Dental space maintainers play a critical role in preserving the integrity of the oral arch following premature tooth loss in pediatric patients. Although these devices are essential for preventing potential complications, dental professionals and their patients often encounter challenges that may require some assistance or intervention. Here is a look at some of the most common problems associated with space maintainers, along with evidence-based solutions and input from relevant professional bodies.
Loose, Dislodged or Broken Space Maintainers
Issue: One of the common challenges associated with space maintainers is that they can become loose in the mouth or dislodged entirely. Fixed space maintainers can break under pressure, and sometimes the patient is not aware of it. This can compromise the device’s effectiveness and potentially lead to unwanted tooth movement or other complications.
Solution: The American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of proper placement and the secure fixation of space maintainers.(1) In instances of a loose, dislodged or broken appliance, it is imperative to promptly assess the situation. If the appliance remains intact and suitable for reinsertion, the dentist should ensure a secure fit. However, if there are signs of damage or the appliance is no longer viable, a replacement may be necessary to maintain effective space preservation and a successful treatment outcome.
Soft Tissue Irritation or Ulceration
Issue: Soft tissue irritation or ulceration is associated with poorly adjusted or ill-fitting space maintainers. This is likely to cause discomfort and pain for patients, in addition to compromising compliance with the treatment plan.
Solution: Addressing soft tissue irritation involves meticulous adjustment and evaluation of the space maintainer. Ensuring that the patient attends regular follow-up appointments is crucial so that any difficulties can be highlighted and resolved. In the case of soft tissue issues, adjustments should be made promptly to enhance patient comfort and encourage adherence to the treatment plan. Ensuring that all edges are smooth and that there are no protruding elements will help minimize irritation.
Difficulty with Oral Hygiene Maintenance
Issue: Maintaining optimal oral hygiene can be challenging for patients with fixed space maintainers where accessing the adjacent teeth can be tricky, especially for children. Poor oral hygiene can lead to plaque accumulation and secondary problems.
Solution: Education for patients and their caregivers about proper oral hygiene practices is paramount. The AAPD underscores the importance of oral hygiene in pediatric dental care, and this extends to those using space maintainers. Providing detailed instructions on cleaning around the appliance, the use of specialized brushes or floss threaders, and regular professional cleanings are essential components of preventing oral hygiene-related complications. Reinforcing the significance of maintaining a clean and healthy oral environment contributes to the long-term success of space maintainers.
Issue: Ensuring patient compliance with space maintainer protocols is a very common challenge, particularly with removable appliances. Children may resist wearing the appliance as prescribed, potentially affecting the outcome of the treatment program.
Solution: The AAPD recommends a comprehensive approach to address patient non-compliance. This includes effective communication with both the child and their parents or caregivers, explaining the importance of the space maintainer in simple terms. Emphasizing the long-term benefits and potential consequences of non-compliance can motivate the child to adhere to the prescribed wear schedule. Additionally, providing a positive and supportive environment can contribute to a more cooperative attitude from the pediatric patient.(2)
Allergic Reactions or Tissue Sensitivities
Issue: Occasionally, patients may exhibit allergic reactions or tissue sensitivities to the materials used in space maintainers, leading to discomfort and potential additional complications.
Solution: Addressing allergic reactions or tissue sensitivities involves an assessment of the materials used in the space maintainer. The American Dental Association Standards Committee on Dental Products develops national standards for dental materials, including steel, acrylic and other materials used in the construction of space maintainers. In cases of known allergies, alternative materials should be considered, with careful monitoring of patient response.
Troubleshooting the common problems that arise with dental space maintainers requires a considered approach, combining clinical expertise with regular and supportive contact with patients undergoing a space maintainer treatment program.
By forming great relationships with patients and, when relevant, their parents and caregivers, dental professionals can navigate these common challenges effectively, ensuring the successful use of space maintainers and the continued well-being of their patients. Regular follow-up appointments, comprehensive and appropriate patient education, and a proactive stance toward potential issues are essential components of successful dental space maintainer treatment plans.
- American Academy of Pediatric Dentistry. Management of the developing dentition and occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:466-83.
- American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:359-77.