The first feature we see in a person is probably their smile. So, we expect it to be presentable and pleasant. Any abnormality in teeth directly hampers the first look and diastema is one of the most common abnormalities seen in teeth. Diastema is usually a midline space between front two teeth, also seen in posterior teeth. In simple words, Diastema is the gap between teeth.
It has a wide range of causes from genetics to growth factors, habits and gum diseases. It is almost entirely treatable, with prognosis, depending upon patient compliance and proper maintenance therapy.
Anterior spaces may interfere with smile, attractiveness and compromise facial esthetics. Diastema is among the most frequent reasons why patients seek orthodontic treatment.
However, midline diastema is commonly considered as a malocclusion with high relapse incidence by orthodontists. (1)
Hence this article provides detailed information on the presentation of a diastema, causes, treatment, and prevention.
What is Diastema?
Diastema is a prominent gap between two teeth. It is most commonly seen between central incisors (your front teeth) and sometimes between molars (posterior teeth).
Diastema is common in milk teeth or primary dentition because of altering teeth and jaw sizes as we grow up. But it self-corrects by the time we reach adolescence (2).
If a diastema persists even after the complete set of permanent teeth have erupted and taken their rightful position in the jaws, then it is a problem.
The gap between teeth can be corrected with the orthodontic intervention which falls under the branch of corrective orthodontics.
It is a simple procedure and involves the use of brackets, stainless steel wires and elastics depending upon the extent of the diastema and overall condition of the jaws.
Like most orthodontic therapy, diastema can be cured completely. The effectiveness of the treatment depends upon how early on the procedure has commenced and how well the post-therapeutic instructions are followed by the patient.
Causes of Diastema
Going into the technicality and medical aspect of the word, there is a wide range of causes for the occurrence of a diastema or diastemata (plural).
Orthognathic developmental causes
As I have already explained earlier, the leading cause of diastema is the discrepancy between the teeth and jaw size. If your teeth are too small or your jaws are too overgrown in the developmental process, it leads to drifting apart of teeth. Hence, the gap between teeth is created. (3)
Another primary cause is childhood oral habits like overuse of pacifiers for babies, nail-biting and even tongue thrusting. Children subconsciously keep repeating these habits.
These habits result in the gap between teeth and the condition persists even in permanent dentition because of drifting of the underlying tooth germ. (4)
Retained infantile swallow or suckling habits of children can also lead to the formation of diastema because of pressure created by the tongue on the lingual aspect of the teeth while swallowing. (5)
Periodontally speaking, if there is an overgrowth in the surrounding tissue of the affected teeth, that is, the overgrowth of gums or attached gingiva, unwanted space is created between the teeth leading to diastema formation.
Diastema is most commonly seen around frenum attachments. The frenum is an extension of our gum in between specific teeth like central incisors, anteriorly and the molars, posteriorly.
If there is an abnormal position of attachment of this frenum to the gingiva, that is, a very low attachment, it can lead to teeth drifting apart.
Gum diseases like Gingivitis and Periodontitis that is, inflammation of gums and surrounding tooth structure, respectively, can also lead to the gap between teeth or diastema.
Gingivitis is majorly caused by poor oral hygiene and detrimental habits like tobacco chewing. In some cases, it might be hormonal, like pregnancy gingivitis or even stress and age-related.
This majorly presents as swollen gums and bleeding gums. The swelling causes teeth to drift apart, which creates the gap between teeth.
Periodontitis, on the other hand, affects structures surrounding the teeth, majorly underlying bone structure. Because of compromised bone structure and periodontal ligaments, mobility appears in teeth, hence the drifting and diastema.
Diastema correction in periodontitis cases are the toughest and depend upon the progression of periodontitis. Prognosis in such cases is not excellent and might relapse might even occur in a few months. (6)
Diastema makes a person visibly uncomfortable, so we all seek therapy for this ailment. The treatment is considerably simple, and once the underlying cause is terminated, relapse probabilities are reduced.
Jaw and teeth size discrepancies
Small teeth and jaw can be treated with fixed orthodontic therapy over six months to a one-year period, depending upon the extent.
Thumb sucking is common in kids and it may cause diastema. It can be taken care of with the help of habit breaking appliances like thumb guards and tongue rollers.
Also, parents need to watch their kids on swallowing patterns since they can also cause diastema. Parents should enforce all necessary measures to stop these habits.
Gum inflammation can cause diastema. But regular cleaning sessions can reduce the gum inflammation over time. In cases of high frenal attachments, frenectomy can be done.
This is a simple procedure that relieves the pressure on the teeth and drifting stops. In all of the cases mentioned above, after treating the underlying causes, fixed orthodontic therapy should be done followed by retention appliances.
This takes care of the diastema almost permanently. (7)
Some diastema is definitely preventable. This includes helping your children break a habit, like a thumb sucking or tongue thrusting as soon as you notice them doing it.
Learning proper swallowing reflexes can train the child get over infantile pattern of swallowing, and practicing good oral hygiene can reduce the gingival and periodontal cause of diastema.
Visit your dentist twice a year for regular cleanings and dental examinations. Brush and floss regularly to avoid a wide array of dental problems.
Over to you on a gap between teeth
So, if you have a void in your dental arch, then visit your dentist as soon as possible. Diastema is a stubborn and sometimes unavoidable ailment.
If you want to maintain a good esthetics, then the gap between teeth shouldn’t be ignored as our jaws expand over time. Over the period, the size of the diastema might enlarge and cause functional problems.
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