Gaps between teeth are one of the common problems patients face and bring them to me to seek an orthodontic opinion. Gaps between teeth not only pose an aesthetic problem but also make effective cleaning more difficult as food particles tend to trap between the teeth more often.
There are many ways to treat to this problem, and the best way to treat the problem will depend on many factors, such as the cause, location, number of teeth involved, as well as time available for the treatment to be completed.
Causes of gaps between the teeth
Generalized gaps between teeth usually are caused by:
1) A mismatch between the size of the teeth and the size of the jaw, e.g. large jaw with very small teeth will potentially lead to gaps between teeth
2) A mismatch between the size of the upper and lower teeth, e.g. large upper teeth but small lower teeth
3) Anterior tongue posture (A tongue that is resting against the teeth all the time at rest) or enlarged tongue
4) Poor periodontal support e.g. severe gum disease
Localized gaps involving one or a few specific areas in the dentition can be caused by:
1) Missing teeth
2) Impacted teeth (tooth prevented from erupting in the correct position due to poor positioning in the bone as a result of trauma, genetics, extra teeth)
3) Small size tooth involving just one or few locations (a common problem in upper lateral incisors)
4) Low frenum attachment
5) para-functional habits such as digit/pacifier sucking
TREATMENT OPTIONS
The ideal treatment option will depend on the cause of your gap. Sometimes, the best treatment option may be a combination of the options below.
1) Orthodontic treatment
This treatment allows for gaps to be closed naturally without requiring any restoration. This is also the treatment of choice in patients with impacted teeth which will require orthodontic treatment to bring the tooth into the correct position. This is sometimes done with a small surgical procedure. A patient with missing teeth but teeth spaced out will also require orthodontic treatment to reposition teeth into their ideal position prior to restoration of missing teeth using restorative options such as implants, bridge and dentures. This treatment option is suitable for patients with a good oral condition or controlled gum condition. The duration of treatment will depend on the complexity of the condition, which usually takes about 9 months-2 years to complete.
2) Restorative treatment
If a patient has a single gap between 2 teeth, with no other aesthetic concern, this can be closed through restorative treatment especially in cases where there is a size discrepancy between the teeth (e.g. a single small tooth). This can usually be done with tooth filling material, a porcelain veneer or a crown. Your restorative dentist will be able to guide you through the ideal choice of material after examination of your teeth condition.
3) Adjunctive treatment
Gaps as a result of poor periodontal/gum condition will require periodontal treatment first to treat and stabilise the oral health condition prior to any form of treatment to close the spaces. In cases where the gaps are a result of an underlying soft tissue problem (e.g. a low frenum attachment), a soft tissue procedure called a frenectomy is advised in conjunction with orthodontic space closure to increase the stability of treatment result.
Patients with underlying airway issues/ parafunctional habit will require appropriate treatment to manage these conditions to prevent relapse of the condition after treatment.
I will strongly suggest having a detailed consultation and examination with your orthodontist if you have concerns about your gaps, so that appropriate treatment options can be discussed before making the best choice to deal with your concerns.
