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SHIVHARE NIKETAN
H. No. 347/291/1,W. No. 16, OPP UCO BANK,
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KHARAGPUR 721301

+91 9475603651

Diastema (Gap Between Teeth)

Gap Between Teeth

A diastema(plural diastemata) is an open space or gap between two teeth. It appears most often between the two upper front teeth (central incisors). However, gaps can occur between any two teeth. Many children experience diastema when the primary teeth fall out, however this gets corrected when the permanent teeth erupt.

mismatch-between-teeth

A mismatch between the size of the jaw bones and the size of the teeth can cause either extra space between teeth or crowding of teeth. If the teeth are too small for the jaw bone, spaces between the teeth will occur. If the teeth are too big for the jaw, teeth will be crowded.

Sometimes some teeth are missing or undersized. This happens most often with the upper lateral incisors (the teeth next to the two upper front teeth). That can cause the upper central incisors to develop a space.

A diastema also can be caused by an oversized labial frenum. The labial frenum is the piece of tissue that normally extends from the inside of your upper lip to the gum just above your two upper front teeth. In some situations, the labial frenum continues to grow and passes between the two front teeth. If this happens, it blocks the natural closing of the space between these teeth, thus relating in a diastema.

Habits can also lead to gaps between the teeth. Thumb sucking tends to pull the front teeth forward, creating gaps.

Spaces can develop from an incorrect swallowing reflex. For most people, the tongue presses against the roof of the mouth (palate) during swallowing. Some people develop a different reflex known as a tongue thrust. When they swallow, the tongue presses against the front teeth. Over time the pressure will push the front teeth forward. This can cause spaces to develop.

tongue thrusting

Symptoms

A diastema that occurs because of a mismatch between the teeth and the jaw does not have symptoms. However, spaces caused by a tongue thrust habit or periodontal disease will tend to expand or grow with time. The teeth may become loose, and discomfort or pain may occur, particularly during biting or chewing.

Diagnosis

You notice a space when brushing or flossingYour dentist can see spaces during an examination.

Prevention

Not all spaces can be prevented. For example, if the reason for a space is a missing tooth or a mismatch between the teeth and the jaw size, the spaces cannot be prevented without treatment.

Maintaining your gum health is essential to good oral health. Regular flossing and brushing will help to prevent periodontal disease and its related bone loss.

Treatment

Sometimes, a diastema is part of a set of problems that require orthodontic treatment. In other cases, a diastema is the only problem. However, some people may seek treatment for reasons of appearance.

Some people get braces, which is orthodontic treatment. Often, no matter where the diastema is, you must wear a full set of braces — on both your upper and lower teeth. That's because moving any teeth affects your entire mouth.


If your lateral incisors are too small, your dentist may suggest widening them using crownsveneers(direct and indirect) or bonding.

If you have a space because you are missing teeth, you might need more extensive dental repair. This might include dental implants, a bridge or a partial denture.

If a large labial frenum is causing the gap, the frenum can be reduced through surgery called a frenectomy. If a frenectomy is done in a younger child, the space may close on its own. If it is done in an older child or an adult, the space may need to be closed with braces.

When To Call a Professional

If you have a space between your teeth or see one in your child's mouth, talk with your dentist. He or she will determine the reason for the space and may refer you to an orthodontist, a specialist in treatment with braces.. Treatment (if needed) may not begin right away. You and the orthodontist will discuss the overall treatment plan.

Prognosis

If a diastema is closed through orthodontics or dental repair, the space will tend to stay closed. However, to help prevent the space from coming back, wear your retainers as directed by your orthodontist. Your orthodontist may also splint (attach) the backs of the teeth to other teeth with composite (plastic) and a wire to prevent them from moving. Visit your dentist regularly to make sure your dental work is in good repair.

Oral Hygiene for the Orthodontic Patient

One of the most important aspects of a beautify smile is to clean teeth properly every day. People who do not keep their teeth clean spend more time in orthodontic treatment than those who clean their teeth.

