One of the more perplexing problems that dentists see is a patient with a gap, or space, between two teeth. A gap—or as it is more properly termed, diastema—can occur naturally anywhere in the mouth.
Most commonly, however, patients complain of it between their two front teeth. The reason for their complaint is because—at least to some people—it is not esthetically appealing, and it can interfere with speech.
Gaps in other areas of the mouth can interfere with inefficient chewing, and they can signal harmful habits or other problems that need attention. Patients therefore want to know what causes gaps in the teeth and how can they be eliminated.
There are a variety of possible causes for gaps naturally occurring between teeth.
Jaw-Teeth Size Discrepancy – They may occur simply because a person's teeth are too small for their jawbone. The reverse can also occur. The teeth can be too large for the jaw, and this results in crowding, rather than gaps.
Congenitally Missing Teeth – Sometimes a permanent tooth that is supposed to be there never formed. These are called congenitally missing teeth, and they can leave a space. The most common congenitally missing teeth are wisdom teeth, lower second premolars, and upper lateral incisors. The most noticeable and troublesome of these are the latter. Their absence creates a gap in a patient's smile, and at the same time, allows the two remaining central incisors to spread apart as they move or drift into the missing space. The esthetic result can be disappointing to a patient.
Impacted Teeth – Any tooth that remains imbedded in the jaw is said to be impacted. Sometimes, a gap exists because the tooth that should be occupying it never erupted. This can happen with any type of tooth but is especially common in canines, or eye teeth
Habits – These could include thumb-sucking or habitually chewing on objects, such as a pencil or a pipe stem. A related cause for unwanted tooth movement is a swallowing reflex known as tongue thrusting. This causes patients to push forward on the upper front teeth with their tongue when swallowing, which can move the teeth and create gaps between them.
Periodontal Disease – Patients with advanced gum, or periodontal, disease can also have unwanted spacing between their teeth. They often have so much bone loss from around their teeth, that the teeth become loose. They can then flare outward, which creates spaces between them.
Muscle Attachment Pull – The most common cause for a space between the two front central incisors is a misplaced muscle attachment. This muscle attachment, called a labial frenum, connects the upper lip to the gum. Sometimes, it is located too close to the teeth and extends all the way between the two central incisors. When this happens, it can exert a pull on this region and prevent the two incisors from coming together.
Often the dentist and patient will agree that the gap is not a problem and that closing or filling it is simply not worthwhile. In fact, this is the case with most gaps, and they are never treated.
Whether or not to treat a gap between the teeth depends on the circumstances. Is it creating a functional or esthetic problem? Does the patient want the gap corrected? Often the dentist and patient will agree that the gap is not a problem and that closing or filling it is simply not worthwhile. In fact, this is the case with most gaps, and they are never treated.
Sometimes, however, there is a good reason to address a space between two teeth. Obviously, if the gap is the result of gum disease or harmful habits, these etiological factors should be addressed.
For a space caused by an impacted tooth, dentists should consider either extracting or orthodontically moving it into place. If the decision is made leave the impacted tooth alone, it should be monitored radiographically in the future to ensure that a cyst or other form of pathology does not form around it.
Any space that creates a chewing problem should be corrected. For example, a space that is causing food to become stuck between the teeth should be closed to prevent it from causing future gum disease. Sometimes, an open space in a patient's teeth can hinder chewing, or the exposed ridge in the space can be traumatized by hard foods. In cases like this, patients should consider having the space filled.
Probably the most common reason to close a gap between teeth relates to esthetics. If gaps between the front teeth bother patients to the point of making them feel embarrassed to smile or causing them to feel self-conscious, they should speak with their dentist about ways to correct them.
There are various techniques for closing gaps between the teeth, depending on how big the gaps are, how many, and what's causing them.
Placement of Restorations – For an isolated narrow space where food is being impacted, a well-designed filling or crown might close the gap sufficiently to eliminate the problem.
Dental Prostheses – Patients with congenitally missing teeth are usually best treated with some sort of dental prosthesis. This can be either a fixed or removable partial denture, but ideally, a dental implant. An implant is a titanium cylinder that is surgically imbedded into the bone, just like the missing tooth would have been, and a false tooth is attached to it.
Orthodontic Therapy (Braces) – For generalized gaps in posterior teeth, caused by tooth and jaw size discrepancy, braces may be the best answer. All the teeth may need to be moved to create a functional chewing arrangement.
Orthodontics can also be employed to move an impacted tooth into proper function. It will require a surgical procedure to gain access to the impacted tooth so that an orthodontic bracket can be placed. Braces and other forms of minor tooth movement can also be used in other situations, but if the gaps are caused by a habit or other factor, that should be addressed first to avoid a recurrence of the spacing.
Splinting – For patients having increased spacing secondary to their periodontal disease, a splinting procedure may be required to tie all their teeth together, thereby stabilizing them.
Patients with a diastema between their two front central incisors, caused by a labial frenum muscle attachment, are a special case. The teeth can be orthodontically moved back together, but they typically will not stay if the muscle pull exists. It is generally recommended to first do a procedure, known as a frenectomy, to move the muscle attachment away from the teeth so that it no longer exerts a pull on them. After it heals, the teeth can then be orthodontically moved together. However, they may still need to be tied or splinted together, since the muscle tissue can regenerate and once again pull the teeth apart.
Another way to close the gap between the two front teeth is to place porcelain crowns on them. This can provide an esthetic result. However, if the space is too wide, the teeth can sometimes appear too large and be esthetically unacceptable. Crowns also have the disadvantage of requiring that the two healthy incisors be ground down to allow for the crowns to be placed. This is, thus, an irreversible procedure.
A simpler way of closing the gap between the two front teeth is to fill the space with tooth-colored composite resin. This material bonds directly to the enamel of the two adjacent teeth. It can usually be done without any anesthesia, and in some cases, it can be a good solution. It has the added advantage of being completely reversible. If the result is not acceptable, it can easily be removed without any damage to the teeth. A disadvantage is that these bonded fillings can sometimes discolor, chip, or break off altogether.
Patients who have gaps in their teeth that bother them in any way should consider making an appointment with their dentist. Together, they can discuss the available options and arrive at a treatment plan that fits the need.
Dr Perry is a great dentist. Very kind and informative. I feel like he is personally invested in my health. He always takes the time to sit and discuss any issues I'm having - I never feel like they're rushing me out.