Early Loss of Deciduous Teeth

Question 1

What role do the deciduous teeth have?

Answer 1

They maintain the dimensions and form of the dental arches during eruption of the permanent dentition.

Question 2

What is the consequence of early deciduous tooth loss in a crowded arch?

Answer 2

Adjacent teeth will drift or tilt around into the space created.

Question 3

In which jaw is there an increased potential for drifting to occur?

Answer 3

The maxilla

Question 4

Which tooth has little effect on the permanent dentition if prematurely lost?

Answer 4

The deciduous incisors, main impact they have is aesthetic.

Question 5

Why is early loss of deciduous canines or molars more serious than incisors?

Answer 5

Because space loss can occur.
In each quadrant, the primary canine and molars together are larger than the succeeding permanent canine and premolars.

Question 6

What is the difference in tooth sizes between the two dentitions known as?

Answer 6

The Leeway Space

Question 7

What may be the effect of extraction of a primary canine or molar?

Answer 7

Mesial drift of teeth behind the space and distal drift of anterior teeth.
Resulting in displacement of permanent teeth and centreline disturbance.

Question 8

What is a possible consequence of drifting of teeth?

Answer 8

Impaction or displacement of permanent canines and premolars.
Therefore, patients who have had early loss of deciduous teeth, require monitoring of the eruption of their permanent successors.

Question 9

Name the 3 important factors to consider in cases of premature deciduous tooth loss.

Answer 9

1) Degree of crowding: relates to the rate and extent of space loss
2) Type of tooth lost: loss of a primary canine may cause a centreline shift, loss of a primary molar, especially the 2nd, may allow mesial drift of the first permanent molar
3) Age of the child: the earlier the tooth is lost, the greater the opportunity for drift

Question 10

Define balancing extractions.

Answer 10

Removal of a similair tooth from the contra-lateral side of the same arch.
Aims to preserve the midline.

Question 11

Define compensating extractions.

Answer 11

Removal of a similair tooth on the same side on the opposing arch.
Aims to preserve the molar relationship and allow teeth to maintain occlusal relationships as they drift.

Question 12

What should be done before the extraction of primary molars?

Answer 12

Radiographic assessment.
To check for presence, position and correct formation of the crown and roots of successional teeth.

Question 13

Recommendations for loss of a primary incisor.

Answer 13

• Tend to have little effect on permanent dentition
• Detracts from appearance
• Not necessary to balance or compensate

Question 14

Recommendations for loss of a primary canine.

Answer 14

• Likely to have the largest effect on centreline on all dentitions except for spaced dentition
• The more crowded, the more need there is for balancing of extractions

Question 15

Recommendations for loss of a primary first molar.

Answer 15

• A balanced extraction may be needed in a crowded arch
• Centreline should be kept under observation and a balance extraction may be performed if indicated
• Compensating not needed

Question 16

Recommendations for loss of a primary second molar.

Answer 16

• No need to balance because there should be no appreciable effect on centreline
• May allow serious forward movement and tilting of the adjacent first permanent molar- consideration may be given to fitting a space maintainer but is often avoided

Question 17

Why are space maintainers avoided by orthodontists in the mixed dentition?

Answer 17

• Implication on dental health
• Tend to minimise straining patient cooperation

Exception: where preservation of space for a permanent successor will avoid subsequent appliance treatment

Space maintainers are rarely used but we should still be aware of them.

Question 18

What type of space maintainer is typically used for a single tooth space?

Answer 18

Band and loop (first image)
Crown and loop (second image)

Question 19

What type of space maintainer is typically used to maintain the E space before the 6 erupts?

Answer 19

Distal shoe

Question 20

What type of space maintainer is typically used to maintain the position of the first permanent molars?

Answer 20

Nance palatal arch space maintainer or lingual arch space maintianer.
Bilateral tooth space.

Question 21

What type of space maintainer is used when active movement is also required?

Answer 21

An upper removable appliance e.g. distalising of the permanent molars whilst maintaining position of other teeth.

Question 22

What are the possible disadvantages of space maintainers?

Answer 22

• Increased plaque
• Caries
• Broken or dislodged maintainers
• Interference of eruption of successor tooth
• Undesired tooth movement
• Soft tissue irritation
• Pain