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What A Space Maintainer (Spacer) Is And Why Your Child Might Need One

Whenever a tooth is lost, the teeth on either side of it move towards the empty space to try to fill it in.

SA Red Headed Boy with Baby Teethometimes this can be a good thing, like if your orthodontist has to extract a tooth due to crowding.  After the tooth is extracted, the teeth adjacent to it move together and line up perfectly to create a beautiful smile.

Other times, this movement can be a bad thing.  Let’s say a little boy named Johnny with baby teeth and his six year molars lost his baby second molar (the second tooth from the back after the six year molars have come in) because he had too many cavities in it and it was too far decayed to try to put a filling in it.  The six year molar (the last tooth – at the very back of the mouth) would move forward to fill that space.

The problem is, Johnny has a permanent tooth right under that baby second molar that may not be able to come into his mouth if the six year molar has moved forward to fill that space.  This permanent tooth may give up trying to come up into Johnny’s mouth and may never come into his mouth, but just stay lodged deep within his jaw.  It could also try to force its way out sideways and cause big problems for Johnny (and his parents who are paying the bill!)

This is where space maintainers (spacers) come into play – they keep teeth from moving together and filling the empty space.

How Dental Space Maintainers (Spacers) Work

A space maintainer consists of one or two stainless steel crowns or bands that attach to the teeth and hold a bar or wire loop between them that prevents the teeth from moving toward each other into the empty space.  This provides a force that keeps the two teeth from coming together.  It’s kind of like an overprotective father following his daughter on her first date to the movies with a cute boy and sitting between them – he will block the natural forces that attract them to each other and prevent them from moving together and filling the empty space between them.

With a nice open space in the child’s mouth, the permanent tooth that is still deep within the jaw will happily erupt into the welcoming space waiting for it.

Do All Prematurely Lost Baby Teeth Need Space Maintainers?

Not all prematurely lost baby teeth will need space maintainers.  If the permanent tooth will be coming in shortly, then it is probably not necessary.  A dentist is able to take x-rays of your child’s mouth and determine about how long it will be before the permanent tooth will come in.

Also, spacers are usually not necessary when kids’ incisors (the front four teeth) are prematurely lost because there is rarely any space loss that occurs in this front area.

It is important to note that when kids naturally lose their teeth, there is no need for a space maintainer.  Space maintainers are only necessary when a baby tooth has been prematurely lost.  For example, if the tooth was knocked out in an accident or the tooth had to be pulled because it was too decayed to be saved.

What If the Teeth Have Started Moving Together Already

Fortunately, there is something called a space regainer, that has springs and can push the teeth away from each other to create a big enough space for the permanent tooth to erupt into the mouth.  Luckily, most dentists know that a space maintainer is necessary and will put one in when indicated.

If you have any questions about space maintainers, type them in the comments.  Thanks for reading!



  1. My 7 yo son had a tooth pulled – second from the back upper. The dentist had put a stainless cap on it which later became infected (blister at gum). The Molar behind that has just came in fully and we have an appt to discuss space maintainers. It seems the type of space maintainer you discuss in your example would be the solution. At our last appt it was mentioned that the space maintainer would probably need to go across the roof of the mouth and sounds much more complicated in putting it in and also upkeep (food/brushing)- and much more expensive. I am trying to inform myself as a parent and would like your advice.
    Thank you, Mary Werner

    • Hi Mary – That type of space maintainer (the band and loop) makes sense to maintain space so that the 2nd premolar can come in without any problems. My guess is that your dentist wants to also make the palate (the upper arch of teeth) a little bit wider to give some more room as well. Since your son is seven, it would be fairly easy to control the growth of the palate at this point, and it gets harder as they get older. For example, I’m in my 20’s and with my bones completely formed, my palate can’t be expanded anymore using orthodontics; I would need surgery.

      This is from what I remember, but when I get home this afternoon I’ll take a look in some of my textbooks and follow-up if I feel like I left something out.

      Talk to your son’s dentist and ask him why a band and loop space maintainer wouldn’t work, and see if there’s anything else that the dentist wants to accomplish to help your son’s teeth erupt into good alignment. Thanks for your question!


    • Hi Mary – I was wrong!