If you thought brushing and flossing were important before you got braces…well, you were right. But people undergoing orthodontic treatment need to be even more dedicated to good oral hygiene.

Braces trap food very easily, which contributes to plaque formation. If plaque is not carefully removed from teeth and from around braces, patients run the risk of developing gum diseasedental decay and bad breath.

Plaque is a mixture of bacteria, debris and bits of food. The bacteria feed on sugars and produce acids. The acids can irritate your gums, erode the enamel on your teeth and contribute to bad breath (halitosis).

It's important to remove the plaque thoroughly and often. Then, when your braces come off, the surfaces of your teeth underneath the braces will be healthy and strong and look good. Here are some tips to help you.

Brushing

Toothbrushing is the first line if defense in removing old debris and plaque from around orthodontic appliances. It is very import ants that orthodontic patients, brush their teeth rail for 2 minutes after every meal.

Use a soft-bristle toothbrush. Soft bristles are better than medium or hard bristles at getting into those nooks and crannies around your appliances. They also don't irritate your gums.

If used properly, a manual toothbrush with a special orthodontic tip can successfully clean around braces, however we strongly recommend the use of an electric toothbrush. Just be careful not to hit the plastic back of the brush against the brackets on your braces because it can damage them. Also, it should be used on a moderate setting so as not to break or loosen braces.

Brushing should be done slowly and carefully. It's important to brush the braces and all the surfaces of the teeth, that is, the inside and outside surface and the chewing surfaces, too. Pay special attention to the areas between your brackets and your gums.

Flossing

Floss at least once a day. It might seem like you can't possibly floss while you have braces, but you can and you should. Special flossing products can help you get into the space between the wires and your gumline. These include floss threaders and a special kind of floss. When your braces are first put on, someone in your orthodontist's office should review flossing techniques. If you're not sure you're doing it right, ask your orthodontist during your next visit. Water flossers can also be used which is an oral irrigator that helps you remove food debris and plaque from areas where your toothbrush simply cannot reach.

Fluoride

Use a fluoride toothpaste.


Your orthodontist may recommend that you use an over-the-counter fluoride rinse. These rinses usually provide enough fluoride to help protect and strengthen teeth during orthodontic treatment. However, if you have a history of cavities or are otherwise at risk of decay, your orthodontist may prescribe a rinse that contains more fluoride.

Consider an office treatment. You can get more fluoride — usually in the form of a gel or varnish — from your dentist during a regular visit. If you have a history of decay, your dentist may suggest this type of treatment.

Tools To Help You

Rubber - tipped and end-tuft or single-tuft brushes — These are special brushes that help you to get into those nooks and crannies, as well as between your teeth. The end-tuft or single-tuft brushes look something like pipe cleaners.

Oral irrigators — These instruments shoot small streams of water onto your teeth at high pressure to remove bits of food. They can be used as an aid in your oral hygiene practice. They also should be used at a moderate setting so they don't damage the braces.

Antibacterial rinses — These rinses are fine for adults, but their high alcohol content makes them off-limits for kids. There are alcohol-free rinses available for children to use.

Caring for Your Retainer

If you have a retainer or other removable orthodontic appliance, it needs to be cleaned regularly, too. After all, it spends a lot of time in your mouth.

Brush the appliance daily with your soft toothbrush and some toothpaste. This is especially important for the side that is in contact with the roof of your mouth or gums. Brush your retainer over a wash bowl filled with a few inches of water. That way, if it slips out of your hand it will not be damaged. You also can soak it in a cleaning solution. There are several that are advertised as denture cleaners. If you want to soak your retainer, talk to your orthodontist about which solution to use. Some cleaning solutions can corrode wires or other metallic areas on orthodontic appliances.

When brushing or soaking your appliance, never use hot water. It can distort the plastic and make the appliance unusable. When your retainer is not in your mouth, keep it in the case that your orthodontist gave you.

Eating Right

While you're wearing braces, you need to think twice about eating foods that could increase your risk of cavities. You also should avoid anything that might damage your brackets or wires. Frequently breaking your braces will add to the overall treatment time.

