The presence of space between teeth is technically known as a diastema. A diastema is defined as a gap or separation of more than 0.5 millimeters between two adjacent teeth, most often appearing between the upper central incisors. Whether this spacing is a normal feature or requires correction depends on the patient’s age, the location of the gap, and its underlying cause. A dental professional must assess these factors, distinguishing between temporary, developmentally normal spacing and pathological gaps that could compromise long-term oral function.
Developmental Spacing: When Gaps Are Normal
In young children, spacing between the primary teeth is normal and desirable for proper oral development. This condition, known as physiological spacing, occurs as the jaw grows to accommodate the much larger permanent teeth. Without this natural spacing, there is an increased risk of crowding when the permanent teeth begin to erupt.
A specific type of space, called the primate space, is often observed in the primary dentition. This space is typically found mesial (closer to the midline) to the upper canine teeth and distal (further from the midline) to the lower canine teeth. These gaps are a natural provision in the dental arch, ensuring that the wider permanent teeth can align correctly without becoming severely overlapped or impacted.
Anatomical and Habitual Causes of Gaps
Persistent or newly formed gaps in the permanent dentition usually stem from specific anatomical or behavioral factors. One frequent cause is a disproportion between the size of the teeth and the jawbone, a genetic factor. This mismatch, which can involve naturally undersized teeth (microdontia) or an oversized jaw, results in generalized spacing throughout the arch.
A localized gap, particularly a midline diastema between the two front teeth, is often linked to the labial frenum. This is a band of tissue connecting the upper lip to the gum tissue between the central incisors. If the frenum is oversized or attaches too low on the gum line, it can physically prevent the front teeth from coming together, creating and maintaining the separation.
Prolonged oral habits exert continuous pressure on the teeth, gradually pushing them out of alignment and creating gaps. These habits include chronic thumb or finger sucking in childhood, which pushes the incisors outward and forward. An improper swallowing reflex, known as tongue thrust, can also cause spacing. This occurs when the tongue habitually pushes against the back of the front teeth during swallowing instead of resting against the roof of the mouth.
Health and Functional Implications of Spacing
Spacing between teeth can affect a person’s oral health and functionality beyond cosmetic concerns. Phonetic issues are a common consequence, as gaps alter the flow of air across the teeth, sometimes resulting in speech impediments like a lisp. The creation of specific sounds, which requires precise contact between the tongue, teeth, and palate, can become compromised by excessive space.
Wide gaps create oral hygiene challenges that affect the periodontal tissues. Spaces can act as traps for food particles, leading to chronic food impaction that is difficult to clean with normal brushing. This persistent trapping and resulting buildup of plaque increase the risk of gum inflammation and periodontal disease.
In cases of generalized spacing, the overall alignment of the bite can be compromised, leading to a form of malocclusion. When teeth are not properly aligned, the forces of chewing are distributed unevenly, which can cause abnormal wear patterns on the biting surfaces of the teeth. Over time, this uneven pressure may contribute to jaw discomfort or problems with the temporomandibular joint.
Dental Solutions for Closing Gaps
The approach to correcting a diastema is dictated by its cause, location, and the patient’s goals. Orthodontic correction is often the most comprehensive solution for closing significant or generalized spacing. This involves using fixed appliances like traditional braces or removable clear aligners to apply controlled forces that physically move the teeth together.
For smaller, localized gaps or cosmetic concerns, restorative dentistry offers quicker solutions without moving the teeth. Dental bonding uses a tooth-colored composite resin material applied directly to the sides of the teeth to increase their width and eliminate the space. Porcelain veneers or crowns are also options, covering the entire front surface of the tooth to improve shape and proportion.
When a thick, low-attaching labial frenum is the diagnosed cause of a midline diastema, a frenectomy may be required. This procedure removes or repositions the frenum tissue to eliminate the physical barrier between the two front teeth. A frenectomy is typically performed during or after orthodontic movement to ensure the teeth can be brought together and the gap does not relapse.