Mind The Gap: Causes, Treatment, and Prevention of Diastema

Diastema, otherwise known as tooth gap, pertains to the spacing between two or more teeth. It is most often seen on the front teeth, although the back teeth may also be involved.

Children are the most commonly affected, albeit temporary and should correct itself once the primary teeth fall off and the permanent teeth comes out.

In adults, however, diastema is most likely permanent and requires orthodontic treatment for correction.

Causes of Diastema

The most common cause of diastema is the discrepancy between the size of the teeth and that of the jaw. Spacing occurs when the teeth are normal in size but the jaw is too big, or if the jaw is normal in size but the teeth are too small for it.

A special condition called a peg lateral refers to the developmental defect of the lateral incisor, resulting to gap between the lateral incisor and the teeth adjacent to it (central incisor and canine).

The spacing may also cause the central incisor to drift into the space, resulting to a small midline gap between the two central incisors.

Other causes of diastema include missing or unerupted teeth, oral habits (such as tongue thrusting and thumb sucking), periodontitis, mesiodens, and oversized labial frenum.

If diastema is caused by a missing tooth, the spacing tends to get worse over time as other teeth drift into the space, leading to gaps between more teeth.

Meanwhile, oral habits such as tongue thrusting and thumb sucking push the upper front teeth forward, creating space as they flare out.

Periodontitis, on the other hand, refers to the advanced form of gum disease characterized by bone loss in addition to the inflammation of the gums.

The aggressive form of this disease results to the fast destruction of the supporting bone, causing the affected teeth to become mobile.

Mobility results to gap formation, which tend to worsen over time if periodontitis is left untreated. The labial frenum, a small band of soft tissue located found just above the two upper central incisors, may also cause diastema if it is large enough.

If this tissue extends far below its normal position and passes between the two central teeth, it prevents these teeth from naturally closing the space between them.

Lastly, mesiodens causes diastema the same way as an oversized labial frenum – it grows at the back of the central incisors, thereby preventing them to come together and close the gap.

Treatment of Diastema

Although diastema doesn’t have any adverse effects on one’s health, most patients prefer to have it corrected for aesthetic purposes.

There are several techniques of closing a diastema, and the use of each one depends on the cause of the problem and the amount of space that has to be closed.

The most recommended method for closing a diastema is orthodontic treatment. It involves the installation of dental braces on the upper and lower teeth to pull the teeth together and close the space.

But if the cause of the problem is an oversized labial frenum or mesiodens, then surgery must be performed first prior to putting braces; otherwise, the problem may only recur once the appliance is removed. The surgical procedure for removing frenum is called a frenectomy.

Take note that in children, orthodontic treatment is not always a necessary follow-up as the space naturally closes once the cause is eliminated.

For small gaps, the patient may opt for placement of composite restorations or crowns instead of orthodontic treatment.

If the space is due to a missing tooth, then tooth replacement options like fixed bridges, removable dentures, and dental implants should be considered.

If it is brought about by periodontal disease, professional cleaning and deep scaling are the initial steps because the aim is to control the disease first. This will be followed by splinting of the involved
teeth, installation of dental braces, or restoration with a fixed bridge or denture.

Prevention of Diastema

If diastema is caused by developmental defects, then there’s no way to avoid it. Further widening of the space, however, can be prevented by using splint to stop the teeth from moving farther away from each other.

Orthodontic treatment is also preferred as early as possible. For diastema due to periodontal disease, the best method to prevent further widening of the gap is to practice proper oral hygiene.

Brushing and flossing can do so much to halt progression of periodontal disease. Then, splinting the involved teeth is also recommended to stop the teeth from moving away some more.

For cases caused by oral habits, the most logical thing to do is to break such habit. You can go to your dentist for counselling and placement of appliances that can help control the habit.

Teeth Whitening: Frequently Asked Questions

Teeth whitening is one of the most popular cosmetic dentistry procedures today, and that is for one very simple reason: your smile is among the first things people notice about you.

If your pearly whites aren’t as “white” as they are supposed to, then that might give a little bit of a thumbs down.

If you looking to undergo teeth whitening to bring back that spark in your smile, then might as well learn more about the procedure.

Listed here are some of the most common questions patients have regarding teeth whitening.


What is teeth whitening?

Teeth whitening is a cosmetic dental procedure wherein your dentist restores the natural color of your teeth by removing stains on the enamel and applying a specially-formulated whitening product.

It is different from teeth bleaching, which involves whitening the teeth beyond its normal color through professional application of products that contain peroxides.

