What Is Diastema?

Diastema is a condition involving a noticeable gap between the teeth that is wider than 0.5 millimeters (0.02 inch). Most commonly, these gaps occur in the front teeth, but diastema can involve the back teeth as well. A diastema is very common in childhood until the permanent teeth come in. When present in the permanent teeth, it can be corrected for aesthetic or functional reasons.

Symptoms

When the gaps occur in the lower teeth, it’s referred to as mandibular diastema. A space between the upper or lower central incisors (two front teeth) is called midline diastema. The presence of a gap between the two maxillary (upper) central incisors is called a maxillary midline diastema (MMD).

According to a 2011 report published in the Journal of American Dental Association (JADA), between 1.6% to 25.4% of adults from various age groups and populations have MMD. The report also discovered a higher prevalence of MMD among African Americans (compared to Caucasians, Asians, or Hispanics).

Generally, MMD is considered normal in children and does not require treatment. In fact, according to a 2013 report published by the POJ Dental and Oral Care journal. midline diastemas occur in approximately 98% of 6-year-olds, 49% of 11-year-olds, and 7% of 12–18-year-olds.

Causes

There are several contributing factors that may play into the cause of diastema.

Teeth that are too small for the mandible (lower jawbone) or maxilla bone (upper jaw bone), may result in gaps between the teeth. And a mandible (jaw) that is too big for the teeth may result in improper alignment of the teeth, because there is too much space, causing gaps.

The size issues are more common as children are still growing, and the size of the teeth and jaw may become more proportional as a child grows. Commonly, hereditary factors come into play because the size of a person’s teeth and jaw is influenced by genetics and can run in families.

Other factors include:

• Overgrowth of the frenum (the skin between the top lip and the front teeth), can cause a gap (diastema) between the two front teeth.
• Periodontitis (severe gum disease caused by poor dental hygiene) can lead to bone loss in the jaw; the bone loss ends up allowing the teeth to shift, creating gaps. The symptoms of periodontitis include red, swollen, bleeding gums, loose teeth, and bone loss.
• Peg lateral is a condition in which the second incisor (a tooth located next to the very front two teeth) develops improperly. The defective tooth is very small and pointed, causing gaps on either side. A peg lateral can be repaired with crowns, veneers, or implants.
• Thumb sucking commonly causes a midline diastema.
• Tongue thrusting often causes mandibular (lower jaw) diastemas as a result of the tongue pushing against the two central lower teeth.

Diagnosis

A diagnosis of diastema is made by a dentist during an oral examination. Keep in mind that children commonly have gaps in their teeth that don’t require treatment. These gaps will resolve themselves as the child grows and the permanent teeth come in. But if gaps remain after the permanent teeth come in, a dentist should be consulted.

Should Diastema Be Corrected?

Getting treatment can help a person's self-esteem and lend itself to improving the overall quality of life for many people. In fact, a 2014 study found that among young people who had a correction of midline diastema, 50% reported that the procedure remarkably improved their quality of life.

Fixing the spaces between the teeth may also restore the normal functionality of the teeth. Any type of space can cause misalignment of the teeth. Biting and chewing problems may result. This can disrupt a person's ability to eat and digest food properly, impacting overall health. Filling the gaps between the teeth can restore the proper structure of the mouth.

Treatment

For most people, the repair of diastema is a painless, uncomplicated process. There are several treatment methods that can close the gaps in the teeth. Each person’s case is individual, and the dental care practitioner will formulate a treatment plan, depending on several factors.

These include:

• Where the gaps are located
• How many teeth are involved
• How large the gaps are
• If there are missing teeth
• The underlying cause of the gaps
• The overall health of the teeth
• The patient's desire for corrective treatment

You and your dentist can work together to formulate a plan for the best treatment for your diastema.

Braces and Aligners

Braces can be used to move the teeth and close the gaps. They are commonly used for large gaps. 

Invisible braces such as the Invisalign brand, are a treatment option for those who do not want braces to be visible. They can be used for closing mild to moderate gaps. Invisible braces are removable, so they are a good option for people who are in the public eye (such as professional speakers, actors, or models).

At-home clear aligners are a cheaper version of invisible braces that have been used to close small gaps between the teeth. They are not the same as clear aligners used by professionals, such as Invisalign. Clear aligners are less expensive, more comfortable, and not as noticeable as metal braces. But there is controversy as to the safety of at-home clear aligners, particularly when an orthodontist is not consulted because they can cause severe complications in some instances (such as when a person has periodontal disease). Keep in mind that there are very few published studies about the safety or effectiveness of at-home clear aligners.

Veneers, Bonding, Bridging

Veneers and composite bonding involve a layer of material (such as porcelain or composite material) placed over the tooth. A composite material is a substance made from two or more materials with different chemical properties. When combined, these materials harden to form a hard, tooth-like substance. Veneers and composite bonding are best used for closing just one or two gaps.

Porcelain veneers may be used to fill small gaps between teeth. A dentist will make the veneer (tooth covering) larger than the tooth, so that the excess material will fill in the space. There are normally two visits required to get porcelain veneers; one visit will involve the dentist preparing for the veneer to be made and the final visit will be needed for the dentist to fit the veneer/s once they are made by the lab.

Composite bonding/veneers involves a synthetic material made by the dentist that fits over the tooth. The procedure does not usually require a second visit because the dentist builds the composite, giving it the right shape and appearance during the office visit. When the entire tooth is covered by composite material, it is called a composite veneer. 

Crowns or bridges crowns may be used as an option to fill in large spaces or when the tooth (located next to the gap) is cracked, chipped, or otherwise damaged. Dental bridges may be used when there are missing teeth. Crowns and bridges can help to restore the proper bite and chewing functionality.

Procedures

Periodontal procedures, such as scaling, surgical, or other treatment of the gums may be necessary.

If the frenum attachment is contributing to the diastema, it may have to be removed in a simple procedure known as a frenectomy. This will be timed according to other treatments, such as orthodontics or other restorative means

A Word From Verywell

Under most circumstances, diastema repair is a relatively quick and painless procedure. Some people with diastema are perfectly OK with their appearance and do not feel that they need to undergo the time or take on the expense of having treatment. If there are underlying dental problems, the decision should be made according to a dentist’s recommendation. When it’s a matter of aesthetics, make sure you discuss your needs and expectations when you decide what to do.