      I ended up reading the book and then talked with one of the professors in our pediatric dentistry department. The band and loop space maintainer would not be a good choice because the tooth that the “loop” part would go up against would be lost before the permanent tooth that we are saving space for (in your daughter’s case, the 2nd premolar) even comes in. Then, you would have the space maintainer just sitting there not doing anything.

      The better choice for when you’re missing that tooth would be to have a transpalatal arch appliance put in. It would connect both of the 6-year-old molars on top. It is more expensive, but it would probably be the best choice in the long run to make sure that both of her premolars have space to come in.

      I hope that helps! Let me know if you have any more questions.

  2. My 7 year old son just had is 4 front teeth instruct, due to a severe decay. i would like to know, when are the front permanent will come out? when the dentist x-ray he’s teeth, i seen them on the top of he’s primary teeth.
    how many months or old is he when they start to be visible or grow?

  3. My son bumped his front two teeth almost two years ago. The one turned gray and we have been watching it since January 2010. The dentist just informed us that he needed to have it pulled. He also mentioned maybe putting in a space maintainer. However, he said that was up to us. My husband and I don’t know what to do as far as the space maintainer. If its not necessary that he get it, I would rather not. But I don’t want to do the wrong thing. Does he have to have the space maintainer?

    • Hi Kerry – We have been taught that it is not necessary to put a space maintainer in when a front tooth is lost prematurely. The biggest reason to put something there would obviously be for looks.

      Pinkham’s Pediatric Dentistry textbook agrees that space maintainers don’t need to be placed after the loss of a front tooth. The author states, “Some dentists think that early removal of a primary incisor results in space loss because the adjacent teeth drift into the space formerly occupied by the lost incisor. However, this does not seem to be true in most clinical situations. There may be some rearrangement of space between the remaining incisors, but there is not a net loss of space. Intuitively, this makes sense because there is no apparent movement or drifting of teeth when developmental spacing is present in the primary dentition.”

      I hope that helps, Kerry. Thanks for your comment!

  4. My son 8 needs to have tooth #A extracted because it is anklyosed. The pediatric dentist said the space maintainer should be placed 1-2 days after but the oral surgeon said it should be done a week after so it will heal and that the teeth will not shift so quickly. Please advise. Thanks..

    • Hi,
      My 5 yr old had to extract upper right 2nd to the last already crowned molar due to gum infection. The doctor said that the X-rays show abnormal causing bubbles bc the adult molar is growing in a little and is effecting the bone and causing the bubbles on his gum via infection. So instead of putting him on an anti-biotic we had pulled it out the same day discussed bc the doctor mentioned that it is fine. Now after extraction, when I asked about the space saver, the doctor responded that (he may not need it bc it’s the top molar. And that usually the top teeth, u normally don’t need it). Would you agree? My son is only 5yrs old.,he has a gap now in btw the last molar; since 2nd the the last was pulled. He has about 5 yrs to wait on for the adult molar to come in, according to my son’s Doctor. But I’m afraid his last molar will move over to fill in the gap and the adult molar growing in won’t have the space for it resulting in teeth crowding; especially if it’s another 5 yrs till he’ll get an adult molar. Could you please, please, please be kind to give me your opinion on this?

  5. my son needs to have his molar removed due to decay… the dentist said he needs a spacer put in.. do these hurt? are they bothersome for the kids? is it hard to clean the behind of the teeth due to the wire that go accrost them? im not sure if im going to have this put in

    • Tanya,

      My son who is 8 (almost 9) had one put in a little over 1 month ago. It was nance appliance which is semi permanent and will be removed once his permanent tooth comes in(told1-2 years). He had no discomfort but his speech was affected slightly for the first few days because the appliance was placed on the roof of his mouth and took a bit to get used to. I was warned of possible fungal infections but was told it is rare and was shown how to clean it properly. So far so good. I hope this helps you.

  6. Tom,

    My son is 9 years old and just had the space maintainer put in and he has the type that has the band on the roof of his mouth. He is having a difficult time eating and we are looking for any tips you can provide to help us with this. He is very frustrated and is just eating yogurt right now. Help!

    Thank you!

