Diastema (gapped teeth) is the name given to the condition where significant gaps form between teeth. It’s usually found between the front teeth and is often viewed as an aesthetic issue. However, considering the underlying causes and potential oral health problems it can cause in the future, prompt treatment may sometimes be necessary. Diastema, which sometimes results from the natural developmental process in childhood, or from genetic inheritance or acquired habits, can be largely corrected through orthodontic (e.g., braces), restorative (e.g., bonding, laminate), or surgical procedures. The appropriate treatment depends on the cause of the gap, its extent, and the current oral and dental health status.
| Causes | – Genetic Factors: Teeth are small compared to the jaw structure
– Tongue Protrusion: The tongue presses against the teeth when speaking or swallowing – Missing Teeth: Other teeth shift due to missing or impacted teeth – Gaps from Baby Teeth: Can be seen naturally in childhood – Periodontal Disease: Tooth displacement due to receding gums – Frenulum (Lip Tie) Problems: The upper lip is too attached to the gums (hypertrophic frenulum) |
| Symptoms | – Visible space between teeth
– Chewing or speech problems (in some cases) – Food accumulation between teeth – Aesthetics Concerns |
| Treatment Methods | – Orthodontic Treatment (Braces or Clear Aligners): This is the most effective method for bringing teeth together.
– Bonding (Composite Filling): The gap is closed with a tooth-colored filling material. – Porcelain Veneers or Crowns: Provides a more aesthetic and long-term solution. – Frenulum Surgery: If the lip tie is large, it can be surgically removed. – Implants or Bridges for Missing Teeth: These are used to fill gaps caused by missing teeth. |
| Treatment Duration | – Orthodontic treatment: 6 months – 2 years
– Bonding or veneers: 1-2 sessions – Surgical procedures: 1-2 week recovery period |
| Harms of Diastema | – Food accumulation and risk of cavities
– Risk of gum disease – Speech problems (in some cases, especially with large gaps between the front teeth) – Aesthetic concerns and low self-confidence |
| Prevention Methods | – Regular dental checkups during childhood
– Early treatment of gum disease – Timely implant or bridge treatment if missing teeth – Tongue thrusting habit or Early intervention for frenulum problems |
What is a diastema and how does it affect dental health?
A larger-than-normal gap between your teeth is called a “diastema.” These gaps are most often seen between the upper front teeth (incisors) and are commonly known as “gapped teeth.” Sometimes, you may feel as if a small corridor has opened up between two teeth. While some people consider this gap a unique smile detail, others find it a rather disturbing aesthetic problem.
Of course, gaps are not just an aesthetic issue. From a dental perspective, gaps between teeth affect oral health in several ways. For example, gaps between teeth create spaces where food debris and bacteria can more easily cling. This can increase the risk of cavities and gum disease in the long run. When plaque adhered to the tooth surface in the area of spaced teeth is not removed, it can initially lead to sensitivity and bleeding in the gums, followed by more serious gum problems (such as gingivitis and periodontitis). Furthermore, in some cases, functional problems such as impaired chewing function can also occur.
From a dental health perspective, it is particularly important for people with diastema to maintain regular brushing and flossing. If there is an abnormal force distribution due to the gaps or if there is a misalignment between your upper and lower teeth, you can place additional stress on the jaw joint (temporomandibular joint). This can lead to secondary problems in the long term, such as joint pain, tension in the chewing muscles, and even headaches.
What Are the Common Causes of Diastema Formation?
While a diastema may appear to be simply a “gap between two teeth,” it can have very different underlying dynamics. It looks like a small gap in a picture, but when you examine the image closely, you’ll realize that the gap stems from a combination of factors. These factors include:
- Genetic predisposition: If your family members have similar gaps in their smiles, it’s not surprising that you might experience them too. In some families, hereditary factors, such as teeth being smaller than the jaw and gums having different anatomical features, can contribute to the development of a diastema.
- Jaw and tooth size discrepancies: Sometimes the teeth are smaller in size compared to the jaw. For example, if you have a wide jaw but relatively small teeth, gaps can unintentionally form between the teeth when they align. Similarly, if your jaw structure is normal but your teeth are unusually small, the potential for a diastema increases.
- Oral habits: Prolonged pacifier or bottle use in infancy and childhood, as well as habits such as thumb sucking (especially thumbs), can disrupt the front-back or left-right balance of teeth. Thumb sucking can constantly push the front teeth apart, creating a distance between them. Tongue thrusting can also cause separation, as the tongue presses against the front teeth.
- Periodontal diseases: Advanced inflammatory diseases that affect the gums and the bone that supports the teeth weaken the supporting tissue of the teeth. Lacking support, teeth can shift or become loose, resulting in gaps. This is especially important in cases of diastema that develops suddenly during adulthood.
