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DiastemaLee W. Boushell, DMD, MS*

WHAT IS IT?

Dentists use the term “diastema”to describe the space that resultswhen a tooth in the dental arch isnot in contact with an adjacenttooth (Figure 1). Numerous factorscontribute to proper tooth andarch interrelationships. These mayinclude the relative height, width,orientation, and number of theteeth as well as the size and shapeof the dental arches. An imbalancein the size and shape of the teethand dental arches may limit theability of the teeth to fit togetherproperly. This may result in theformation of one or multiplediastemas. Normal contactbetween adjacent teeth in eachdental arch serves to limit driftingand/or crowding. Tooth contactprovides protection of the gumtissue and tooth root surfacesimmediately beneath the contact bylimiting the accumulation of foodparticles during chewing. There arevarious reasons why diastemasform in children and adults.

Children are using all of their babyteeth by age 5 to 6 years. Babyteeth are characteristically smallerand usually do not fill in the totalavailable space of the dentalarches. This typically results in thepresence of multiple spaces or

diastemas, but, with baby teeth atthis age, it is a normal condition.Dentists are rarely concerned aboutdiastemas in growing children, asthese may actually indicate thatthere will be an adequate amountof arch space for the developingadult permanent teeth thatwill follow.

Diastema formation in childrenusually does not result in gum ortooth problems. However, somechildren develop an excessive soft-tissue attachment between the lipand the dental arch (called a “highfrenum”). This may result in adiastema between permanent frontteeth just adjacent to the attach-ment. Habits such as thumbsucking also often prevent teethfrom moving into normal archposition and may result in a dis-torted dental arch as well asdiastema formation. Routine dentalexaminations will allow early iden-tification of the conditions thatcreate diastemas that may requireprofessional intervention.

The adult permanent top andbottom teeth usually fit togetherwithout diastema formation.About 7 out of every 100 adultsdevelop a diastema between theirtop front teeth.1 Some individuals

(or their parents/peers) may noticethe formation of a diastema andfind it esthetically unsatisfactory.Adults also may develop diastemasbetween their back teeth. Diaste-mas also may result from condi-tions that prevent dental fillings orcrowns from restoring naturaltooth contours. Some individualsdevelop severe gum/jawbone prob-lems that allow teeth to moveapart from each other with result-ant diastema formation. Diastemasbetween front or back teeth,which allow food particles to con-tinually collect, may predisposethe area to gum or toothroot problems.

HOW IS IT TREATED?

It is essential for your dentist toidentify the reason for the diaste-ma(s) that has been detected. Chil-dren may require modification ofhigh frenum attachments that havecontributed to diastema formation.Some children require professionalassistance to discourage thumb-sucking habits that are distortingthe dental arches and/or creatingdiastemas. Adults who have toothand/or arch size discrepancies thathave caused diastemas may requireorthodontic intervention (braces).Underlying disease states, such asgum disease, may need to be

*Assistant professor, Department of Operative Dentistry,University of North Carolina School of Dentistry, Chapel Hill, NC, USA

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resolved before diastema correctionis implemented. In some cases,additional procedures beyondorthodontic intervention may berequired to create naturaltooth–tooth contact.

Adhesive dentistry is ideal in theconservative correction of diaste-mas, a procedure commonlyreferred to as “diastema closure.”This procedure uses addition ofresin-based composite materials tothe teeth on either side of thediastema. Normal tooth color andshape are accomplished withoutmaking permanent changes to theteeth (Figures 1 and 2). Currentcomposite materials have thepotential to retain their color and

shape for years. More aggressiveprocedures, such as porcelainveneers or crowns, may berequired to correct overall toothshape and color in addition toclosing the diastema. Your dentistwill recommend the most predict-able treatment method based onthe particular circumstances thatresulted in the diastema.

CONCLUSION

“Diastema” is the term dentistsgive to a space that has formedbetween adjacent teeth. Not alldiastemas require treatment. Identi-fication of the cause is necessary toensure appropriate treatment plan-ning. Children with diastemasbetween their permanent teeth that

are caused by high frenum attach-ments or thumb-sucking habitsmay benefit from treatment.Diastema closure procedures areideal for adults who are concernedabout appearance or are experienc-ing localized gum or tooth diseaseas a result of diastema formation.

D I S C L O S U R E

The author does not have anyfinancial interest in the manufac-turers whose materials are dis-cussed in this article.

R E F E R E N C E

1. Mitchell L, Littlewood SJ, Doubleday B,Nelson-Moon ZL. An introduction toorthodontics. 3rd ed. Oxford, UK: OxfordUniversity Press; 2007.

Figure 1. Clinical photograph of a diastemalocated between the top front teeth. Courtesy ofDr. Edward Swift, Jr.

Figure 2. Diastema closure with composite resin. Courtesyof Dr. Edward Swift, Jr.

TA L K I N G W I T H PAT I E N T S

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