Today, “whitening” and “bleaching” are used interchangeably and practically means the same thing for patients.


How is teeth whitening done?

Your dentist will first perform a thorough dental examination to determine if you are suited to undergo teeth whitening. Take note that both teeth whitening and bleaching can only target extrinsic stains.

If the discoloration is caused by intrinsic stains (flurosis, tooth decay, etc), then neither whitening nor bleaching can solve the problem.

Once cleared, your dentist will now present you with two options – to have the whitening done in the clinic or at home with a teeth whitening kit.

In chairside whitening, which is done at the dental clinic, your dentist will first put a rubber shield or use a special gel on your gums to protect it from the whitening agent.

Once the gums are fully-protected, the whitening or bleaching agent – also in gel form – will now be applied on your teeth.

This whitening agent contains either carbamide peroxide or hydrogen peroxide and is activated by a special blue light.

For at-home whitening kits your dentist will first take an impression of your upper and lower teeth.

This will help create a replica of your teeth which, in turn, will be used to fabricate custom-made trays that fit perfectly in your mouth. This tray will serve as vehicle for the whitening agent that will be provided by your dentist as part of the kit.

You will be provided with instructions as to how much gel should be used and how often you have to apply it.


How many appointments does chair-side whitening require?

It depends on how discolored your teeth are prior to the treatment, and how much whiter you wish them to be. Typically, it takes at least three appointments to see the difference.

In each appointment, your dentist will monitor the improvements and provide you with further instructions as needed.


How long will the effect of teeth whitening last?

On the average, the whitening effect lasts for up to three years, but it can be shorter or longer depending on your behavior and habits.

Shorter effects are expected in patients who smoke, or those who love to consume heavily-colored food and beverages. Not to mention, poor oral hygiene can also cause your teeth to darken much faster.


Will teeth whitening affect my existing restorations?

Whitening agents have very little or no effect at all to restorative materials. They do, however, affect the bond strength of composite filling to the tooth enamel.

But this effect is only temporary and won’t cause the restoration to fall off. A consultation with your dentist should answer concerns like this before the actual whiting procedure.


Is teeth whitening safe?

Both teeth whitening and bleaching are absolutely safe if done by well-trained licensed dentist. There will be some sensitivity after the procedure, but it is only temporary and should go away after a day or two.

None of the whitening or bleaching agents used should cause damage to tooth structure. With regards to at-home whitening kits, there shouldn’t be any problem as long as you follow your dentist’s instructions thoroughly


How much does teeth whitening cost?

The cost of teeth whitening varies, ranging from a measly $20 to a whopping $1000. Chairside whitening costs $300-800 on the average, while at-home kits are only a bit cheaper at $200-600. And since teeth whitening is done mainly for cosmetic purposes, dental insurance plans don’t cover it.

Most Common Dental Treatments – Explained! (Part 2)

You’ve made yourself more familiar about scaling and polishing, restorations, root canal treatment, simple extraction, and odontectomy from the first part of this article.

Now, let’s discuss some more in this second part. Learn more about the different options for tooth replacement, as well orthodontic treatment.

Denture Service

Denture service refers to the replacement of missing teeth with fixed or removable prosthesis.

A fixed denture is secured in place using dental cements, while removable dentures can be taken out of the mouth whenever you want to.

Fixed dentures include your tooth- or implant-supported dental bridges. Removable dentures, on the other hand, are your partial or complete
conventional dentures.

A fixed bridge replaces one or more missing teeth. It is made up of porcelain, metal, or a combination of both, depending on your functional and esthetic needs.

Front teeth calls for the use of highly-esthetic porcelain, while back teeth mostly require metal due to heavy biting forces.

Metal-porcelain bridges, otherwise called a PFM (porcelain-fused-to-metal) bridge, can be used on any teeth regardless of their location because it combines the esthetics of porcelain with the strength of metal.

Making a fixed bridge requires removal of some tooth structure on the teeth adjacent to the space left by the missing ones. These teeth will provide support for the prosthesis.

Once enough tooth structure is removed, the dentist will take an impression of your teeth and send it to a dental laboratory for the fabrication of the fixed bridge. Once done, your dentist will now install it in your mouth.

Removable dentures, meanwhile, replace two or more missing teeth. It may also be used to replace a single tooth whenever a fixed bridge or a dental implant is not indicated.

Partial dentures replace several, but not all, missing teeth while complete dentures are for patients who have absolutely no teeth left. Removable dentures also require impression-taking, and they are made mostly of a plastic-like material called acrylic.