- Extraction gaps and missing teeth: When you lose a tooth, the side teeth naturally tend to move toward the gap. This can lead to various gaps, including diastema. Some people are born with a missing tooth (hypodontia), which can lead to gaps in the alignment of their teeth.
- Labial frenulum problems: When the connective tissue under the upper lip (frenulum) is larger, thicker, or extends downward than normal, it can act as a physical barrier, preventing the two front teeth from approaching each other.
- Shape and size irregularities of teeth: A misalignment between the front teeth occurs, particularly in individuals with small, conical lateral incisors, also known as peg-shaped lateral incisors. This discrepancy is reflected as gaps between the teeth.
Can Genetics or Jaw Size Lead to the Development of Diastema?
Genetic factors play a key role in the position and alignment of teeth, as they do in almost every aspect of our bodies. If you see your grandfather and father in your family having the same gap between their front teeth and experience a similar situation yourself, it’s no coincidence. Genetics determine the shape of the teeth, the size of the jawbone, and even the shape of your gums.
- Family predisposition: In some families, the balance between tooth size and jaw width is inherited. If your family has a large number of individuals with wide jaws but small teeth, you may experience a similar situation. This leads to a spaced-out arrangement where teeth have difficulty meeting.
- Jaw size: An anatomically wider jaw causes gaps to increase, as if the teeth were scattered on a “stage.” Conversely, crowding can also occur in cases where the jaw is narrow but the teeth are large. Therefore, the ideal proportion between jaw and teeth is crucial for proper alignment.
- Tooth bud development: Certain genetic mechanisms influence the number, quality, and position of tooth buds. For example, in cases of congenital missing teeth, gaps in the alignment of the teeth become inevitable. Similarly, if one of the existing teeth is too small or misshapen, it can also trigger the formation of a diastema.
Is Diastema Merely an Aesthetic Issue or a Health Risk?
Many people perceive gaps between their teeth as solely a cosmetic issue. Of course, aesthetic concerns are valid; many people may avoid smiling in photos due to diastema and experience self-esteem issues. However, the health aspect is just as important as the aesthetic aspect.
- Aesthetic Aspect: Facial expression, smile, and overall appearance play a significant role in social interactions. Individuals with diastema may be particularly bothered by the significant gap between their front teeth, which can negatively impact both psychological and social communication.
- Oral health risks: When there are gaps between teeth, plaque and food debris accumulate more easily in this area. Bacteria can easily multiply on the lateral surfaces of teeth and in the areas close to the gums. This can eventually lead to cavities or gingivitis. The likelihood of more serious conditions like periodontitis increases in the future.
- Chewing function: Gapped teeth can prevent the even distribution of chewing force in the mouth. Especially when the lateral teeth are also spaced apart, your ability to grind food can decrease and indirectly contribute to digestive problems.
- Speech and articulation disorders: In some individuals, a diastema can make it difficult to pronounce certain letters correctly (especially slurred consonants like “s” and “z”).This can cause a slight lisp in daily communication.
How is Diastema Diagnosed?
Seeing the spaces between teeth doesn’t always require special effort; often, both the patient and the doctor can detect a diastema at first glance. However, a professional evaluation not only determines the presence of a space but also investigates its size, location, possible underlying causes, and any associated problems.
- Clinical Examination: Your dentist first performs a detailed oral examination. The condition of the gums, the presence of decay, the alignment of the teeth, and the jaw closure are observed. The width of any spaces between the teeth is also measured.
- X-ray examination: Panoramic or periapical X-rays show the condition of the tooth roots and surrounding tissues, the bone level, and the presence of impacted teeth. Sometimes, a diastema can be caused by a previously unnoticed impacted tooth or a missing tooth. Bone loss caused by periodontal disease can also be detected with X-rays.
- Digital scanning and model analysis: Some dentists examine the position of the teeth in detail using digital scanning devices or plaster models. This simplifies both treatment planning and progress monitoring.
- Gum health assessment: Since diastema is sometimes a sign of advanced gum disease, the general condition of the gums, including pocket depths (gaps in the gums), and signs such as bleeding tendency are checked.
- Oral habit analysis: The dentist may inquire about the patient’s habits such as thumb sucking, tongue thrusting, or nighttime teeth clenching (bruxism). These habits are important because they can cause or trigger cavities.
What are the Most Effective Methods for Diastema Treatment?
Methods used to close gaps between teeth vary depending on the cause of the gap, its width, the patient’s age, and overall oral health. These treatments should be considered as “custom-tailored” and no one-size-fits-all solution should be offered. For example, the treatment plan for a gap as small as 1 mm or a severe gap of up to 5 mm will not be the same.
