Teeth - gapped teeth

”Gapped teeth” means a gap or space between any two teeth, but it is particularly common between the upper front teeth.

Causes of gapped teeth

The most common cause of gapped front teeth is a fraenum that sits lower than usual and keeps the two top front teeth apart. The fraenum inside the upper lip is a fold of skin that attaches the top lip to the upper gum. If you lift up your top lip, you should be able to feel it easily.

Other causes of gapped front teeth can include:

• natural development – Baby teeth often have gaps between them to make space for larger adult teeth to come through. Adult teeth usually have spaces between them when they first come through, but the arrival of more adult teeth, especially the canine teeth, often help close any gaps.
• missing teeth – Some children are born missing one or two teeth (either baby or adult) in their jawbones, which leaves a space. Sometimes these teeth are stuck in the bone and don’t come through, leaving a gap.
• extra teeth – Sometimes there are extra teeth in the bone which can prevent other teeth coming through, leaving a gap.
• small teeth – Some children or adults may have small teeth that allow for gaps.
• large jaws – Some jaws are relatively large compared to the size of the teeth.
• the teeth and jaws not fitting together properly where there is a difference between the size or shape of the jaws and the arrangement of teeth.
• lingual fraenum – This attaches the tongue to the bottom of the mouth. In some cases of severe tongue-tie (a condition caused by a restrictive fraenum that stops the tongue from poking out past the lips), the fraenum may cause a gap in the front teeth of the lower jaw.

Gaps in teeth may close by themselves

Gaps between baby teeth are very normal. In most cases, these gaps close by themselves with growth and time.

When the baby teeth start to come through (around six to nine months), the front teeth could have a gap and the fraenum may be attached low to the gum. By the time the child turns one, the fraenum may have shortened, and more teeth may have come through and closed any gaps.

Gaps between adult front teeth often close by themselves as more adult teeth come through.

Possible issues of gapped front teeth

Some issues related to gapped front teeth may include:

• self-consciousness – some people may feel embarrassed and may not want to smile
• crowded or crooked teeth – a large gap between the front teeth may not leave enough room for other teeth to come through. This may cause problems with a person’s bite.

Treatment for gapped teeth

Often gapped teeth can be left as they are if they are not a concern or do not cause any issues. A person with gapped teeth may benefit from treatment if it prevents damage or improves a person’s self-esteem.

Talk to your oral health professional who can help identify any problems and suggest solutions. You may be referred to an orthodontist – a dentist who has done additional study to specialise in the diagnosis, prevention and treatment of problems in the alignment of teeth and jaws.

For more complicated cases you may also be referred to a prosthodontist – a dentist with additional training in restoring teeth, or even an oral maxillofacial surgeon who is trained in surgery of the teeth, bone, jaw and face.

Treatment options may include:

• composite fillings – a tooth-coloured material commonly used to fill cavities can be added onto a tooth with a bonding agent to help fill the gap.
• veneers – a type of tooth covering made from porcelain or composite. If the gap is small, veneers that are just a little bit wider than the natural teeth could be used to cover the gap. Veneers are permanently stuck to the tooth surface.
• crowns – a permanent type of tooth covering made of porcelain or metal or both that is used to cover, protect, restore and improve the shape and function of your teeth.
• bridges - a permanent dental restoration that joins a few crowns and artificial teeth together to replace one or more missing teeth.
• implants - a metal screw that is placed into the bone of the jaw to support a crown, bridge, or denture.
• removable appliance – such as a plate. This helps to move the teeth closer together.
• fixed appliance – such as braces. Braces are fixed to the front teeth and rubber bands and wires are used to pull the teeth together.
• clear aligners – also known as ‘invisible braces’, clear aligners are a series of clear pieces of custom-moulded plastic that sit over the teeth and slowly move them.
• fraenectomy – surgery to remove the fraenum that has caused the gap. This is usually done before the gap is closed by orthodontic treatment.
• oral surgery – in severe cases, surgery may be required to remove buried teeth, or make it easier for them to come out. Surgery can also be useful when there is a problem with the jaws, or to improve the outcome of orthodontic treatment.

Where to get help

• Your dentist or other oral health practitioner
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics for eligible people.
• Australian Dental Association 'Find a Dentist' or Tel. (03) 8825 4600