The advantage of having a removable denture instead of a fixed one is that you can take them out of the mouth whenever you need to clean them. Fixed dentures, nonetheless, look and feel more natural and tend to restore function much better.

Dental Implant Surgery

Another option for replacing missing teeth is through the use of dental implants.

A dental implant is a small screw inserted into the jawbone to act as an artificial tooth root to which a crown, bridge, or denture will be attached.

The procedure for placing dental implants is called an implant surgery. Dental implant is the best tooth replacement option available due to its excellent restoration of both function and esthetics.

The material of choice for dental implants is titanium, a metal which is inert, biocompatible, and has the ability to integrate into the surrounding bone tissue.

A dental implant surgery is usually performed by an oral surgeon, but it can also be done by a dentist trained in implantology.

It consists of two stages, although there are some practitioners who do the first and second stages in one operation. In a two-stage surgery, the first stage involves drilling the jaw bone and burying the implant into it.

The area will then be allowed to heal for a couple of months before proceeding with the second stage of the surgery. The second stage involves the uncovering the buried implant and placing a healing abutment into it. This abutment will hold the crown, bridge, or denture.

Orthodontics

Orthodontics is the field of dentistry that deals with the diagnosis, prevention, and correction of malocclusion (a.k.a. bad bite).

Malocclusion results when the upper and lower teeth are misaligned. An orthodontic treatment involves the installation of various dental appliances – the most common of which are dental braces – to bring the teeth to their proper alignment and, in turn, correct the patient’s bite.

Dental braces can be used to straighten the teeth, close tooth gaps, or push the teeth backwards to make space for other teeth. They consist of metal wires and brackets, and are fixed on the teeth using dental cements.

Removable braces are also available, although they work much slower than their fixed counterpart. And if show of metal is your concern, there are more esthetic braces made of ceramic or clear plastic.

A special type of braces called Invisalign (short for invisible aligners) is an excellent alternative to metal braces as far as esthetics is concerned.

Conclusion

So that concludes our article for the most common treatments offered by your dentist. Hopefully, knowing more about these treatments will make your next dental visit as comfortable as possible. But of course, not every little is covered in these two articles, so it is still best to ask your dentist to fill you up on some details. Don’t hesitate to ask questions so you can have a full understanding of whichever treatment you are about to undergo.

Most Common Dental Treatments – Explained! (Part 1)

The very thought of going to the dentist can be overwhelming for most patients, regardless of whether it is just for a simple dental check-up or a lengthy treatment.

But knowing what to expect per visit, especially information on the dental treatment you are about to receive, can help your next experience at the dental clinic go a lot more smoothly.

So in this article, we will try to explain the most common treatments provided by dentists, and these include the following:


Scaling and Polishing

Scaling and polishing are your dentist’s term for what you probably know as professional cleaning. It involves the use of hand instruments or an equipment called ultrasonic scaler to remove plaque and calculus deposits (a.k.a. tartar) from the surface of the teeth.

Aside from removing these deposits, scaling also results to micro-scratches on the tooth surface. That is why your dentists always follow it up with polishing.

Polishing makes use of a polishing paste delivered to the teeth by a rotary instrument. It is advised that you undergo scaling and polishing at least once a year to maintain the health of your teeth and gums.


Restoration

Restoration pertains to replacing missing tooth structure caused by decay or trauma. The restoration may either be a simple filling, a veneer, or a crown.

Fillings are used to repair small holes in the tooth surfaces. They can either be silver-colored or tooth-colored depending on which tooth needs to be restored.

Silver-colored fillings are known as amalgam and are indicated for the back teeth. Tooth-colored fillings, on the other hand, are used mainly on front teeth because they are more esthetic.

A dental veneer is commonly used for a discolored tooth instead of a decayed or damaged one. Made from a thin shell of either porcelain or composite, it is placed on the facial surface of the front teeth. Putting a veneer requires some slight modification of the front surface of the tooth.

Meanwhile, a crown is a type of restoration that covers the entire tooth crown. It is usually indicated for teeth with extensive damage, particularly the ones that underwent a prior root canal treatment. The materials used to fabricate a crown include metal, porcelain, or a combination of both.

Like your dental veneers, modification of the tooth crown is also required, and a greater amount of tooth structure reduction may be necessary. A dental laboratory will fabricate the crown, but it is your dentist who will put it on your teeth through the use of special dental cement.


Root Canal Treatment

Root canal treatment (RCT), otherwise called endodontic treatment, is a dental procedure done on badly-broken down teeth wherein the infection or decay has already reached the pulp.

