her to go back to the dentist and get this done and i am affraid the back tooths will shift...what do you recomend me to do...any help will be greatly appreciated it
Hi Damian - You won't have to worry about the front teeth, but when we take out back teeth early due to cavities, you usually need some sort of space maintainer. The only time you wouldn't need a space maintainer is if the permanent teeth are expected to come into the mouth within six months.
When taking teeth out, it can be very traumatic for kids. All that they would need to do to get the space maintainers in would be to take an impression of her teeth and then make the space maintainer using that cast. After that, they would just need to put the space maintainer in. None of it should be painful at all.
As for getting her to go back here's a few suggestions:
1 - You can be honest with her and tell her that her permanent teeth might not come in if she doesn't get the space maintainer. This works better with older kids - if she's 3 or 4 years old, she may not care.
2 - You can tell her how proud you are of her and how brave she was for going to the dentist and getting her teeth out. Let her know that at the next visit, it will be fun - they will put some gel in her mouth that will get hard, they will take it out and then make a model of her teeth. After that, they will put the space maintainer on her teeth and it shouldn't hurt.
3 - You can try rewarding her with something she wants for going to the dentist. We have stickers and silly bands in our pediatric dentistry department and we tell the kids that if they open their mouths for us they can have some stickers and silly bands. That usually works.
If you (or others that may be reading this) have any other ideas, please reply so others can try them in the future. Thanks for your comment, Damian. I hope that helped.
thank you for your quick response i am looking into dentist that use laughing gas so her nest visit wont be as painful as last one, they did promised me they used the laughing gas but rite after i signed the $800 dollar tab they said they dont even use it
thanks for your help it is really nice to hear an honest opinion
damian
I'm sorry to hear that, Damian. Luckily, since there shouldn't be any pain with her next appointment, it may not be necessary.
Another thing you could try is to ask your dentist for one of the plastic impression trays. You could take it home and practice putting it in your daughter's mouth so she'll know what will be happening at the next visit. A lot of kids simply fear the unknown. Good luck getting her to get that spacer!
My son had his 2nd molars extracted due to cavaties he was 4 yrs old at the time. The dentist said that when his six yr molars come in that he will have to have space maintainers placed. I assumed that they would come in around 6 yrs old. Well he just turned 5 and is very independent when it comes to brushing his teeth. I just noticed that his 6 yr molars are completely in, and im scared that its to late. There is still an opening between the teeth, but it doesn't look very big. Will a space maintainer still be helpful?
Hi Brittany - Based on what I've been taught in my three years of dental school, your son probably should have had what we call a "Distal Shoe" space maintainer put in right after his 2nd molars were extracted. You can read more about these at this page (it is the third image down - also take a look at the two x-rays below that which show how it works)
Your son's permanent tooth, a premolar isn't extremely wide, so there may still be room for it to come in. Your best bet would probably be to take him to a pediatric dentist to find out if there is still room. They will be able to let you know if the tooth will still be able to come in or if a space maintainer would help at this point.
I hope that helps, Brittany! Good luck with everything - Thanks for your comment.
thank you so much for the response. knowing that something should of been placed there even before his 6 yr molars came in does make me a little upset though. he just had his 2nd molars removed about six months ago. what will happen if there isn't enough room for the permanant teeth to come in or if a space maintainer can't be placed? i tend to drive myself crazy over everything when it involves my children. i am going to make him an appointment with a pediatric dentist in the morning hopefully they can get him in rather soon.
Hi Brittany - I'm just going by what I've learned in dental school. It could be that your son's dentist had a good reason for not placing the space maintainer. If there isn't enough room for the permanent teeth to come in, then orthodontics can most likely create the needed room to allow the teeth to come in normally. Hopefully the teeth haven't moved too much and there's still room for the permanent teeth to come in. Keep us updated on what happens at the appointment. Good luck with everything, Brittany!
Thanks for much for your post.
I am 22 years old. My first lower molar was removed dued to some dental problem. I plan to wear brace in the next two years when I get back to my country ( because now I am abroad.) I want to know whether I should put a space maintainer for the hole or just leave it like that ( as I am going to wear the brace in the next 2 years anyway)?
And if I put a space maintainer, will the tooth above the lost tooth still erupt a little more to fill in the space below?
I am waiting for your reply. Thank you so much.
Natalie
Hi Natalie - We usually use space maintainers in children so that there is room for the permanent teeth to come in. Although your teeth will slowly "drift" into the empty space, if you are planning on having braces, then your orthodontist should be able to move everything back to the way it was before you lost the tooth.
The best space maintainer in adults is to replace the empty space with a false tooth, by getting a bridge or an implant. Let me know if you have any other questions. Thanks for your comment, Natalie!
Hi Tom, our son is 7 and we were told by his dentist that he needs a "baby root canal" in his bottom left molar. Our other option is pulling the tooth and placing a spacer. His father and I have concerns with either alternative and need advice on which is the better option. Our concern with the "baby root canal" is what if they don't remove all of the bad stuff and it becomes abcessed (that happened to my husband). Second option leaves me worried about my son's future dentist visits if this becomes traumatic for him. My husband had a molar pulled when he was a child and did not have a spacer and the rest of his teeth came in fine, could this be another option for us? Or, what would happen if we left the tooth in until it fell out on it's own? Any advice you can share with us would be greatly appreciated!