Stay away from hard and sticky foods. Caramel, hard candy, gum - you get the idea. They can damage your braces and get stuck in the wires and brackets. While the food's stuck there, it provides lots of sugar for cavity-causing bacteria to munch on. Also, do not chew on ice cubes.

Cut down on all sugary foods. You can still have a limited amount of sweets and soda, but the more sugars you eat, the greater your risk of tooth decay. Always brush after eating sugary foods or candy.

It's not just what you eat, but also when you eat it. Frequent snacking on sugary foods is worse than eating those foods with a non-sugary meal. Don't eat sugary foods or candy before going to bed without brushing. The more chances you give the bacteria to turn sugars into acids, the higher your risk of decay.

Orthodontics: Braces and More

What Is Orthodontics?

Orthodontics is a specialty field of dentistry that diagnoses, prevents and treats irregularities of the teeth and face. Treatment can correct an irregular or "bad" bite, also known as a malocclusion.

Orthodontic care involves the use of appliances. There are two main types. Braces are attached to the teeth. Removable appliances are put in and taken out by the patient. These devices can be used to:

  • Straighten teeth
  • Correct an irregular bite
  • Close unsightly gaps

They also can help with procedures in other areas of dentistry. Examples include cosmetic and implantdentistry.

In young children, orthodontic treatment also may guide proper jaw growth and permanent tooth eruption.

Bite Irregularities

Many people's teeth are irregular in some way. For example, teeth may be slightly crowded or unevenly spaced. In fact, experts say many adults have an irregular bite. Sometimes the main problem with a "bad" bite is appearance. In other cases, it can cause difficulty in chewing or talking.

You may have inherited an irregular bite, but not all bite problems are genetic. Other causes include:

  • Trauma — When teeth are broken or knocked out and then replaced, they may fuse with the bone that surrounds them. This is called ankylosis or abnormal root fusion to the bone. If this happens in a growing child, the teeth will not be able to line up properly in the jaw. An irregular bite will result.
  • Prolonged thumb sucking or pacifier use — These habits can cause bite problems. For example, it may cause your upper teeth to protrude (stick out) in front of your lower teeth. A tongue-thrusting habit when you swallow can cause a similar problem.
  • Premature loss of primary (baby) teeth — If a primary (baby) tooth is lost too early, the permanent tooth loses its guide. It can drift or come into the mouth (erupt) incorrectly. In some cases, the permanent teeth may be crowded, or they may come in only partially. Sometimes the teeth next to the lost primary tooth can move or tilt into the space left by the missing tooth. This may prevent the permanent tooth from coming in.

Why Seek Orthodontic Care?

Whether to seek orthodontic care is a personal decision. Many people live with crowding, overbites or other types of bite problems and do not seek treatment. However, many people feel more comfortable and self-confident with properly aligned, attractive teeth. Orthodontic care can help improve appearance and build self-confidence. It also may help you to chew better or speak more clearly.

Orthodontic care is not just cosmetic in nature. It also can benefit long-term dental health. Straight, properly aligned teeth are easier to brush and floss. This can help reduce the risk of tooth decay. It also can help prevent gingivitis, an inflammation that damages gums. Gingivitis may lead to infection, which occurs when bacteria cluster around the area where the teeth meet the gums. Untreated gingivitis can lead to periodontitis. This type of gum disease can destroy bone that surrounds the teeth and lead to tooth loss.

People with bad bites also may chew less efficiently. Some people with a severe bite problem may even have problems getting enough nutrition. This especially may occur when the jaws are not aligned correctly. Fixing bite problems can make it easier to chew and digest foods.

When the upper and lower front teeth don't align right, people also can have speech difficulties. These can be corrected through orthodontic treatment, often combined with speech therapy.

Finally, orthodontic treatment can help to prevent premature wear of back tooth surfaces. As you bite down, your teeth withstand a tremendous amount of force. If your front teeth don't meet properly, it can cause your back teeth to wear more.

Who Can Benefit From Orthodontic Care?

