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A gap between two teeth — called a diastema — can often be the result of a discrepancy between the size of the teeth and that of the horseshoe-shaped dental arch. "Sometimes it's a function of having Daddy's arches and Mommy's teeth, which are too physically small for the arches," said Dr. Paul Chalifoux, a dentist in private practice in Wellesley, Mass.
In other cases, the labial frenum, the tissue band that connects the upper lip to the gums, attaches too close to the front teeth, resulting in a gap eventually. The problem can be fixed with minor surgery.
Other causes include a tendency to thrust the tongue outward upon swallowing, a habit that can create sufficient pressure on teeth to create a gap, or bone loss caused by gum disease. "If there isn't as much bone," Dr. Chalifoux said, "there's a potential for teeth to start to move."
Treatment can include orthodontic braces, veneers or composite bonding, though it is often not medically necessary to close a gap.
"The main reason for closing spaces is an esthetic demand, since the majority of diastemas do not represent a pathological condition," said Dr. Anabella C. Oquendo, an assistant professor at New York University College of Dentistry.
Perhaps the simplest fix is direct bonding, closing the space between the teeth with the application of a resin composite. Bonding does not require that someone wear a retainer afterward, like braces do, although bondings may need to be redone periodically, Dr. Oquendo said.
Braces can be expensive and take months or years to work. Porcelain veneers, thin moldings that cover the fronts of filed-down teeth, are sometimes used, but how good they look is determined by a laboratory technician's skill. And a few visits are needed.
The underlying cause of the diastema needs to be addressed, whatever course of action a dentist suggests. A classic mistake, Dr. Chalifoux said, is to close the space with braces, only to have the gap return over time if the patient grinds his or her teeth at night with enough force to render the retainer useless.
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