Maintaining Space in the Dental Arch
Although braces and Invisalign are two of the most well-known orthodontic appliances, they are far from the only ones used to treat patients. A variety of orthodontic appliances are used to accomplish different goals—from widening the jaw to preserving space in the mouth.
Burke & Redford Orthodontists want their patients to feel comfortable with the appliances that might be used during treatment. Patient education is an integral part of our mission. In this blog post, we’re going to focus on two appliances that are used to maintain space in the lower and upper dental arches—the lower lingual holding arch and the Nance arch.
Dental arch is simply the medical term for the curved row of teeth in each jaw—the crescent shape where teeth fit into the jaw. Everyone has two dental arches—a lower one and an upper one.
Lower Lingual Holding Arch
A lower lingual holding arch is a fixed appliance that preserves space in the lower dental arch. Acting as a “space maintainer,” this appliance keeps the lower molars from moving forward, where they might block permanent teeth from erupting.
This appliance is most commonly used when baby teeth are lost prematurely or a child’s lower teeth are somewhat crowded. This means the appliance is typically used with younger patients who haven’t yet gotten all their adult teeth. The lower lingual holding arch usually remains in place until adult teeth have fully erupted.
The lower lingual holding arch can also act as an “anchor” for various types of elastics, which might be used in conjunction with “overbite” correction with another appliance such as a Carriere Distalizer. Other lingual holding arch uses might include:
- Stabilizing and supporting molars
- Regaining additional space (“leeway space”) that is available when baby molars shed (baby molars are wider front-to-back than their associated permanent teeth)
The appliance itself is relatively simple. Two stainless steel rings (bands) are attached to the lower first molars with orthodontic adhesive. The bands are then connected with a stainless-steel wire that runs along the inside of the lower teeth. Patients can feel this wire with their tongue as it is on the lingual (tongue) side of the teeth. It sits passively on the teeth, so no pressure or discomfort is associated with the appliance.
The appliance is wholly contained within the mouth and isn’t easily visible. The appliance is custom made for each patient. It is created after the orthodontist takes an impression or 3D scan of the patient’s mouth.
The Nance arch does the same thing for the upper jaw as the lower lingual holding arch does for the lower jaw—it keeps molars from moving forward and preserves space in the mouth.
Although similar in design to the lower lingual holding arch, the Nance arch has one significant difference. Two stainless steel rings (bands) are attached to the upper first molars using orthodontic cement. The bands are connected with a stainless-steel wire that runs across the roof of the mouth. An acrylic plate (“button”) covers the wire that touches the roof of the mouth (palate). This button is placed directly behind the front teeth and is about the size of a quarter. Like the lower lingual holding arch, the Nance appliance sits passively so no pressure or soreness is caused by its presence. Most patients say it feels “just like a part of my mouth” after the first few days of getting accustomed to it.
The Nance arch holds the upper molars in place once they are in the correct position. These molars are often moved into their proper positions (bite relationship) with a pendulum appliance.
What to Expect The First Few Days
Whenever something new is placed in the mouth, patients will need some time to adjust. However, most patients adapt to these appliances within a few days. Here are some things to expect immediately after the appliances are placed.
- Speech might sound a little funny at first. This happens because the tongue has a new object in the mouth to function with. To help the tongue get adjusted, patients should talk out loud as much as possible during the first few days. One suggestion to have patients read a book or talk to themselves in front of a mirror for five minutes a day. This helps a patient’s speech get back to normal faster.
- Saliva production might increase for a few days after placement. However, this will quickly subside.
- Soft tissue may become irritated during the adjustment period. If this happens, patients can swish with warm salt water. There are also alcohol-free oral rinses available if a child doesn’t like the taste of salt water. If part of a wire is causing a problem, patients can put orthodontic wax or wet cotton balls over the affected areas. Don’t worry though—these areas will “toughen up” quickly.
- The mouth might be sore for the first few days. Over-the-counter pain medication can be used, and a diet of soft foods may also be helpful.
Maintenance and Cleaning Tips
Both the lower lingual holding arch and Nance arch are virtually maintenance-free. However, there are a few rules to follow while they are in place.
- Refrain from using the tongue to play with the wires. Patients should also avoid picking at the wire or bands.
- Use caution eating hard or crunchy food, since they might damage the appliances.
- Avoid sticky foods (such as taffy, gum, caramel) and chewy candies (such as Starburst or Skittles) as they can loosen the appliance.
- If one or more bands move up or down, contact the orthodontist to have the appliance re-cemented.
- If anything feels loose or broken, contact the orthodontist’s office immediately.
Extra care and additional time spent brushing and flossing will keep the appliances clean. It will also help patients avoid cavities or gum infections as food can sometimes become caught in the wires. Here are some cleaning tips.
- Rinse with water after every meal.
- Brush and floss at least twice a day for at least three minutes. Special care should be taken around the bands, wires, and “button.”
- A floss threader, proxy brush, or water flosser can be used to keep the wires clean of debris.
Although these appliances may seem intimidating at first, the adjustment period is usually quite short. Before they know it, patients are back to normal and forget they are wearing them.
If you have questions or concerns about the lower lingual holding arch, the Nance arch or any other orthodontic appliance or braces for your child or an adult, contact Burke & Redford Orthodontists at (951) 699-8011 or fill out the contact form on our website.