What This Guide Covers
This guide explains what causes gaps between teeth, when treatment is needed, and which options work best for different situations. It is written for adults and parents of children who have a visible space between teeth and want to understand their choices.
The clinical term for a gap between teeth is diastema (pronounced dy-uh-STEE-muh). A diastema can appear anywhere in the mouth, but it most commonly shows up between the two upper front teeth (the central incisors). [1] Gaps are extremely common in young children with baby teeth. According to the American Dental Association, many of these gaps close naturally once the permanent canine teeth come in, typically around age 11 or 12. [6]
When a diastema remains into adulthood, it may be purely cosmetic, or it may signal an underlying problem like gum disease or a missing tooth. Understanding the cause is the first step toward deciding whether and how to treat it.
Causes of a Gap Between Teeth
Gaps between teeth develop for several reasons, from genetics to habits to gum health problems. Identifying the specific cause helps determine whether the gap will stay, worsen, or close on its own.
Genetics and Tooth Size Mismatch
The most common cause of diastema is a mismatch between the size of the teeth and the size of the jawbone. When teeth are small relative to the jaw, extra space is left between them. This trait runs in families. [1]
Sometimes only one or two teeth are undersized. The upper lateral incisors (the teeth on either side of the front two) are a frequent culprit. When these teeth are smaller than normal or missing entirely, a gap can form or widen between the central incisors. [1] [4]
Oversized Labial Frenum
The labial frenum is a small band of tissue that connects your upper lip to the gum above your front teeth. You can feel it if you pull your upper lip upward. In some people, this tissue is thicker or extends further down between the front teeth than usual. [1]
When the frenum attaches low, close to or between the teeth, it can physically prevent the teeth from moving together. A review of diastema causes notes that an enlarged or low-attaching frenum is one of the most frequently cited local factors. [1] In these cases, a minor surgical procedure called a frenectomy (removal or reshaping of the frenum) may be needed before or after orthodontic treatment.
Oral Habits and Functional Pressures
Repeated pressure on the front teeth can push them apart over time. Tongue thrusting, a habit where the tongue pushes forward against the teeth during swallowing, is a well-known cause. [1] Thumb sucking in childhood can produce similar outward pressure.
These habits matter because they are ongoing forces. Even after a gap is closed with treatment, it can reopen if the underlying habit is not addressed. This is why orthodontists often evaluate tongue posture and swallowing patterns as part of diastema treatment planning.
Gum Disease and Bone Loss
Periodontal disease (gum disease) is a serious cause of diastema in adults. As the disease progresses, it destroys the bone that supports the teeth. Teeth can then shift, drift apart, or tilt forward, creating new gaps or widening existing ones. [3]
A gap caused by gum disease is different from a cosmetic diastema. It signals active tissue destruction that needs treatment before any cosmetic or orthodontic correction can begin. A study in the Angle Orthodontist demonstrated that an interdisciplinary approach, combining periodontal treatment with orthodontics, can improve both function and appearance in patients with gum disease-related spacing. [3]
Missing Teeth, Extra Teeth, and Other Dental Anomalies
A tooth that never developed (congenitally missing) leaves an obvious space. Extra teeth (called supernumerary teeth) can also cause gaps by blocking the normal eruption path of permanent teeth, preventing them from settling into their correct positions. [2]
These structural anomalies often require an interdisciplinary approach. An orthodontist may work with an oral surgeon or a prosthodontist (a specialist in tooth replacement) to manage the space correctly. [2]
What You Should Know Before Choosing Treatment
The best treatment for a diastema depends on its cause, its size, and the patient's age and goals. Here are key factors to consider before deciding.
Timing: Children vs. Adults
In children, gaps between baby teeth are normal and usually harmless. They often close without treatment once the permanent teeth erupt. The American Association of Orthodontists recommends a first orthodontic evaluation by age 7, which allows a specialist to monitor whether a gap is likely to close on its own or needs intervention. [5]
In adults, a diastema that has been stable for years is typically a cosmetic concern rather than a health risk, unless gum disease or shifting teeth are involved. Adults have several effective treatment options, and the decision to close the gap is often a personal choice.
Cosmetic Choice vs. Medical Need
Not every gap between teeth requires treatment. If a diastema is small, the teeth and gums are healthy, and the bite functions well, leaving the gap alone is a perfectly valid option. Many people live comfortably with a midline diastema their entire lives.
Treatment becomes more important when the gap is caused by gum disease, bone loss, or a structural problem like a missing tooth. [3] In these situations, leaving the gap untreated may allow the underlying condition to worsen. An orthodontic evaluation can clarify whether treatment is medically advisable or purely elective.
Comparing Treatment Options
Several approaches can close a gap between teeth. Each has distinct advantages and limitations. The right choice depends on the size of the gap, the overall alignment of the teeth, and the cause of the spacing. [4]
- Braces (metal or ceramic brackets): Move teeth gradually using brackets and wires. Effective for gaps of any size and especially useful when other alignment issues are present. Treatment typically takes 12 to 24 months for spacing cases, though this varies. [5]
- Clear aligners (such as Invisalign): Use a series of custom plastic trays to shift teeth. Work well for small to moderate gaps when the bite is otherwise fairly aligned. Treatment time is often similar to braces for comparable cases.
- Dental bonding: A tooth-colored resin material is applied directly to the tooth surface to widen it and close the gap. This is the quickest and least invasive option. Bonding generally lasts around 5 to 10 years before it may need repair or replacement, according to sources such as the Cleveland Clinic and the American Academy of Cosmetic Dentistry. [7] Actual longevity depends on factors like bite force, oral habits, and the size of the restoration.
