Orthodontics

A diastema is a space or gap, most often between the two upper front teeth. At some stages of dental development, it's normal to have a diastema, and the space eventually closes after the permanent canine teeth (eye teeth) erupt into the mouth. However, in some people, the space does not close.

Sometimes, a diastema is part of a set of problems that require comprehensive orthodontic treatment. For some people, however, a diastema is the only problem that requires orthodontic treatment.

Often, people have a diastema treated for cosmetic reasons. They may be self-conscious about having a space between their teeth. However, a diastema also can affect speech. When you speak, your tongue pushes forward to produce certain sounds (for example, "S"). This constant tongue pressure can worsen a diastema over time.

If you're concerned that your child may need treatment for a diastema, you can find out by visiting an orthodontist. The American Association of Orthodontists recommends children have a consultation appointment by age 7, although treatment may not begin for several years.

Causes
In some people, a diastema is caused partly by lateral incisors (the teeth next to the two front center teeth) that are undersized. If this is the case, consult with your dentist to determine whether these teeth should be made wider using crowns, veneers or bonding.

A diastema also can be caused by an overly large frenum — the piece of gum tissue above and between your two front teeth. If your frenum is too thick, it can impede the normal development of teeth and the natural closing of the space between the two front teeth. Orthodontic treatment may not be effective unless the tissue is removed in a procedure called a frenectomy.

Some people have permanent teeth that may have never developed, known as congenitally missing teeth. If the lateral incisors never develop, the extra space can allow the front teeth to move apart and create a diastema. If you are missing these teeth, there are several options for replacing teeth eventually, including implants, bridgework and orthodontic treatment that moves the canine teeth (eye teeth) into the positions where the lateral incisors should be. Which treatment is right for you depends on many factors, and you should discuss the options with your orthodontist.

Treatment
Treatment for a diastema starts with a consultation with an orthodontist, who will do an evaluation and determine if treatment should proceed. If you are ready for treatment, the orthodontist will take impressions of your teeth to make study casts, do a detailed clinical exam, take a series of facial and dental pictures, and take a full series of radiographs (X-rays), including panoramic and side head views.

Orthodontic treatment for a diastema that is the only orthodontic problem can consist of one or more of these options:

• Full braces (upper and lower)
• Full braces on only the upper teeth
• Partial braces on only some of the upper teeth
• A removable appliance similar to a retainer

Treatment depends on many factors, including your age, dental development and facial/skeletal relations. Facial / skeletal issues that will be taken into consideration include whether you have a long or short, narrow or wide face and how symmetrical your face is. Discuss the options with your orthodontist to find out which is best for you.

After Treatment
If you wear braces to treat your diastema, you will receive a retainer after the braces are removed. The retainer will maintain the corrected tooth positions. Consult with your orthodontist about time and duration of wear.

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