Health

Mind the gap

No effect on health, but can be corrected for aesthetic purposes

by Dr Sharon Robinson

Sunday, August 06, 2017

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DIASTEMA, otherwise known as tooth gap, pertains to the spacing between two or more teeth. It is most often seen on the front teeth, although the back teeth may also be involved.

Children are the most commonly affected, albeit temporary and should correct itself once the primary teeth fall off and the permanent teeth comes out.

In adults, however, diastema is most likely permanent and requires orthodontic treatment for correction.

Causes of diastema

The most common cause of diastema is the discrepancy between the size of the teeth and that of the jaw. Spacing occurs when the teeth are normal in size but the jaw is too big, or if the jaw is normal in size but the teeth are too small for it.

A special condition called a peg lateral refers to the developmental defect of the lateral incisor, resulting in a gap between the lateral incisor and the teeth adjacent to it (central incisor and canine).

The spacing may also cause the central incisor to drift into the space, resulting to a small midline gap between the two central incisors.

Other causes of diastema include missing or unerupted teeth, oral habits (such as tongue thrusting and thumb sucking), periodontitis, mesiodens, and oversized labial frenum.

If diastema is caused by a missing tooth, the spacing tends to get worse over time as other teeth drift into the space, leading to gaps between more teeth.

Meanwhile, oral habits such as tongue thrusting and thumb sucking push the upper front teeth forward, creating space as they flare out.

Periodontitis, on the other hand, refers to the advanced form of gum disease characterised by bone loss in addition to the inflammation of the gums.

The aggressive form of this disease results in the fast destruction of the supporting bone, causing the affected teeth to become mobile.

Mobility results in gap formation, which tends to worsen over time if periodontitis is left untreated. The labial frenum, a small band of soft tissue located just above the two upper central incisors, may also cause diastema if it is large enough.

If this tissue extends far below its normal position and passes between the two central teeth, it prevents these teeth from naturally closing the space between them.

Lastly, mesiodens causes diastema the same way as an oversized labial frenum – it grows at the back of the central incisors, thereby preventing them from coming together and closing the gap.

Treatment of diastema

Although diastema doesn't have any adverse effects on one's health, most patients prefer to have it corrected for aesthetic purposes.

There are several techniques of closing a diastema, and the use of each one depends on the cause of the problem and the amount of space that has to be closed.

The most recommended method for closing a diastema is orthodontic treatment. It involves the installation of dental braces on the upper and lower teeth to pull the teeth together and close the space.

But if the cause of the problem is an oversized labial frenum or mesiodens, then surgery must be performed first prior to putting in braces; otherwise, the problem may recur once the appliance is removed. The surgical procedure for removing frenum is called a frenectomy.

Take note that in children, orthodontic treatment is not always a necessary follow-up as the space naturally closes once the cause is eliminated.

For small gaps, the patient may opt for placement of composite restorations or crowns instead of orthodontic treatment.

If the space is due to a missing tooth, then tooth replacement options like fixed bridges, removable dentures, and dental implants should be considered.

If it is brought about by periodontal disease, professional cleaning and deep scaling are the initial steps because the aim is to control the disease first. This will be followed by splinting of the involved teeth, installation of dental braces, or restoration with a fixed bridge or denture.

Prevention of diastema

If diastema is caused by developmental defects, then there's no way to avoid it. Further widening of the space, however, can be prevented by using splint to stop the teeth from moving farther away from each other.

Orthodontic treatment is also preferred as early as possible. For diastema due to periodontal disease, the best method to prevent further widening of the gap is to practise proper oral hygiene.

Brushing and flossing can do so much to halt progression of periodontal disease. Then, splinting the involved teeth is also recommended to stop the teeth from moving away some more.

For cases caused by oral habits, the most logical thing to do is to break such habit. You can go to your dentist for counselling and placement of appliances that can help control the habit.

Dr Sharon Robinson DDS has offices at the Dental Place Cosmetix Spa, located at Shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 630-4710. Like their Facebook page, Dental Place Cosmetix Spa, for an opportunity to take advantage of weekly specials.

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