Premature loss of a tooth in the primary dentition may compromise the eruption of succedaneous (replacement) if there is a reduction of space in the arch length.

Band and Loop

Fixed space maintainers can be unilateral or bilateral. Space maintainers also can be placed on the mandibular or maxillary arch.

Distal Shoe Appliance

The thumb and finger habits make up the majority of the oral habits. The effects on the dentition is dependent on the intensity (amount of force), duration (time spent) and frequency (number of times throughout the day) of the habit. Duration plays the most critical role in tooth movement in digit habit. It takes 4-6 hours of force per day to cause tooth movement. Thus, a child who sucks intermittently with high intensity may not produce much tooth movement at all, whereas a child who sucks continuously can cause a significant change. Symptoms of an active habit are 1. anterior open bite 2. Facial movement of the upper incisors and lingual movement of the lower incisors 3. Upper jaw constriction (narrowing).

Timing of treatment is critical. A child should be given the opportunity to stop the habit naturally before eruption of the permanent teeth, thus treatment is performed between age 4 and 6 years. The approaches are:

1. 1. Reminder therapy: This gives the willing child the opportunity to quit but needs a little help. For example, the use of a band aid or ill-tasting solution painted onto the sucking digit.
   2. Reward system: In this the child agrees to stop the habit for a certain length of time and receives a reward if accomplished. The reward should be special enough to give the child incentive to quit. The more involved the child is the better the chance for success. This can involve the use of stickers being placed on a calendar at the end of the day when the habit is not conducted.
      3. Appliance therapy: This is used if the habit persist following reminder and reward therapy and the child truly wants to stop the habit. The appliance physically discourages the habit by making it difficult to suck the digit. The parent and child should be informed that this is not a punishment but rather a permanent reminder.

Bruxism is a grinding of the teeth and is usually reported to be a night activity though some children do so during the day. The masticatory muscle soreness and temporomandibular joint pain may be attributed to bruxism. The cause of bruxism is not known. Most explanations are centered around local, systemic and psychological reasons. The local theory speculates that bruxism is a reaction to an occlusal interference, high restoration or irritating dental condition. The systemic factors include intestinal parasites, subclinical nutritional deficiencies, allergies and endocrine disorders. The psychological theory claims the manifestation of personality disorder or increased stress. Children with musculoskeletal disorder (cerebral palsy) and those with mental retardation commonly grind their teeth. Treatment should begin with occlusal equilibration to remove interferences. If occlusal interference or equilibration is not successful then referral to the necessary physician to determine or treat systemic problems. If neither two steps are not successful then a mouthguard appliance can be constructed of soft plastic to protect the teeth and eliminate the grinding habit. If the habit is due to psychological factors, then refer to child development specialist.

The American Association of Orthodontists considers orthodontic treatment as being very important part of children’s oral health care. Teeth are very important in many ways. Teeth work together to make it possible to bite and chew properly, and contribute to clear speech.  Proper functioning teeth tend to have a pleasing appearance. A beautiful smile is the outward sign of good oral health, and sets the stage for overall well-being.

The American Association of Orthodontists recommends children get their first orthodontic check-up at the first recognition of an orthodontic problem, but no later than age 7. At this age, children have a mixed dentition, primary (baby) and permanent teeth. During each dental visit an assessment of the dental changes is conducted to note any possible problems as the permanent teeth take the place of baby teeth, and as the face and jaws are growing. If a problem exists, or if one is developing, treatment will be recommended or referred to an orthodontist who will then further advise you on whether treatment is recommended, when it should begin, what form the treatment will take, and estimate its length.

Sometimes preventive or interceptive orthodontic treatment (first phase) is all that is needed. More often, patients will require a comprehensive orthodontic treatment (second phase) after most or all of the permanent teeth are present. This will complete the tooth and jaw alignment that was started in the first phase of preventive or interceptive treatment.