The dental pulp is the soft tissue at the center of the tooth. This tissue houses the blood and nerve supply of the tooth.

Pulp infection is always irreversible, and the only way to save the tooth is to perform RCT. If RCT is not done and the tooth is left untreated, the infection will spread into the supporting structures of the tooth and it may have to be extracted eventually.

In RCT, your dentist will remove the entire pulp tissue to get rid of all the infection. The root canal, or space previously occupied by pulp, will then be cleaned, shaped, and obturated with a rubbery filling material.

The filling material will help seal the canal and prevent it from becoming infected again. Once RCT is complete, the tooth will then be restored with a crown to seal it from the oral environment. Multiple appointments are required for this treatment.


Extraction

Extraction basically means pulling the tooth out of its socket, and it is done whenever the tooth is so damaged that not even RCT can save it.

It is often the last resort after your dentist has decided that other treatment won’t just work. A special, more complicated type of extraction called odontectomy is performed on impacted teeth.

A simple extraction is done under local anesthesia, while odontectomy may be performed under local or general anesthesia.


Odontectomy

Odontectomy is an extraction procedure done on impacted teeth. A tooth is said to be impacted if it fails to fully erupt in the mouth due to some sort of impediment and/or lack of space.

The third molars, also known as the wisdom teeth, are the most commonly impacted mainly because they are the last teeth to erupt and by then, there’s not enough space left for them.

Other teeth that are often impacted include the upper canines and the premolars.
Odontectomy is usually done under general anesthesia, although local anesthesia may sometimes be enough.

A general dentist or an oral and maxillofacial surgeon performs the procedure. The operation starts with your dentist creating an incision in the area of the impacted tooth. The gum tissue overlying the tooth will then be lifted, and bone reduction will be done as necessary.

This will be followed by sectioning the tooth to facilitate easy removal from its socket. The crown will be removed first, followed by the roots.

After the entire tooth is removed, the gum flap will now be re-positioned and closed with stitches. Your dentist will provide you with some post-operative instructions to minimize bleeding and swelling. You will also be asked to come back after a week for check-up and removal of stitches.

So that’s it for now. Think we missed something? You’re right. Learn more about the other procedures on the second part of this article.

5 Most Common Dental Concerns of Teens

Teenage years are probably the most awkward period in one’s life. It’s that time when you worry too much just about anything, most especially on how you look.

Dental problems are just one of the many issues teens have as they go through the adolescent period. Most of these dental concerns are so common that they were deemed normal part of life.

Learn more about what these concerns are and find out what you and your dentist can do about it.

Crooked or Misaligned Teeth

Misalignment of teeth is a very common dental anomaly that occurs not just in kids and teens, but even in adults as well.

It often occurs when the space left for the erupting permanent teeth is too little or too much. Too little space leads to crowding, while too much space results to spacing or diastema.

Both can result to an unpleasant smile, malocclusion (a.k.a. bad bite), early wear of teeth, and TMJ (temporomandibular joint) problems. To correct misalignment, installation of dental braces is often necessary.

Dental braces are placed in the patient’s mouth by an orthodontist, a dentist who specializes in the correction of malocclusion.

Braces are typically made of metal secured in position by colorful dental elastics. But for some teens, metal display is an issue so there’s also ceramic braces that looks less obvious and Invisalign which, as its name suggests, is virtually invisible.

Consult your dentist to find out which option is best for you.

Impacted Wisdom Teeth

The third molars, more commonly known as the wisdom teeth, are the last teeth to erupt in the mouth. They come out at the age of 17 to 21.

Most of the time, there isn’t enough space for them or their position simply does not allow them to erupt straight up.

In both cases, they are referred to as impacted. An impacted wisdom tooth must always be removed unless contraindicated. If left in the mouth, they may lead to other problems like tooth decay, gum disease, and damage to adjacent teeth.

Impacted teeth are extracted through a surgical operation known as odontectomy. In this procedure, which is done under local or general anesthesia, the dental surgeon makes an incision on the area of the impacted tooth.

The overlying gum tissue is then lifted or reflected to expose the tooth. Bone reduction may be done as necessary.

Once the tooth is extracted, the gum tissue is then put back into its original position and the incision is closed with sutures. Complete healing of the surgical site takes about 3-6 months.

Tooth Decay

Tooth decay pertains to the destruction of tooth structure by the acid-producing bacteria in the mouth. It is caused by eating lots of sugary foods without brushing the teeth after.