- Orthodontic treatment: If the underlying problem is related to the position of the teeth, orthodontics are one of the most permanent and healthy solutions. Braces or aligners gradually move the teeth closer together. Especially in young people, as jaw development continues, orthodontic treatments offer quicker and more effective results. While similar results can be achieved in adults, treatment times may be longer.
- Restorative treatments (bonding, composite, laminate veneers): This is a popular approach for small to medium-sized gaps. Bonding involves applying composite resin to the tooth surface to close the gap. Laminate veneers, on the other hand, aim to achieve the desired tooth shape and color by bonding thin porcelain or composite material to the front surface of the tooth. They are particularly preferred for addressing aesthetic concerns, especially in the case of gaps between the front teeth.
- Frenectomy: If the gap between the teeth is caused by an abnormally large size of the tissue connecting the lip and gum, this tissue, called the “frenulum,” can be surgically reduced or repositioned. Frenectomy is often combined with orthodontic treatment, as tissue removal alone does not guarantee complete closure of the teeth.
- Dentures or implants: When gaps created by tooth loss are present, implants or bridges can be considered to replace the missing tooth. If the adjacent teeth are not positioned appropriately, orthodontic intervention is first used to align the teeth, followed by prosthetic treatment.
- Surgical interventions (advanced): In some cases, the jawbone may be severely disproportionate. In such skeletal disorders, orthognathic surgery to reposition the jaw may be necessary. This is the most invasive and complex procedure, so it is not suitable for every diastema case.
Can Braces Close Diastema Gaps?
Orthodontics is perhaps one of the most effective methods for diastema treatment. Constant and controlled forces applied to the teeth with the help of braces gradually move the teeth in the desired direction. This process relies on a planned period of pressure and waiting, similar to a cast applied to a bone fracture. Just as a broken bone requires time to heal, so too does the teeth need time to settle into their correct position within the bone.
The duration varies depending on the width of the diastema, the patient’s age, and the jaw structure. While 6-9 months may be sufficient for some mild cases, treatment plans can extend up to 1.5-2 years for complex cases.
Teeth tend to return to their “previous positions” as soon as treatment is completed. This is why the retainer phase is so important. Fixed retainer wiresThe goal is to make the new tooth positions achieved through treatment permanent, using removable clear aligners.
Braces close the diastema by protecting the tooth roots and bone support, while also correcting potential misalignments or upper and lower jaw bite problems. This provides both aesthetic and functional improvement. Furthermore, the tooth tissue is not subjected to any abrasion or cutting.
The treatment period is relatively long, and the patient may have to live with braces. Braces also require extra care in their care and hygiene. Plaque accumulation can increase on the tooth surface, so patients should take extra hygiene measures such as regular brushing, interdental brushing, and flossing.
How Do Dental Veneers Solve Diastema?
When talking about cosmetic dentistry today, one of the first procedures that comes to mind is laminate veneers. Made of thin porcelain or composite material, these veneers are bonded to the front surface of the tooth, providing both shape and color correction. So, how do they offer solutions for diastema?
First, minimal abrasion is performed on the tooth (in some cases, the “prepless veneer” concept can be applied without any abrasion at all). Impressions are then taken of the mouth or a digital scan is taken. The thin veneer, prepared in the laboratory, is fixed to the front surface of the tooth with a strong adhesive. If the diastema is small, these veneers make the teeth appear slightly wider, closing the gap.
Veneers are made of materials that preserve the natural appearance and shine of the teeth. When the color match is well-matched, it can be difficult to even tell if a veneer has been applied. A close alignment of the front teeth, especially if they match the golden ratio, makes a significant difference in the aesthetics of the smile.
Porcelain or composite veneers are manufactured today to be quite durable. Of course, actions like cracking nuts directly with your teeth or biting a pencil can damage the veneers. However, under normal conditions, they can last for many years without any problems. Porcelain veneers are also quite resistant to discoloration.
In cases of very wide diastemas, laminate veneers alone may not be sufficient. For example, if gaps larger than 3-4 mm are to be bridged, the natural proportions of the teeth may be disrupted, and the veneers may appear much wider than they actually are, negatively impacting aesthetics. Furthermore, if there is a malocclusion, orthodontic treatment may be necessary first.
Is Bonding Suitable for Small Diastemas?
Bonding is a very popular and preventative approach in dentistry that aims to create “big differences with simple touches.” A tooth-colored material called composite resin is applied to the tooth surface in layers and hardened with a special light. This allows the shape of the tooth to be adjusted to the desired direction, closing small gaps.
The bonding procedure is usually performed in a single appointment. It is often performed with minimal or no incisions. This makes it a cost-effective method that increases patient comfort and improves tooth size.
