Diastema

A diastema can present symptoms depending on its cause:

• A visible gap between the teeth (main symptom if gums and teeth are healthy)
• Inflammation, redness, or pain in gums (if related to gum disease)
• Gum bleeding or loosening of teeth (in severe cases)

Diastema is reported to be hereditary; hence, family history can serve as a risk factor for this condition. Diastema can also develop due to other dental conditions, such as: 

• Missing teeth or reduced tooth size
• Oversized frenum: The connective tissue band that connects the gums and lips can exert pressure between the two front teeth, leading to a gap formation
• Abnormal swallowing reflex: Repeated pressure resulting from the tongue thrusting against the front teeth may result in the gradual formation of a gap between the teeth)
• Advanced gum disease: The infection in the gums erodes the bone underneath, thus loosening the teeth and eventually causing the formation of a gap.

Diastema is often diagnosed by dentists during a routine dental exam, without the need for further testing. Additional assessment may be required if the gap is increasing, associated with gum disease, or causing functional problems.

There are several methods to correct and/or treat diastema. The course of treatment depends on whether the diastema is a result of gum disease or merely of cosmetic concern.

• Cosmetic treatments for diastema: Several cosmetic dental treatments are available for patients who wish to close the gaps and otherwise have healthy teeth:
  • Dental bonding: To conceal the gaps, the dentist will apply a tooth-coloured composite resin onto the tooth/teeth. Thereafter, to ensure that the teeth have a natural look/appearance, they are shaped and polished.
  • Porcelain veneers: Custom-made thin ceramic shells (veneers) are fabricated and attached (often permanently) onto the front teeth to close the gaps, offering a more uniform look.
  • Braces or aligners: If the gaps are large, the teeth may need to be physically moved together via the use of orthodontic treatments, i.e., clear aligners or braces. In mild cases, diastema can usually be fixed without braces.
  • Frenectomy: The presence of an oversized/thick oral frenum causes the teeth to be pushed apart, resulting in the formation of a gap. A frenectomy removes or loosens the frenum and is usually performed along with other cosmetic procedures, such as veneer application or dental bonding.
  • Dental bridges: Dental bridges are often recommended by dentists if a missing tooth is the cause of diastema; the bridges serve to replace the tooth. To place a bridge, the presence of two healthy teeth on either side of the gap is necessary; these teeth are shaped to serve as anchors that hold the bridge in place.
  • Dental implants: Similar to a dental bridge, an implant serves as a replacement for a missing tooth but without the need for reshaping of the neighbouring teeth. Implant procedure involves the placement of a threaded titanium post in the bone to replace a missing tooth root; once the tissues around the implant heal, a dental crown is fixed on top to close the gaps between the teeth.
• Gum disease treatment for diastema: If gum disease is cause of diastema, the dentist would need to first perform periodontal treatment to eliminate the harmful bacteria. Once the infection is treated, the aforementioned cosmetic treatments may be performed to close the gap. Common methods for gum treatments include the following:
  • Teeth cleaning: For cases for mild gum disease, deep dental cleaning, i.e., scaling and root planing, is recommended by dental experts. This cleaning process involves thorough clearing of the bacteria from the deeper crevices under the gums under local anaesthesia.
  • Gingival flap surgery: For cases of moderate to advanced gum disease, gum surgery may be needed. During this procedure, an incision is created along the gum line to gently move the gums back and expose the tooth roots. After the roots are thoroughly cleaned, the gums are repositioned and carefully sutured back into place. If bone loss is observed around a tooth, a dental bone graft may also be used to aid the regeneration of bone tissues.

Patients who are concerned by gaps between their teeth due to cosmetic reasons or notice an increase in the gap between teeth accompanies with symptoms of gum disease should schedule a dental consultation. 

While not all cases of diastema can be prevented, few measures can be taken to avoid gum disease, including:

• Regular brushing and flossing
• Routine dental check-ups and cleanings
• Managing thumb-sucking or tongue thrusting habits, especially in children

Patients with suspected or confirmed periapical abscesses should consult a:

• General dentist or Orthodontist (for cosmetic correction)
• Periodontist (for gum disease-related diastema)