- Porcelain veneers: Thin ceramic shells are bonded to the front of the teeth. Veneers can close gaps while also changing tooth shape, size, and color. They require removal of a small amount of tooth enamel and typically last 10 to 15 years or longer, based on current estimates from the American Dental Association. [8] Veneer lifespan varies with material quality, placement technique, and home care habits.
- Frenectomy (if needed): A minor surgical procedure to remove or reshape an oversized frenum. This is usually done in combination with orthodontic treatment, not as a standalone gap closure method. [1]
What to Expect During Diastema Treatment
Treatment typically starts with a diagnostic evaluation and ends with a retention plan to keep the gap closed long term. Here is a general step-by-step overview.
Step 1: Evaluation and Diagnosis
Your first appointment will involve a clinical exam, X-rays, and possibly photographs or digital scans of your teeth. The specialist will measure the gap, check for gum disease, evaluate your bite, and look for contributing factors like a large frenum or missing teeth. [1] [4]
This evaluation determines the cause of the diastema and helps narrow down the best treatment approach. If gum disease is present, you will typically be referred to a periodontist (a gum disease specialist) for treatment before any gap closure begins. [3]
Step 2: Active Treatment (Orthodontic Approach)
If braces or clear aligners are recommended, treatment begins with bracket placement or aligner fitting. For a diastema-only case with no other alignment issues, treatment may be shorter than a full course of orthodontics. Many spacing cases require 6 to 18 months, though complex cases take longer.
During treatment, you will have regular check-up appointments, typically every 4 to 8 weeks. The orthodontist will adjust wires or provide new aligner trays to continue moving the teeth. If a frenectomy is needed, it is often performed partway through orthodontic treatment, after the gap has been partially closed. [1]
Step 2 (Alternative): Active Treatment (Cosmetic Approach)
Dental bonding is typically completed in a single office visit per tooth. The dentist roughens the tooth surface, applies the composite resin, shapes it to fill the gap, and hardens it with a curing light. No anesthesia is usually needed.
Porcelain veneers require two or more visits. At the first visit, a thin layer of enamel is removed, and impressions or digital scans are taken. Temporary veneers may be placed. At the second visit, the permanent veneers are bonded to the teeth. [4] Both bonding and veneers can close small to moderate gaps effectively, but they do not move the teeth. The tooth roots stay in their original positions.
Step 3: Retention and Long-Term Stability
After orthodontic treatment, retention is critical. Without a retainer, teeth tend to drift back toward their original positions. For diastema cases, a fixed retainer (a thin wire bonded behind the front teeth) is commonly used because it provides continuous support. [4]
For cosmetic treatments like bonding and veneers, retention is not needed in the traditional sense, but ongoing care is important. Bonding material can chip or stain and may need touch-ups. Veneers are more durable but still require regular dental check-ups. If the original cause of the gap, such as tongue thrusting, is not corrected, the gap may return or the restoration may fail sooner.
Diastema Treatment Costs and Insurance
Costs depend on the treatment type, the complexity of the case, your geographic location, and the provider. Below are general ranges based on national averages to help you plan. All costs vary by location, provider, and case complexity.
Dental bonding typically ranges from $300 to $600 per tooth. Because bonding may need to be replaced every 5 to 10 years, factor in long-term maintenance costs. [7] Porcelain veneers generally cost $900 to $2,500 per tooth and last longer, but the upfront investment is higher. [8]
Orthodontic treatment with braces or clear aligners for a spacing case typically ranges from $3,000 to $7,000. Simpler cases with only a diastema and no other alignment issues may fall on the lower end. Cases that involve a full course of treatment for additional bite corrections will be on the higher end. [5]
A frenectomy, if needed, typically adds $200 to $1,200 to overall treatment costs, depending on the method used and whether sedation is involved.
- Dental insurance: Orthodontic benefits often cover a portion of braces or aligners, especially for patients under 18. Cosmetic procedures like bonding and veneers are less frequently covered. Check your specific plan for details.
- Gum disease treatment: If periodontal therapy is required before gap closure, this is usually a separate cost. However, it is more likely to be covered by medical or dental insurance because it is medically necessary.
- Payment plans: Many orthodontic offices offer in-house financing or work with third-party payment plans. Ask about options during your consultation.
When to See an Orthodontist or Specialist
See a specialist when the gap is growing, causing bite problems, or linked to gum disease. A general dentist can handle straightforward bonding, but an orthodontist is better equipped for diagnosis and movement-based treatment.
You should consider seeing an orthodontist if your gap appeared recently or has been getting wider. A new or widening gap in an adult can signal gum disease, bone loss, or other changes that need investigation. [3] An orthodontist can take the necessary imaging to evaluate bone levels and tooth positions.
An orthodontic consultation is also advisable if you have a gap along with other alignment problems such as crowding, an overbite, or an underbite. Treating the gap in isolation with bonding or veneers without addressing the larger bite issue may lead to problems later. For children, the American Association of Orthodontists recommends an evaluation by age 7 so that potential issues, including diastema, can be monitored early. [5]
If your general dentist has identified an oversized frenum, a missing tooth, or a supernumerary tooth as the likely cause, an interdisciplinary team may be needed. This could include an orthodontist, an oral surgeon, and possibly a prosthodontist. [2] Visit the orthodontics page to learn more about what orthodontists treat and how to find one near you.
Find a Specialist for Your Diastema
If you are considering treatment for a gap between your teeth, a consultation with an orthodontist is a practical first step. An orthodontist can identify the cause of the gap, discuss whether treatment is needed, and explain which options are most likely to give you a stable, long-lasting result. Use the My Specialty Dentist directory to search for orthodontists and other dental specialists in your area, read about their credentials, and request a consultation.
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