  7. My 8 year old had her 2 bottom first bicuspids pulled and had a spacer put in. It has fallen out 3 times in 8 days. I am very frustrated and wondering what can be done or if she would be able to go without it. She is already almost eight and a half. The dentist is wanting to make her a new one and charge me over $300 for it and I do not feel that I should have to pay. Twice it fell out within 24 hours of being put in. Will it hurt that much to just not have one? I feel that making another will only be the same problems.

  8. Hi Doc, I have question about space maintainer. My son who is 10 years old doc pull out his baby teeth and use maintainers from last 2years. Now once again he pull his teeth his dentist said because adult teeth has not enough space to come out so we have to pull out his baby teeth. so we did the proper treatment for my son. he still using space maintainers it cost me $1000.00. Now he suggest me the same thing for my daughter too Dentist said she does not have enough space for adult teeth to come out he already pull out her eight teeth. now he is insisting to use space maintainers I was wondering its a need or money making thing how I can find out that my daughter need these space maintainers. Please suggest me if you can I’ll be waiting for your answer.

  9. Hey Tom,my daughter had her four front incisors extracted three years ago and we are now(shes 6)seeing the inflammation in the gums which is an indicator of eruption(as we also see some of the bone emerging in the gumline).I am unable to determine which tooth it is which is a little concerning.its on the left side and considering two teeth are supposed to erupt,it feels like one big tooth,which leaves very little room for the second tooth on that this normal? Thank you!

  10. Dear Doctor,

    My daughter 5 yrs old, hv cavity and teeth to be removed and our dentist sugested to put spacer. Will space pain full? will she sollowe it while eating food by accedient.

    Thx to advice.

  11. My 9 year old son has a baby tooth that will not push through even though his permanent tooth is trying to push it through. The orthodontist wants to put a lingual arch on his lower molars to keep them back and have the K tooth pulled so the other will come in. The cost estimated to me was 1200.00 Does that seem inline with what this should cost or should I get a second opinion? Thank you for your time and consideration.

  12. my 7 year olds 2nd to back molar is loose….and the dentist wants to put a spacer in…..will he pull that tooth first? and is it really even nec. /??? thanks…

  13. Hi Dr. Tom, I have a 4 year old son who fell off his scooter and clanked his upper and lower jaw together. The end result, the upper left canine shaved off half of the bottom molar (the molar behind his bottom canine). Upon his dentists examination, it was discovered that he fractured the root of the tooth and she was very relaxed about treatment. She wanted to wait and see what happened. After a week, I had enough and called the office because the tooth was bothering him and I do not want a risk of infection. From there he was referred to an oral surgeon. The surgeon said it needs to be pulled and it will Friday. He also spoke voiced a concern to speak to the dentist about something to maintain the gap between the teeth and the adult tooth won’t erupt till he is 10 (6 yrs away). I have some concerns such as what are the options, how well do they work and are there any side effects?

  14. My daughter is 6 years old. She has an extremely small mouth and I’m afraid all of her permanent teeth that come in will be crooked. She has only lost her 2 front bottom teeth and they are crooked and seem to be getting more crooked. Is there something they could put in her mouth to give her space for new teeth? A space maintainer? How does that work?

  15. My daughter has a spacer with the band wrapped around one tooth. Last night she ate a gusher and it fell out. Will I be able to wait 2 weeks to get it put back in with out teeth shifting?

  16. My 4 year old has to go under for root canals, is it possible that they will just be extracted prematurely and if so, would she need a spacer?

  17. Hi my 8 yr old son got a spacer after having his back tooth out. This was about 10 months ago. The tooth is coming in and the spacer is still there. Should I be concerned? The dentist said it will fall out on its own but this seems like a long time.

  18. Getting a space could be a really big step for your child, but it will all be worth it in the end. The earlier you start to take real care of your child’s teeth, the better chance they have of a perfect smile later on. Talking with your orthodontist about the things you can do to ensure the oral health of your child is the first step on the road to healthy teeth.

  19. Hi!! My 6 y/o son’s lower central incisor have just fallen out.Actually it is already moving few weeks from now.i’m just waiting for the right time for it to fall naturally.But this morning he ate an apple and then it fall out.I can also barely see that there is a new teeth that will come out for its replacement, but the first teeth wasn’t there anymore,is it just alright? Or is he going to have problem with teeth spacing?? And also he has obvious cavities on his molars, is teeth filling still needed for those molars??Is it okey even if he’s just 6 yrs.old? And one more thing, is spacer expensive?how does it look like?