For example, it is possible to slightly expand the tooth size to bridge gaps as small as 1-2 mm. If the gap is larger, closing it with composite may disrupt the aesthetic “proportion of the teeth.” In this case, your dentist may recommend orthodontic treatment or veneers first.
Composite is not as resistant to staining agents like coffee, tea, and cigarettes as porcelain. Minor discoloration or wear may occur over time. However, it can be restored with simple touch-ups if necessary.
The dentist’s dexterity and artistic vision are crucial in bonding applications. It is essential to achieve natural transitions between the composite material and the tooth surface; otherwise, color or shape discrepancies may be noticeable.
Are There Surgical Options in Severe Diastema Cases?
Some diastema cases may be too complex to be easily resolved with simple orthodontic or restorative procedures. Especially in diastema cases accompanied by skeletal jaw deformities, braces or veneers alone are insufficient. In such cases, surgical interventions are considered:
As mentioned above, if the connective tissue between the upper lip and gum (frenulum) is abnormally positioned or too thick, it can prevent the teeth from coming together. In this case, a simple surgical procedure shortens the frenulum, and then orthodontic treatment brings the teeth together.
If the diastema is caused by advanced gum disease such as periodontitis, surgical interventions may be necessary to restore the health of the gums and bone tissue. For example, a flap operation cleans the tooth roots and bone surfaces, and bone grafts are applied if necessary. This repairs the supporting tissues that keep the teeth stable, and then closes the gap with orthodontic or restorative methods.
If there is a significant disproportion between the jaws (Class II or Class III malocclusion) and the alignment of the teeth is disrupted due to this skeletal disorder, jaw surgery may be necessary. The jawbones are surgically adjusted forward-backward or left-right.The desired alignment is achieved by adjusting the teeth. This is a comprehensive procedure and is always planned in conjunction with orthodontic treatment. After surgery, braces continue to be used to allow the teeth to adapt to the new jaw position.
Can Diastema Be Prevented with Early Intervention?
Many dental and jaw structure problems in childhood can be resolved much more easily and quickly with early diagnosis. This also applies to diastemas. Especially during the “mixed dentition” period (approximately between ages 6 and 12), when primary teeth fall out and permanent teeth begin to emerge, gaps can be closely monitored by a dentist.
Diastema can be prevented by teaching children proper brushing techniques, flossing, and avoiding harmful habits (e.g., thumb sucking). This is because many teeth gaps are caused by exposure to unfavorable forces while the teeth are still developing.
In some children, the frenulum between the upper lip and gum can naturally “pull” upwards over time. However, if the frenulum appears thicker or longer than normal, the dentist can plan early to prevent diastema formation later in life. While it’s sometimes more ideal to postpone frenectomy surgery until after puberty, early detection is advantageous.
During childhood, while the jaw is still developing, using simple appliances can prevent future diastemas or the widening of existing spaces. For example, dental arch expanders (palatal expansion devices) help align the teeth more properly by regulating the direction of jaw growth.
If primary teeth must be removed prematurely (e.g., due to decay), neighboring teeth can shift into the space, blocking the space needed for permanent teeth to erupt. This can lead to permanent teeth erupting in the wrong location, creating a gap. In such cases, dentists can use “space maintainer” appliances to prevent the gap from closing and prevent diastema formation.
What Risks Can Occur If a Diastema Isn’t Treated?
Many people believe a diastema is merely an “unsightly” aesthetic detail and may postpone treatment. However, ignoring this space between your teeth can lead to problems that can affect both your oral health and your overall quality of life in the long term:
Gaps can be thought of as “little pockets” where food particles and bacteria can easily accumulate. Without regular cleaning, plaque buildup accelerates, leading to damage to tooth enamel and inflammation of the gums. As the process progresses, it can lead to gum recession, loose teeth, and even tooth loss.
A gap between your front or side teeth can cause your upper and lower teeth to not meet properly. This prevents the equal distribution of chewing forces. In the long term, you may experience symptoms such as temporomandibular joint pain, a locked jaw, and tinnitus.
Food particles that cannot be properly digested cause your digestive system to expend more energy. This may not cause direct discomfort, but it can reduce digestive efficiency. As a diastema progresses, some people may experience unpleasant chewing sounds or toothaches.
A diastema can alter airflow during speech and make it difficult to pronounce certain letters. For example, the sounds “s” or “ş” can produce a whistling sound due to the gap between the front teeth. This can damage a person’s self-confidence, especially in social settings.
Untreated diastema can lead to negative psychological consequences over time, such as hiding one’s smile, developing self-consciousness, or avoiding social situations. While some people embrace their gaps as a unique feature, for others, the condition can become an obsession and lead to problems such as depression and anxiety.
