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Space irregularities are best thought of in terms of the anterior teeth and arches and the posterior teeth and arches. Space and tooth loss in these two regions can vary. The primary reason for premature loss of a front tooth or incisor is trauma, with dental decay coming in second. Trauma to the primary front teeth is most common when a child is learning to crawl and walk/run. There is no space loss in the anterior regions (upper/lower) with premature loss of a primary tooth. In addition, speech and feeding should not become problems with premature loss of primary anterior teeth. A replacement can be fabricated for esthetic reasons when the child is old enough to handle the procedure and placement.
Parents will often notice space irregularities with the eruption of the permanent mandibular (lower) incisors. These lower incisors can erupt in back of the primary incisors and cause significant concern in families. When this happens, children should be encouraged to 'wiggle' or move their primary incisors back and forth or side to side even when the teeth are mobile. Positive reinforcement is very important during this time so that the child does not develop any fears or negativity towards losing his/her teeth. Over the next five to seven years the child will lose twenty primary teeth and replacements should erupt. Parents should not be overly concerned if a child appears not to have adequate space for erupting incisors. This time of eruption usually coincides with a growth in height and weight. Parents should be encouraged to make an appointment with their regular dentist for a check-up or for a new patient visit.
Premature loss of posterior primary teeth is most often due to dental caries. Space loss will occur do to shifting of teeth in back, in front and above/below the empty space. If space loss has not occurred, a space maintainer appliance is appropriate in most cases. The space maintainer can either be removable or fixed with the appliance cemented to the surrounding teeth. The permanent successors of the primary molars will not erupt for several years. A dentist should evaluate the child to evaluate whether space loss has or has not occurred.
Cases when trauma and dental caries are not the etiology of premature loss of a primary incisor or molar should be investigated and a dental consultation should be obtained for clinical and radiographic evaluation. Systemic illnesses that are associated with premature loss of primary teeth include hypophosphatasia, Langerhans Cell Histiocytosis, neutropenias and leukemias.
Spacing between the teeth in the primary dentition is common. Lack of or no space between the primary teeth can be indicative of space problems in the permanent dentition. Children who do not have spacing between the anterior and/or posterior teeth are more likely to have dental caries between their teeth. Oral hygiene should be reinforced with the parent and dental evaluation should not be delayed.