The American Association of Orthodontists recommends that children have an orthodontic screening no later than age 7. By then, enough of the permanent teeth have emerged to identify potential problems.

Don't wait until all the permanent teeth erupt in the mouth. Starting orthodontic treatment early in life may have many advantages. For example, while children are still growing, expansion devices can be used to widen the palate. This can help teeth come in straighter by providing more space. It also may help to correct the way the top teeth and bottom teeth meet or come together. Such treatment should be done at an early age for best results.

An increasing number of adults now have orthodontic treatment as well. However, adult treatment can be more complicated. It may require more than one dental professional to fully correct a problem. For example, adult patients may be more susceptible to gum problems. They will need to take care of these problems before orthodontic treatment can begin. Sometimes they also have jaw alignment problems that require corrective surgery. One of the biggest limitations in adult treatment is that adults are no longer growing.

Types of Bad Bites

An improper bite doesn't look good. That is the usual reason that people seek treatment from an orthodontist. In addition, an improper bite causes difficulty in chewing. In people with crowded teeth, it can lead to morecavities or gum disease. Treatment of an irregular bite can improve your overall oral health and stabilize your bite.

Incorrect bites are grouped into categories. Common bite problems include:

  • Crossbite — Here, the upper teeth rest significantly inside or outside the lower teeth. A crossbite often can make it difficult to bite or chew. It also may cause the jaw to shift to one side as it grows.
  • Crowding — Permanent teeth may not have room to move into the right position:
  • If there is not enough room for the teeth
  • If the teeth are unusually large compared with the size of the dental arch
  • If the jaw is narrower than it should be
Deep overbite — This occurs when the upper front teeth (incisors) overlap too far over the lower teeth. In some cases, the biting edges of the upper teeth touch the lower front gum tissue and the lower front teeth may bite into the roof of the mouth.Underbite — A crossbite of the front teeth is commonly referred to as an underbite if the lower teeth are ahead of the upper teeth. This may also be a sign that the jaws are not in the correct position. Sometimes surgery is needed.Open bite — If your upper and lower front teeth don't meet when you bite down, this is called an open bite. This may make it impossible to bite off food with the front teeth. It also can affect speech. Because the front teeth don't share equally in the biting force, the back teeth may receive too much pressure. This makes chewing less efficient. It can lead to premature wear of the back teeth.Spacing problems — Some people have missing teeth or unusually small teeth in a normal sized jaw. This can result in large spaces between the teeth. People who have lost one or multiple teeth may have uneven spacing because adjacent teeth may drift into the unoccupied areas. Braces can be used to shift the position of these teeth so the missing tooth or teeth can be replaced.
Treatment: Braces and Retainers

Everyone has a slightly different bite, so treatment techniques vary. Braces are the most common approach. They help to move the teeth slowly by applying precise amounts of light pressure over a long period of time.

Most orthodontic treatments occur in two phases:

  • The active phase — Braces or other appliances are used to move the teeth into proper alignment and correct the bite.
  • The retention phase — A retainer is used to hold the teeth in their new positions for the long term.

In addition to braces, orthodontists sometimes use special appliances (called functional appliances) to direct the growth of the jaw in young children. These appliances are rarely used in adults. That's because they are not effective after growth is complete.

Getting Braces

You can choose braces (brackets) made of metal, ceramic or plastic. However, orthodontic treatment is most often done using stainless steel brackets.

Ceramic or plastic brackets often are chosen for the sake of appearance. But plastic brackets may stain and discolor by the end of treatment. Bands made of plastic or ceramic also have more friction between the wire and brackets. This can increase treatment time. Your orthodontist will discuss the available options.

The cost of braces varies, but expect to pay between $2,000 and $6,000. The cost may depend on how severe the problem is. Some insurance plans may cover part of the cost. Others will not cover it at all.

Braces work by applying continuous pressure to move teeth in a specific direction. Braces are usually worn for about one to three years, depending on how severe your problem is. As treatment progresses, teeth change position. Your orthodontist will adjust the braces as needed.

