What Is Diastema?

A space or gap between two teeth is known as diastema. It commonly occurs between the upper front teeth (incisors) and hence referred to as central or midline diastema.¹ Space between teeth may vary in size but the one that is wider than 0.5mm is considered as diastema. It can develop naturally or brought on by a wide range of underlying causes that may or may not be related 

Overview

Diastema can have both aesthetic and functional implications. From an aesthetic perspective, some individuals may find diastema undesirable and seek treatment to close the gap. However, it is important to note that diastema can also be perceived as a natural and unique feature, and some people may choose to embrace it. Some of the famous celebrities like Michael Strahan, Madonna and Eddie Murphy kept their gap tooth as a part of their identity.

Functionally, diastema can cause problems such as difficulty in speaking or biting, particularly when the gap is wider. Additionally, diastema may raise the risk of gum disease or tooth decay since it is more difficult to clean correctly and food particles may become lodged there. Treatment for the diastema might not be necessary for health reasons, and in many situations, the sole objective of the procedure is cosmetic. 

Causes of diastema

Some of the underlying causes of diastema are,^{2 3}

• Hereditary- Midline spacing in teeth can be influenced by genetic factors and have a racial and familial background
• Physiological- spacing in between milk teeth. In growing children, diastema can be observed as an “ugly duckling” stage which is a part of tooth development and is self correcting. This stage is the transitional phase, indicating the available space for the emerging permanent teeth
• Habits such as thumb sucking and tongue thrusting (tongue presses too forward in the mouth) can lead to forward inclination of teeth resulting in diastema along with generalised spacing between teeth
• Tooth size discrepancy- Midline diastema can occur when the amount of tooth material that will fit in the gap exceeds the amount of space that is available in the arch. It occurs in conditions including tooth loss, microdontia (lower jaw is smaller than normal), macrognathia (lower jaw protrudes or becomes disproportionately large) and extractions that cause nearby teeth to drift
• Abnormal labial frenum- It is the thick and fleshy tissue on the front surface of upper teeth that can cause a midline diastema. The restriction caused by the frenum's thick fibrous tissue prevents the two front teeth from contacting one another in this type of frenal attachment
• Gum disease- The sudden occurrence of a diastema can occasionally occur, and the fast movement of the teeth can be an indication of advanced gum disease. Gum disease is an infection that weakens the tissues that support the teeth by inflaming the gums. And gaps can frequently result from this damage

Signs and symptoms of diastema

• Visible gap- The most prominent indication of diastema is the presence of a visible space or gap between two teeth, particularly between the upper front teeth
• Tooth misalignment-  Diastema can sometimes be associated with misaligned teeth, causing the teeth to be crooked or positioned at irregular angles
• Food lodgement- Diastema may leave gaps in which food particles may collect. Due to the difficulties in cleaning in between the teeth, there is a higher chance of developing gum disease and dental decay. Additionally, the buildup of plaque and bacteria in the gap, diastema may result in gum issues, including gum inflammation or gingivitis
• Speech difficulty- People who have a diastema may have speech issues, particularly if they have trouble pronouncing specific sounds that require use of the front teeth
• Cosmetic concerns- Diastema can make you feel self-conscious, which can affect your self-esteem and may concern your appearance

Management and treatment for diastema

Effective diastema treatment requires accurate diagnosis of underlying cause and management specific to that cause.⁵ Obtaining a patient's medical and dental histories, doing clinical and radiographic examinations, and even measuring the size of the teeth are all necessary for a proper diagnosis. 

Some of the treatment options for diastema depending upon the cause:⁷

Orthodontic treatment may be suggested if teeth crowding or misalignment is the root cause of the diastema. The gap between the teeth can be closed over time with the use of braces or clear aligners.

• Dental veneers or bonding may be an option for people who have a small to moderate-sized diastema and are looking for an immediate aesthetic fix. Dental veneers are thin, customised shells that cover the front of the teeth to enhance their aesthetics. In dental bonding, the gap is closed by moulding tooth-coloured resin onto the teeth
• Dental crowns may be utilised in specific situations, especially when the diastema is brought on by irregularities in the shape or size of the teeth. Dental crowns are caps in the shape of teeth that completely cover the tooth, enhancing its look and filling the gap
• Dental bridges or implants: If the diastema is brought on by missing teeth, dental bridges or implants may be recommended. With dental implants, an artificial tooth root is surgically placed into the jawbone so that it can support a dental crown to close the gap. Dental bridges are fixed restorations that support an artificial tooth and bridge a gap by using nearby teeth as anchors
• Retainers or dental bands may be used in some situations to close a diastema by applying pressure to the teeth to gradually bring them closer. This method is typically appropriate for filling small gaps or as a maintenance step following orthodontic treatment to maintain the results

Diagnosis

Dental examination of your teeth and oral tissues will be examined by your dentist or orthodontist when they begin your treatment.⁶ They will look for any noticeable gaps or spaces between the teeth.

• Dental history- The dentist will start by asking about your dental history, including previous orthodontic treatment, dental procedures, or concerns regarding the appearance of your teeth
• Visual inspection- Your teeth will be visually examined by the dentist, who will pay close attention to any gaps or spaces between your teeth. To determine the size of the diastema, they could utilise a dental mirror and try out various angles
• Dental radiographs can be used to evaluate the position, alignment, and structure of the teeth as well as the underlying bone in the mouth. Radiographs can give a clearer picture and help in identifying any underlying issues, such as irregularities in the bone structure, impacted teeth, or differences in tooth size discrepancies
• Dental impressions or digital scans- In certain cases, it may be necessary to take dental impressions or digital scans in order to replicate your teeth. This enables a more thorough evaluation of the teeth and their relationships with one another

Analysing your bite will help the dentist or orthodontist identify whether the diastema is caused by malocclusion or other bite-related problems.

In complicated cases, the dentist or orthodontist may collaborate with other dental experts, such as an orthodontic specialist or a periodontist (a specialist in gum health), to ensure a thorough diagnosis and treatment plan.

FAQs

How can I prevent diastema

Diastema cannot be preventable when it is due to hereditary factors or normal growth of teeth. However, certain preventive steps you may take to lessen the risk or severity of diastema.

How common is diastema

Diastema is a relatively common dental condition, although its prevalence varies among different populations. The occurence of diastema can also depend on factors such as ethnicity and age.

Who are at risks of diastema

Children and adults are both affected by diastema. Children are more likely to have the condition, and after their permanent (adult) teeth erupt, any gaps between their teeth may fill.

When should I see a doctor

Plan a visit with your dentist if the space between your teeth bothers you. Your alternatives for treatment options can be discussed with them.

Summary

Diastema is a gap between teeth which can appear in either the upper or lower jaw and may vary in size. Diastema is a relatively common dental condition that can be caused by  various factors, including genetics, a discrepancy between tooth and jaw size, or habits such as thumb sucking. Diastema may be considered as an aesthetic concern in some cases, while it may cause functional issues like having difficulty in speaking or biting in others. Treatment options include braces, aligners, dental bonding, veneers, or orthodontic surgery for severe cases. The choice of treatment depends on individual needs, and consulting a dental professional is recommended to determine the most suitable approach.