Clefts – the hype about huge gaps between teeth
For decades, people have been turning to dentists for professional help to close existing gaps between teeth and get a normal, if not perfect, smile. But have you ever heard of the exact opposite? Creating gaps between teeth? If so, what is the first thing that comes to your mind?
My response: “You can’t be serious!” I couldn’t believe it and my jaw dropped. But I am an ambassador for healthy and functional teeth and for preventing tooth loss and gum disease. I would like to say that this is a completely normal reaction. I am often asked by patients, friends and acquaintances what treatment options are available for gaps between teeth, but none of them ask how to create gaps between teeth.
Clefts are most commonly found between the two front teeth (midline clefts) and appear as a gap. In some cases, it is barely visible, but in others, it is very noticeable. Think of a friend, perhaps your favorite celebrity, a catwalk model or even a family member who has such a gap between teeth. Or more gaps. Many find it cute, unique, different, sexy or unusual, ugly, unattractive, abnormal. It’s a mixed bag. But with social media and beauty ideals driving new dental trends, many women in particular are looking for information and advice on how to fill these gaps.
“Prevention is better than cure!”
It is important to understand that we treat gaps in adults primarily because we did not prevent them during childhood and/or adolescence. Causes of diastema are:
Oversized lip frenulum
Small teeth size compared to jaw size
Small teeth size in relation to arch length
Bite development
Missing teeth
Gum disease and tooth loss
Genetic factors
All of the above causes occur early in a child’s tooth development and can be corrected by:
Orthodontic treatment (braces)
Surgical treatment (frenectomy)
Behavioral changes (e.g. thumb sucking)
Failure to take these steps can leave an adult with a permanent gap, which can be corrected later in life by doing one of the following:
Orthodontic treatment (fixed/removable braces, permanent retainers)
Veneers
Dental bonding
You may have noticed that gap reduction is a dental procedure designed to maintain the health and function of the dental appliance and only becomes an aesthetic issue in adulthood.
Closing the gap sounds simple, but it is a very complex process involving many challenges and efforts for both the dentist and the patient, as it involves:
Long-term treatment (months, years for orthodontic patients)
Very good oral hygiene (requires extra time, special tools and techniques)
Pain and discomfort
Multiple visits to the dentist, dental hygienist and prosthetist (sometimes even dental surgeon)
Extra care when biting (for teeth restored with veneers, dental bonding)
Gum disease (caused by teeth restored with veneers)
Financial burden (can be very expensive)
Results (the final result cannot always be predicted and is not guaranteed to meet your expectations).
The implications are multifaceted, and this little big picture should help you understand that it is not a simple thing that happens overnight or at the snap of a finger. Now, with this information, try to imagine what it means to create a fissure.
“If it ain’t broke, don’t fix it!”
This quote is well known, but don’t smart people know best? We believe that our dentists are knowledgeable and smart when it comes to protecting teeth and maintaining oral health, function and beauty. While there is a ton of research and clinical data on “space closure” and its outcomes, there is none when it comes to “creating one or more spaces.” Therefore, we must be wise and cautious in deciding to offer this type of treatment to our patients, and the only treatments currently available are:
Orthodontic treatment (fixed/removable braces, permanent retainers)
Veneers, dental bonding
Now note that the long list of treatment consequences below remains the same. But the most important things to consider are:
Your overall appearance will change dramatically
There will be speech impairments (e.g. lisp)
Tongue thrust may occur, which may cause the position of teeth to shift over time
Saliva and fluids will be difficult to retain in the mouth, resulting in involuntary “spitting.”
Gum disease may develop
Reversing the process may not be an option
Finally, remember:
“Trends come and go”
Many trends are like the stock market: unpredictable and highly volatile. They can create insecurity and unrealistic expectations, or promote good, healthy habits and personal acceptance. There are a lot of comments on social media platforms from frustrated people who hate their gaps and want to change that, and there are a lot of comments from happy people who love their gaps and wouldn’t change them for the world. But what if you had an amazing set of healthy, straight, white teeth? Would you choose to make your teeth look cuter, more unique, different, sexier or unusual, ugly, unattractive or abnormal? You are already at least one of these things, to someone else or yourself. So what’s there to change? And more importantly: why?