A few decades ago, braces consisted of thick bands of steel wrapped around all of the teeth. These days, stronger bonding agents are available. Smaller braces can be used, and orthodontic bands rarely have to be used on front teeth.

When applying braces, the orthodontist will attach small brackets to your teeth with special dental bonding agents. He or she will then place wires called arch wires through the brackets. The arch wires usually are made of a variety of metal alloys. They act as tracks to create the "path of movement" that guides the teeth to their correct positions.

Wires made of clear or tooth-colored materials are less visible than stainless-steel wires. However, they are more expensive and may not work as well. Tiny elastic bands called ligatures also can be used to hold the arch wires to the brackets. Patients can choose from a multitude of colors at each visit.

Expect some minor discomfort for the first few days after getting braces. Your teeth may be sore. The wires, brackets and bands also may irritate your tongue, cheeks or lips. Your doctor will give you some special soft wax to cover any sharp areas on your braces that may be irritating you. Most of the discomfort disappears within a week or two. You also may have moderate discomfort when wires are changed or adjusted. Taking ibuprofen (Motrin, Advil) or other over-the-counter painkillers can help to ease any discomfort.

Wearing a Retainer

A retainer's purpose is to maintain tooth positions after treatment is completed and braces are removed. Once your bite has been corrected, bone and gums need more time to stabilize around the teeth.

The recommended length of time for wearing a retainer varies. Most children and teenagers wear retainers until their early to mid-20s or until their wisdom teeth come in or are removed. You should strictly follow your orthodontist's advice because he or she knows your treatment best.

Risks and Limitations of Orthodontic Care

There are few risks involved in orthodontic treatment. In rare cases, certain patients may have allergic reactions to the metal or latex. People with periodontal (gum) disease have a greater risk of problems during orthodontic treatment. That's because their gums and the supporting bone may be more likely to break down. This can cause loosening and possible loss of teeth. Orthodontic treatment should not begin until all evidence of gum disease has been treated and eliminated.

It is also possible that root resorption (shortening of roots) may occur during orthodontic treatment. This is usually minor and not significant. In a few cases, however, it may be severe. This can jeopardize the life of the tooth or teeth affected.

Your orthodontist will discuss the risks of your particular treatment.

Your choices can affect whether you achieve the desired results from orthodontic treatment. Adults, in particular, may require treatment by several specialists. They may need implants, treatment of periodontal disease or even corrective jaw surgery in addition to braces.

Many times, results are limited because you don't want the full treatment. However, compromises often can be reached that improve your condition, even if not ideally. The treatment options and expected outcomes depend on the individual. Not following the doctor's instructions also can lead to less than ideal results. The orthodontist will review your options fully with you before beginning treatment.

Space Maintainers for Premature Tooth Loss

Baby teeth aren't just for chewing. Each one also acts as a guide for the eruption of the permanent tooth that replaces it. If a baby tooth is lost too early, the permanent tooth loses its guide. It can drift or erupt into the wrong position in the mouth. Neighboring teeth also can move or tilt into the space. This means that there may not be enough space for the permanent tooth to come in.

Dentists call baby teeth primary or deciduous teeth. Primary teeth can be lost too early for several reasons:

  • They can be knocked out in a fall or other accident.
  • They may need to be extracted because of severe decay that causes infection.
  • They may be missing at birth.
  • Some diseases or conditions can lead to early tooth loss.

Space maintainers may be used:

  • If a primary tooth is lost before the permanent tooth is ready to come in
  • If a permanent tooth is missing

The maintainer keeps the space open until the permanent tooth comes in.

Types of Space Maintainers

A space maintainer is made of stainless steel and/or plastic. It can be removable. Some space maintainers are cemented onto the teeth on either side of the space in the child's mouth. This is called a fixed space maintainer.

A removable space maintainer looks like a retainer. It uses artificial teeth or plastic blocks to fill in the space or spaces that need to stay open. This type of space maintainer often is used when the space is obvious to other people. Removable space maintainers work well in older children who can reliably follow directions about caring for this appliance.

