Diastema correction MiamiThere’s a growing trend in the fashion world these days that I must admit is a bit of a challenge for this orthodontist to embrace: the gap between the two upper front teeth.

The technical term for this gap is “midline diastema.” Most children and adults who have a significant space between their front teeth want it corrected, and I’ll share in this article how that is accomplished.

But first let’s discuss what causes midline diastema. There is a stage in childhood where everyone has diastema, as it is part of your normal development as you lose your baby teeth and the permanent teeth erupt. It is most prevalent between ages 9 and 11, but it decreases gradually until you’re about 15 years old, according to the American Academy of Pediatric Dentistry.

Approximately 19 percent of American children between ages 8 and 11 have midline diastema; 6 percent of 12- to 17-year-olds have it; and five percent of adults ages 18 to 50 years old retain that gap.

We have long touted the benefits of having your child evaluated by an orthodontist by age 7, and diastema is just one reason why this is recommended. We can assess your child’s diastema, monitor it, and determine an appropriate time for treatment, if necessary.

Other Causes of Diastema
Besides normal growth reasons, other causes for diastema include:

  • Poor fit between the teeth of the upper and lower jaws
  • High attached labial frenum
  • Tongue thrust
  • The presence of a mesiodens (an extra tooth in the midline), cyst or other abnormal structure
  • Muscular imbalances
  • Physical impediments
  • Abnormal structure of the upper arch.

In most cases, a diastema can be closed with routine orthodontic treatment, either with traditional brackets and arch wires, lingual braces that are bonded to the back of the teeth, or with a product such as Invisalign, which aligns teeth using a series of clear plastic aligners. As our Durham, NC dental peers say, “consulting a specialist is never a bad decision.”

Cause Dictates Treatment
The cause determines the treatment. For example, if tongue thrust is the culprit, we may need to refer you to a speech therapist for assistance in correcting that oral habit, in addition to undergoing orthodontic treatment. Failure to eliminate the root cause of the problem means the diastema could return after we take off your braces.

The presence of supernumerary teeth – teeth in excess of the regular number of teeth we’re supposed to have as adults – such as a mesiodens will require coordinating with your dentist or an oral surgeon to have the tooth removed prior to orthodontic treatment.

When a thickened labial frenum – the tissue band that connects the lips to the upper gum – is the cause of diastema, we often must work in cooperation with an oral surgeon to permanently close the gap. An oral surgeon can perform a frenectomy, which is a procedure to remove a portion of the thickened tissue. This procedure is required because otherwise, the tissue will continue to prevent us from bringing the two front teeth together with orthodontic treatment.

Even when methods such as this are used to correct diastema, retention after treatment is paramount to prevent the teeth from gradually drifting apart once more. There was a time when orthodontists recommended wearing retainers for a year or two after completing orthodontic treatment. But these days, we recommend wearing your retainers a few times per week for life to ensure your teeth remain in proper alignment. This is particularly true for lifetime correction of diastema cases.

Must We ALWAYS Correct Diastema?michael-strahan-diastema
This is a question you might be asking yourself, and it’s a good one. As an orthodontist, I am in the business of perfecting smiles by correcting all types of malocclusions. But the truth is, not everyone dislikes the gap between their teeth. For some people, that small space is simply a part of who they are. And let’s face it, there are some famous faces that wouldn’t be the iconic images they are without their diastema. Think about Madonna. Would you even recognize Madge if she didn’t have that space between her teeth? What about Michael Strahan? The same could be said for late night talk show icon David Letterman.

While our Western culture tends to lean toward correcting diastema, others view those gaps quite differently. The French call the teeth on either side of a space or gap “dents du bonheur,” or “lucky teeth,” according to an Inside Dentistry article. In Nigeria, a gap between the teeth is viewed as a particularly attractive physical attribute. Early English societies equated the presence of a gapped-tooth smile on a woman with lustful connotations. Even here in the U.S. a small space between the two front teeth isn’t seen as unattractive by many people.

There also is some evidence that culturally, we might be warming up to the gapped-tooth smile, at least for supermodels. While America’s Next Top Model Executive Producer Tyra Banks told Danielle Evans in Cycle 6 of the reality show to have her diastema narrowed, Banks sang a different tune to Chelsey Hersley in Cycle 15.  She told Hersley to widen her diastema, and she did. A cosmetic dentist filed a quarter of a millimeter off both of her upper front teeth.

Actor Zach Efron had his diastema closed, but lots of young actresses and models today are embracing that space between their teeth. Anna Paquin, the Oscar-winning actress who stars in the HBO series True Blood, is unapologetic about her gapped-tooth smile. Georgia May Jagger, daughter of that famous Rolling Stones front man, has a burgeoning modeling career, and her diastema is prominent. Models Lara Stone, Lily Aldridge, Lindsey Wixson, Abbey Lee Kershaw, Jessica Hart, and French pop star and model Vanessa Paradis also sport gaps between their front teeth.

The key is this: you ought to feel confident in your smile. So if you like that space between your teeth and you’re not at all hesitant to grin and bare it to the world, rock on. But if you feel self-conscious about that gappy grin, there’s no need; we can fix it with orthodontic treatment including Invisalign.