Hi Candis - As far as I know, it's almost always recommended to get a space maintainer when you get that tooth pulled out. However, as you stated, getting that tooth pulled out can be traumatic for your son. The replacement tooth (the mandibular premolar) usually comes in between the ages of 10 and 12, so your son will be looking at 3-5 more years until that tooth comes in. For this reason, it's probably not a good idea to simply leave the tooth in his mouth without doing anything. You can read this article about why baby teeth are important to see that an abscess can damage the permanent tooth.
As for the baby root canal, that could be the better option. I understand that you're reluctant to go through with this since things didn't go very well with your husband. Although they are usually successful, sometimes root canals end up not working out.
You do have a few options. All I can say is that if it were my own son, I would probably go with the root canal over the extraction. I hope that helps, Candis. Thanks for your comment!
My son is 7 yrs. old and his back tooth was extracted 2 yrs ago. Unfortunately, the Dentist suggested space maintainer after the space healed. After that Dentist kept rescheduling. Now i went to see someone else and it is too late. The Dentist/Orthodontist suggested to put retainer because there is not enough space. The cost is $600. Any other suggestions?
Hi Janete - I'm sorry to hear that. The only way I know of to create enough room is through orthodontics. This means that either braces or a retainer would be needed to move the adjacent teeth so that there is room for the permanent tooth to come in.
I wish I could give you better news! Let me know if you have any other questions. Thanks for your comment, Janete!
My son had two (baby) top molars removed a year ago -- his six year molars came in too close, destroyed the roots of the baby teeth in front of them. He had a spacer placed, and it came loose -- so they simply removed the spacer and said his new teeth would just come in. My understanding was that the permanent molars (replacing the pulled teeth) were 10-12 year molars. My son is 7 1/2... I questioned them (twice) and was assured that these permanent teeth would indeed come in correctly. But do they come in earlier just because the baby teeth were pulled? We spent $300 on this spacer, not to mention time and frustration on my son's part because of the length of time it took him to get used to having the spacer in his mouth. I worry that now the spacer is out, his teeth will move around because it will be years until his permanent teeth come in! I would love some advice. Thanks!
Hi Julie - The permanent "premolar" or "bicuspid" teeth are what will replace those two baby teeth that were removed. You are correct - those 2nd premolar teeth come in anywhere from 10 to 12 years old according to the eruption chart from the American Dental Association.
To be honest, everything that I've been taught in dental school would indicate that a space maintainer is necessary in this case, since I am guessing that the six year old molars are excited to keep moving forward as they have been doing.
Generally, a good choice of space maintainer would be a transpalatal arch appliance, one that hooks onto both of the six year molars on top and goes across the roof of the mouth. I had previously looked into this in response to a comment.
It might be a good idea to get a second opinion from a pediatric dentist, and then try to get your money back or have a new, well-fitting appliance made from this other dentist. I hope that helps, Julie. Let me know if you have any other questions. Thanks for your comment!
my son is 7yrs9 mths old. he had developed a cavity in his first molar 7 mths back which the doctor extracted. he said there was no need of a space maintainer. but after reading your articles i think i have done a blunder to my child. what should i do now? can i still put a spacer for him or it is too late? please guide me.
Hi Rekha - The baby first molar usually falls out on its own around the age of 10 to 11. Three years without a space maintainer may cause some shifting problems. You may want to go to a pediatric dentist to get their opinion on whether a space maintainer will be beneficial at this point since it's only been seventh months.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Rekha!
I had a crown AND post come out of my molar area but the dentist didnt have time to do anything but drill away at the cavity that had grown in there. He has stopped it up with a little cement(all ok with that for now) but my concern is my gums, my molar root is still in my gum so how long can for an appointment b4 the gum starts to grow around my tooth?? I have no crown to push down on gum line so im afraid now.
thank you
My daughter had spacer put in 3 years ago we have since moved and just started with a new dentist I was told they were going to remove her spacer (she is 9 ) and see how how she does and then she will have to have another one put in. My question is, is this necessary? Or are they just trying to make a few more bucks out of me.
My son had a tooth pulled two weeks ago and the Dentist took a mold to make a spacer. Yesterday he had the spacer installed. It looks like he has braces on the back side of all of his bottom teeth. He has crowns around both back teeth and a wrinkled wire running between them. The tooth that was removed was the middle molar on the bottom left. The wire looks so uncomfortable and my son says it hurts to chew and his tongue is being scratched by the back crowns. The photo you provided with your article is what I expected to see when my son came out. Do you think my son should have the work redone?
I have an 11 year old son who needs 6 teeth removed - one ortho says he needs a maintainer and the other says a retainer (he says it helps if my son grinds his teeth) what is the big difference - I do know the retainer does cost a bit more? Thanks.
Hello,
My son had his first molars removed in July. He never got the spacers and I can see his teeth shifted. Is there a lab that can make it for me or does a dentist have to make it?
Hi, I have a 5 1/2 year old son that had two molars removed from the bottom less than a year ago. He had spacers put in and has had no problems before now. He can't even eat lately because of the pain. I noticed some molars coming in in the back. Is it just the pressure of those teeth pushing against the teeth and spacer? The gums don't look irritated, that I can tell. Thanks.