Much as it is the most common dental disease, it is also very preventable. The best way of avoiding it is to practice good oral hygiene and do regular visits to your dentist for consultation, professional cleaning, and topical fluoride application.

Fluoride helps make the teeth stronger to stop further decay.

But if the decay is already extensive and tooth enamel has been worn off, your dentist will remove the decay and fill the cavity with an appropriate filling material.

And if the destruction has reached the pulp, the damage is said to be irreversible and a simple filling won’t solve the problem. In such case, the treatment would either be root canal or extraction.

Bad Breath

Bad breath, medically known as halitosis, is brought about by accumulation of bacteria in the tongue and teeth.

In most cases, a simple improvement in one’s oral hygiene is enough to get rid of this problem.

A good oral hygiene means brushing at least twice a day and using floss to clean in-between teeth. And as always, regular dental visits are also necessary.

Tooth Discoloration

Tooth discoloration may result from surface stains or from changes within the tooth. Surface stains are referred to as extrinsic stains.

This type of stain affects only surface of the enamel, and is commonly caused by smoking and consuming dark-colored food and beverages.

Intrinsic stains, on the other hand, are those that affect the inner structures of the tooth – the dentin and pulp.

Causes of intrinsic stains include too much fluoride, tetracycline antibiotics, and trauma. Discoloration may also be age-related.

As we age, our teeth appear more yellow as the enamel thins out, causing the yellow-colored dentin to show through.

Extrinsic stains can be removed by regular brushing using whitening toothpastes and by professional cleaning.

But if you want your teeth to be whiter than their natural color, bleaching is recommended. Intrinsic stains won’t respond to whitening products nor bleaching.

To get rid of them, your dentist will either cover the stains with tooth-colored filling material or put veneers on the facial surface of the teeth.

Most Common Complications of Impacted Wisdom Teeth

The wisdom teeth, or the third molars, are the last teeth to emerge in the mouth.

Some people won’t have any problem with these teeth but most of the time, there is no enough space for them to erupt properly or develop normally.

In such case, these teeth get trapped, or in a more scientific term, become impacted.

An impacted wisdom tooth may be partially- or fully-impacted. Partial impaction is when some of parts of the crown have erupted, while full impaction is when the entire tooth is completely covered by gums and/or bone.

In both cases, surgical removal of the impacted tooth is necessary. The problem is, not all patients are willing to go through surgery.

However, retention of an impacted tooth can also be a problem, as it will lead to one or more of the following complications:

Tooth Decay:
Partial impaction allows bacteria to have access to the tooth, making it more likely to develop tooth decay.

Add to that the fact that its location makes it difficult to clean through brushing and flossing.

Tooth decay may result to pain, swelling, and in worst cases, difficulty opening the mouth. And if the impacted tooth is inclined towards the second molar, destruction of that tooth by decay or resorption is also very likely.

Damage to the Adjacent Teeth:
Sometimes, the impacted tooth may push against the tooth next to it, causing the latter to resorb.

Tooth resorption refers to the destruction or breakdown of the tooth structure, most especially the roots.

Severe resorption is usually very difficult to treat and may often lead to the extraction of the tooth involved.

Misalignment of Teeth:
The pressure exerted by the impacted teeth to against the nearby teeth may sometimes be enough to cause crowding, especially of the anterior teeth.

To correct crowding and bring the teeth back to their normal alignment, extraction of the impacted tooth is required along with orthodontic treatment.

If orthodontic treatment is done without extracting the impacted tooth, then crowding will recur once the orthodontic appliance is removed.

Pericoronitis:
Pericoronitis, otherwise called operculitis, is the inflammation of the gum tissue that surrounds the crown of a partially-impacted tooth.

The inflammation is usually caused by the accumulation and entrapment of debris underneath the gums, or it can also be brought about by repeated trauma when biting or chewing.

Pericoronitis can be mild or severe in nature.

Mild pericoronitis is characterized by localized redness and swelling of the gum tissue, whereas severe pericoronitis leads to difficulty opening the mouth in addition to the inflammation.

Cysts:
The crown of an unerupted tooth is enclosed in a so-called follicular sac.

This sac has the potential to become a cyst, which can grow larger by destroying the bone around it.

Unless the tooth and its sac are removed, the jawbone will get weaker and weaker over time, ultimately resulting to fracture.

All impacted teeth, unless contraindicated, should be considered for extraction. But of course, being a surgical procedure, it is important to have it done by a skilled and experienced dentist that you trust.