There are several kinds of fixed space maintainers. A band-and-loop maintainer is made of stainless steel wire. It is held in place by a crown on the tooth next to the space or an orthodontic-type band around one of the teeth next to the open space. A wire loop is attached to the band or crown. It sticks out across the space where the tooth is missing and just touches the tooth on the other side of the open space. The wire loop holds the space open. This allows the permanent tooth enough space to come into the mouth without crowding.

A lower wire known as a "lingual arch" is used when back teeth are lost on both sides of the lower jaw. "Lingual" refers to the inside or tongue side of the teeth. This type of space maintainer uses bands wrapped around a tooth on either side of the mouth behind the missing teeth. A wire connected to the bands runs along the inside of the bottom teeth, just touching them. This will maintain the space on both sides.

Another type of fixed space maintainer is called a distal shoe appliance. It is inserted under the gums. It is used when a child loses the baby tooth in front of a 6-year molar that has not yet come into the mouth. The 6-year molar is also called the first permanent molar. Because it has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum. This keeps the space from closing.

Distal shoe appliances must be checked often because the incoming tooth can easily become blocked by the wire. The appliance may require adjustment to allow the tooth to come in properly. As a result, most dentists will try to avoid using a distal shoe appliance. Instead, they will try to keep the primary tooth in the mouth until the permanent tooth underneath is ready to come in.

For children missing several teeth, a partial denture may be used instead of a space maintainer. For example, children with a congenital disease called ectodermal dysplasia often are missing multiple primary teeth. There are no permanent teeth to replace them. A child with this condition will use a removable denture into adulthood. After that, the child can receive dental implants or a bridge or continue to use a partial denture to replace the missing teeth.

Are Space Maintainers Always Necessary?

Not every tooth that is lost too early requires a space maintainer. If one of the four upper front teeth is lost early, the space will stay open on its own until the permanent tooth comes in.

If you do not take your child to the dentist regularly — at least every six months — a space maintainer can cause problems. This especially can occur if your child does not brush well. The gum tissue in the space can grow over the wire arm, increasing the risk of infection. If that happens, your child's dentist may have to remove the gum tissue by surgery.

If the permanent tooth is about to erupt, the dentist may decide not to use a space maintainer unless your child needs braces and space is a critical issue.

Some children may not be able to cooperate during the process of making the space maintainer. Others may be at risk of injury if the space maintainer comes loose or breaks. These include children with diseases that affect how they breathe or swallow, and children who are very young. The ability to cooperate with the dentist is more important than a child's age. Most young children can have space maintainers placed, if needed. Most of them are able to cooperate during the process.

Making the Space Maintainer

Each space maintainer is custom-made by a dentist or orthodontist.

For a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made. Impressions are made with a soft material that tastes like toothpaste. It sets into a gel around the teeth and is easily removed from the mouth. This allows the laboratory to make a copy of the teeth to use in making the space maintainer. The band is also removed and sent to the dental laboratory with the impressions. The lab creates the space maintainer and sends it back to your child's dentist. He or she cements it into place at a second office visit. Sometimes, a space maintainer can be made in the office in a single visit without impressions.

To make a removable space maintainer, the dentist first makes impressions. They are sent to a lab, which makes the appliance.

Caring for Your Space Maintainer

The space maintainer may feel unusual at first. But after a few days, your child probably will forget about it. A removable space maintainer with replacement teeth can affect speech until your child gets used to it.

It's important for your child to brush regularly to keep the gum tissue healthy. A child with a fixed space maintainer needs to avoid hard or sticky foods and chewy candy and gum. They can loosen the band or get caught in the wire arm. If the space maintainer comes loose, there is a risk of swallowing or inhaling it into the lung.

Finally, your child shouldn't push on the space maintainer with his or her tongue or fingers. That could bend or loosen it.

Follow-Up

Your child's dentist will take X-rays regularly to follow the progress of the incoming permanent. When the tooth is ready to erupt, the space maintainer is removed.

If a permanent tooth is missing, the space maintainer will be used until your child's growth is completed (age 16 to 18). Then a dentist will place a bridge, implant or removable partial denture in the space.