  20. My 12 year old daughter been slow to lose her baby teeth and has only lost the front 4 teeth on the top and bottom. It has been 5 years since she lost a tooth but her X-rays show the permanent teeth are in place and getting close. Her dentist wants to put in a space maintainer for when she starts losing the rest of her teeth. She does have some crowding and will require braces at some point. Is a space maintainer necessary?

  21. Are there any alternatives to metal space maintainers. We are very natural in our family (we see a naturopath) and have been advised against putting metal in our children’s mouths.

    • Do you know what types of metal they recommended not putting in their mouths? Most of the space maintainers are made of stainless steel bands and some solder to put them in the proper position. With that said, their dentist may be able to make a retainer to keep the teeth in their proper position. I hope that helps!

  22. My daughter is 8 years old and needed to get 2 teeth extracted. The extracted teeth are both on the top (one on the left side and one on the right side) and they are both the third tooth from the back… starting in the back is a 6 year old molar, next is a baby tooth and then next is the extracted tooth. …. one dentist suggested a space maintainer and the other dentist said they didn’t think it was necessary… help… I have 2 dentists with 2 different opinions. What should I do?

  23. My granddaughter who is seven just got a spacer it is very hard for her to eat an the spacer is cutting her tongue. Will it get easier down the line or will she have this discomfort the entire time waiting for her tooth to pop up.

  24. My almost 7 year old daughter has a stainless steel crown in her first primary molar. Her bite was high, so the dentist filed it down a bit after it was cemented. He did not polish it. Is this safe?

  25. I have an 8 yr old that has a cavity on the right bottom side about 4th from front of his bottom teeth. The Child Dentist recommends extraction and a spacer. Cost about 1,000 It is a baby tooth and he is loosing his baby teeth weekly. Is a spacer necessary?

  26. My son is 8 years old they pulled out both his premolars on bottom left and both pre molars on top left what do you think they should put there to make sure there is space for his permanent teeth to come in

  27. My son is 8 years old the dentist pulled both his pre Mollars on bottom left and both his pre molars on top left what do you think they should put there to make sure there is room for permanent teeth to come in

  28. Hello!
    My son is 7 1/2yo. His two 6yo molars are growing in diagonally. Unfortunately his baby teeth are in the way, making his grown-up teeth to don’t have space. I have lots of conflict of ideas from orthodontist, one recommends me to pull out his two baby teeth. Another orthodontist that I visited today recommends me not to pull out those teeth, instead he recommends spacers. He says that we would have a bigger problem if we extract those baby molars. I don’t know who to trust. Should my son get those teeth pull out or keep them and with the spacers hoping the teeth will open space for the new teeth?


    I have x-rays that would like to share if I can.

  29. Hello!
    My son is 7 1/2yo. His two 6yo molars are growing in diagonally. Unfortunately his baby teeth are in the way, making his grown-up teeth to don’t have space. I have lots of conflict of ideas from orthodontist, one recommends me to pull out his two baby teeth. Another orthodontist that I visited today recommends me not to pull out those teeth, instead he recommends spacers. He says that we would have a bigger problem if we extract those baby molars. I don’t know who to trust. Should my son get those teeth pull out or keep them and with the spacers hoping the teeth will open space for the new teeth?


    I have x-rays that would like to share if I can. I really appreciate your reply.

  30. My 8 yr old twin at 7 had a tooth pulled out from the top. Third tooth from the back on the left side. So it goes grown up molar then crown then tooth pulled. They said she does not need a spacer. Is this correct? The other twin who is 8 got a spacer on the second space from the back. Top. So goes adult molar then pulled tooth and they put in a spacer? Thoughts

  31. Hi Dr.
    My baby is 5yrs old and just got her upper and lower spacer appliances and I’m not sure if it was the right thing to do she is crying and complaining of the pain pls help me understand this and if was really necessary

  32. Hi,
    I have a 7 year old daughter who had a tooth pulled a couple of months ago ( the third from the back). At the time of extraction the dentist did not comment on anything about a space maintainer. Does she need one??


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