Introduction:
If the gap present between the upper front teeth is more than 0.5 mm proximally, a space is visible between the upper central incisors. Usually, midline diastema is seen in children during the mixed dentition period (6 to 12 years), which is also called the ugly duckling stage. Generally, the spacing present in the upper front teeth during the mixed dentition period closes after the eruption of permanent canine. Some gaps may be barely noticeable, but some may be obvious and can be of cosmetic concern for many people.
What Are the Causes of Midline Diastema?
The causes are as follows:
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The size of the tooth and the jawbone can be determined genetically, so midline diastema can be hereditary. If the individual’s teeth are very small when compared to the size of the jawbone, diastema or gaps can develop.
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If some teeth are smaller in size than the adjacent teeth or are missing, then diastema can develop. This phenomenon can be commonly noted in upper lateral incisors (teeth that are adjacent to the two upper front teeth).
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The tissue that starts from the inner surface of the upper lip and ends in the gum above the upper front teeth is called the labial frenum. A large labial frenum can result in the formation of diastema.
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The spacing between the teeth can also indicate the presence of an underlying gum (gingiva) disease. Any damage to the gum can cause inflammation which can affect the bone that provides anchorage to the tooth. Hence, the tooth becomes loose and tends to shift from its original position.
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The usual swallowing reflex follows a pattern in which the tongue presses itself against the roof of the mouth while swallowing. In case of abnormal swallowing reflex, an individual might thrust their tongue against the front teeth while swallowing. Over time, this repetitive pressure can push the front teeth forward creating a gap between them.
Other reasons for midline diastema include:
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Oral habits such as thumb sucking, tongue thrusting, and so on.
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Unerupted mesiodens (an extra tooth that is sometimes present between the upper front teeth).
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Abnormal maxillary arch (the upper jaw is known as maxilla).
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Following the extraction of mesiodens, midline diastema can occur.
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Missing teeth, leading to a shift of the incisors.
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Peg laterals (underdeveloped, small, and pointed lateral incisors that appear like a cone), and missing laterals.
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Hard and soft tissue pathologies such as a cyst, tumors, odontomes (benign tumors), and an impacted tooth.
What Are the Signs of Midline Diastema?
The spacing between the teeth is the only sign of diastema. In the case of gum disease, the person might experience discomfort and pain which is common while eating. Other signs of gum disease include:
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Swollen, tender gums.
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Bleeding gums.
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Bad breath.
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Loose teeth.
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Gums that are bright red.
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Receding gums.
How Is Midline Diastema Diagnosed?
The gap between the teeth can be diagnosed during a dental examination or the individual can recognize it while brushing. The diagnostic tests for various causes that cause midline diastema include:
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Blanch Test: The upper lip is lifted and pulled outward to look for blanching (whitening of the skin) of the soft tissues at the back of the tooth and between the two central incisors. If the blanch test is positive, it indicates that a high frenal attachment is the cause of midline diastema.
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Radiograph: A radiograph is taken to check for the presence of any impacted tooth, cysts, tumors, or any other pathology.
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Oral Habits: The presence of any oral habits such as tongue thrusting, or thumb sucking should be checked.
How Can Midline Diastema Be Corrected?
No treatment is required for diastemas that develop during the ugly duckling stage. In most cases, the diastema gets corrected following the eruption of the canines. If the midline diastema is a cause of esthetic concern, then the following treatment modalities can be preferred:
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Fixed or Removable Appliance: Oral habits like thumb sucking and tongue thrusting can be corrected with the guidance of fixed or removable appliances.
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Braces: Diastemas are usually treated with the use of braces. Braces exert pressure on the teeth which closes the gap over a period of time. Braces cannot be placed only on the teeth with midline diastema but rather on all the teeth since moving one tooth will have an impact on the entire mouth.
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Veneers or Dental Bonding: If peg laterals are present, the space can be camouflaged by veneers or crowns. Veneers or dental bonding are apt if the diastema is due to the presence of small teeth. A procedure in which a resin is applied to the surface of the teeth which is then hardened with a light source is called dental bonding. Veneers are fitted by using thin, customized pieces of porcelain on the surface of the teeth.
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Dental Bridge and Implants: If the diastema is due to the absence of a specific tooth or teeth, then it requires extensive dental treatment like dental bridges or implants. Dental implants are placed by driving the metal screws into the jawbone followed by the attachment of the replacement teeth. False teeth that are placed in the areas of missing teeth are called dental bridges and these false teeth are anchored by a device that sits on the teeth on either side of the gap.
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Surgery: If the midline diastema is due to the presence of an enlarged labial frenum, then the dentist may suggest a procedure called frenectomy in which the excessive tissue is removed. Following the surgery, the gap might close by itself in young children whereas older children and adults may require braces or other treatment to close the diastema.
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Treatment of Gum Disease: It is important to treat gum disease to avoid developing an infection and prevent tooth loss. The treatment involves a scaling procedure in which the tartar or the calculus is removed from the gums. Topical or oral antibiotics can aid in the recovery process. In severe cases of gum disease, surgery might be required to remove the tartar that is present beneath the gums. Once the gums return to their healthy state, any of the above methods may be suggested by the dentist to close the diastema.
Can Diastema Increase With Age?
If the oral cavity is healthy, diastema usually does not increase with age. If the diastema increases with age, then it can be a sign of gum disease.
Can Midline Diastema Be Prevented?
Midline diastema can be prevented in the following ways:
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Breaking the thumb-sucking and tongue-thrusting habits in children.
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Following proper swallowing reflexes.
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Maintenance of good oral hygiene by brushing and flossing regularly.
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It is advisable to visit a dentist at least twice a year for routine dental examinations and cleanings.
When Should One Visit a Dentist?
Individuals can consult a dentist if they notice any signs of diastema in themselves or their children. The American Association of Orthodontists (dentists who diagnose, prevent, and treat irregularities of teeth and jaw) suggest that it is good to visit an orthodontist and get the child evaluated when they reach seven years of age. This can help diagnose the underlying cause if any, at an earlier stage and treat it.
Conclusion:
A gap between the teeth is called diastema and if it is present in the midline it is called midline diastema. It can occur due to many reasons and diastemas do not affect oral health unless it is caused by an infection. If one prefers to close the gap due to aesthetic concerns, there are a variety of treatment options available. Thus, correction of midline diastema will improve the esthetics of an individual and also enhance the smile. It boosts confidence, and improves the well-being, and personality of an individual. Proper teeth alignment is the gateway to a perfect smile.