Introduction

A diastema is a space or gap between two teeth. It appears most often between the two upper front teeth. However, gaps can occur between any two teeth. At some stages of dental development, it's normal to have a diastema, and the space eventually closes after the permanent canine teeth (eye teeth) erupt into the mouth. However, in some people, the space does not close. Any space between the front teeth will make the smile irregular and can have profound effects on the face. Space Closure will not only improve the self image of the patient, but it will also allow people to look at the face without being distracted by the irregularity in the smile.

Causes

A mismatch between the size of the jaw bones and the size of the teeth can cause either extra space between teeth or crowding of teeth. If the teeth are too small for the jaw bone, spaces between the teeth will occur. If the teeth are too big for the jaw, teeth will be crowded.

Sometimes some teeth are missing or undersized. This happens most often with the upper lateral incisors. That can cause the upper central incisors to develop a space.

A diastema also can be caused by an oversized labial frenum. The labial frenum is the piece of tissue that normally extends from the inside of your upper lip to the gum just above your two upper front teeth. In some situations, the labial frenum continues to grow and passes between the two front teeth. If this happens, it blocks the natural closing of the space between these teeth.

Habits can also lead to gaps between the teeth. Thumb sucking tends to pull the front teeth forward, creating gaps.

Spaces can develop from an incorrect swallowing reflex. For most people, the tongue presses against the roof of the mouth (palate) during swallowing. Some people develop a different reflex known as a tongue thrust. When they swallow, the tongue presses against the front teeth. Over time the pressure will push the front teeth forward. This can cause spaces to develop.

Periodontal (gum) disease results in the loss of the bone that supports the teeth. In people who have lost a lot of bone, the teeth can become loose. This movement can result in gaps between the front teeth.

Children may have temporary gaps as their baby teeth fall out. Most of these spaces close as the permanent teeth reach their final positions.

Symptoms

A diastema that occurs because of a mismatch between the teeth and the jaw does not have symptoms. However, spaces caused by a tongue thrust habit or periodontal disease will tend to expand or grow with time. The teeth may become loose, and discomfort or pain may occur, particularly during biting or chewing.

Diagnosis

You may notice a space when brushing or flossing. Your dentist can see spaces during an examination.

Expected Duration

If the gap was caused by a mismatch between the permanent teeth and the jaw size, the spaces can be expected to remain throughout life.

Gaps caused by a tongue thrust habit or periodontal disease can get larger with time.

Prevention

Not all spaces can be prevented. For example, if the reason for a space is a missing tooth or a mismatch between the teeth and the jaw size, the spaces cannot be prevented without treatment.

Maintaining your gum health is essential to good oral health. Regular flossing and brushing will help to prevent periodontal disease and its related bone loss.

People with a tongue thrust habit can re-wallow by pushing their tongue up against their palate. Breaking this habit can prevent widening of the spaces between teeth.

Treatment

Many people with diastema feel very comfortable with it and do not look for a way to correct it. Some of them believe that it makes them look sexy. Even some famous actors have not treated their gapped teeth considering it as a part of their personality. But if you do not belong in any of these groups and you think that diastema has a negative effect in your appearance, there are several cosmetic dentistry treatments available for its correction.

The most common treatment options depending upon the type of case, cost factor, time and patients requirement and expectations, includes

  • Orthodontic Treatment.
  • Veneers and Crowning.
  • Dental Bonding.

Orthodontic Treatment

An orthodontist can close a gap between teeth with the use of dental braces by slightly moving the gapped teeth close to each other. For big diastemas, several teeth have to be moved towards the area of the gap, so that there are equal gaps between all front teeth. Orthodontic treatment of diastema provides permanent results but it may take a long time to complete (more than one year for big gaps). . In some cases treatment consist of nothing more than removable appliances or retainers. In other, clear plastic brackets, instead of traditional metal ones, can be used.

Lingual braces are one of the most exciting developments in moving teeth. They are virtually imperceptible to others. However, the treatment can also cost more and take longer than with other devices.

Although orthodontic treatment requires regular check up and require most of the time of the alternatives, it has the advantage of leaving the natural teeth intact and being closest to a permanent solution. Bonding, laminating, the other hand, will require repair or periodic replacement.

Porcelain Veneers

Veneers offer the most revolutionary (but also the most expensive) advancement in aesthetic dentistry. Porcelain veneers are made of a thin layer of porcelain only around half a millimeter thick which is glued to the front of the tooth to restore its natural appearance. They are custom made by the same material used to make tooth-colored crowns or caps, which once cemented to the tooth, looks like natural tooth structure. Although bonding is the quickest way to close spaces between the teeth, laminating with porcelain is also an option.

The major advantage is the accuracy that it provides and better esthetic appearance. It wears less than the composite, stain less and lasts more.


Dental Bonding

Bonding consists in the application of a tooth-colored dental composite resin (plastic) material that looks like the natural enamel to the surface of the tooth, where it is sculpted into shape and contoured. The material is hardened and bonded on the enamel with a special high-intensity blue light and finally it is polished. Despite its tendency for staining, for minor cosmetic corrections placing dental bonding on teeth is still the technique of choice. This is because in those cases where its application is appropriate, placing dental bonding is typically more conservative than other restorative choices such as dental crowns and possibly porcelain veneers (where amounts of tooth structure must be removed as part of the restorative process). In those cases where the cosmetic aspects of the bonding has become objectionable, it is common that it can simply and easily be buffed back and a new layer of dental composite placed so to rejuvenate its appearance.

Prosthetic Dentistry

If the diastema is created because there are missing teeth, the available treatments include dental implants, bridge, or partial denture


Frenectomy

If a large labial frenum is causing the gap, the frenum can be reduced through surgery called a frenectomy. If a frenectomy is done in a younger child, the space may close on its own. If it is done in an older child or an adult, the space may need to be closed with braces.


Periodontal Treatment

If the gap is caused by periodontal disease, then periodontal treatment by a dentist or gum specialist (periodontist) is necessary. When gum health is restored, in many cases braces can be used to move the teeth into place. A splint can be used to attach teeth to other teeth and prevent them from moving again. In some cases, a bridge will be required to close the spaces.

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