What is Diastema?

By: Jayne Leonard, Medical News Today

A diastema is a gap between the teeth. It is not harmful, and it appears in children and adults. In children, the gap typically closes when their permanent teeth come through.

A diastema is a gap between teeth that is wider than 0.5 millimeters. It can develop between any teeth.

Treatment is not usually necessary for medical reasons. But if a person dislikes the appearance of their diastema, it is possible to close or narrow the gap.

In this article, we explore the causes of diastemas and describe their treatment and prevention.

Causes

A diastema may result from the following:

The size of the teeth in relation to the jawbone

If a person’s teeth are too small, relative to the size of their jawbone, gaps may develop between the teeth.

Jawbone and tooth sizes can be genetic, which is one reason that diastemas can run in families.

Missing or undersized teeth

If some teeth are missing or smaller than others, a diastema can develop.

This often involves the upper lateral incisors — the teeth to either side of the two upper front teeth. If the upper lateral incisors are missing or relatively small, a gap can develop between the two front teeth.

Oversized labial frenum

The labial frenum is the tissue that extends from the inside of the upper lip to the gum above the upper front teeth.

If this tissue is especially large, it can cause a gap to form between these teeth.

Gum disease

Tooth migration is a typical sign of advanced gum disease.

In people with gum disease, inflammation results in damage to the bone that supports the teeth.

Eventually, the teeth may become loose, and gaps can appear.

Incorrect swallowing reflex

When the swallowing reflex happens correctly, the tongue presses against the roof of the mouth.

A person may instead push their tongue against their front teeth when they swallow. Over time, this repetitive pressure against the front teeth pushes them forward, causing a gap to form.

Habits

Thumb sucking, lip sucking, tongue thrusting, and similar habits can put pressure on the front teeth, pushing them forward.

This can lead to diastemas.

Loss of primary teeth

Children can develop temporary diastemas when their primary teeth, or baby teeth, fall out. When their permanent, or adult, teeth come in, these gaps typically close.

This type of gap is common enough that dentists consider it to be a normal developmental phenomenon in children. No treatment is usually necessary.

A 2012 study reports older findings that these diastemas may be present in approximately two-thirds of children in whom only the central incisors have erupted. The central incisors are the two flat teeth at the front of the upper jaw.

Symptoms

The only indication of a diastema is a visible gap between teeth.

If the teeth become loose because of gum disease, the person may experience pain and discomfort, especially while eating.

Other symptoms of gum disease include:

  • bright red gums
  • swollen, tender gums
  • bleeding gums
  • receding gums
  • bad breath
  • loose teeth

Diagnosis

Diagnosis of a diastema is straightforward — the dentist spots the gap while examining the teeth.

Typically, the individual will notice the gap first, while brushing or flossing.

Treatment

Treatment for a diastema may not be necessary — especially if the gap arises from a mismatch between the size of the teeth and the jawbone, or if it results from the loss of primary teeth.

If treatment is not medically necessary, but the person wishes to close the gap for aesthetic reasons, a dentist can help determine the best approach.

Treatment options include:

Braces

Dentists commonly treat diastemas with braces. The braces put pressure on the teeth, closing the gap over time.

It may be necessary to wear a full set of braces, even if there is just one gap, because moving any teeth affects the entire mouth.

Veneers or bonding

As an alternative to braces, a dentist can fit veneers or perform dental bonding.

These options may be especially suitable if the diastema results from having smaller teeth.

Dental bonding involves applying resin to the surface of the teeth, then hardening the resin with a light source.

Fitting veneers involves securing thin, custom-made pieces of porcelain to the surface of the teeth.

Dental implants or a bridge

If a diastema exists because the person is missing teeth, they may need more extensive dental work, such as implants or a dental bridge.

Placing dental implants involves inserting metal screws into the jawbone and attaching the replacement teeth.

A dental bridge is a false tooth held in place by a device that attaches to the teeth on either side of the gap.

Surgery

When a diastema results from an oversized labial frenum, the dentist may recommend a frenectomy — a procedure to remove the excess tissue.

Older children and adults may then require braces or another treatment to close the gap. In younger children, the space may close on its own.

Gum disease treatment

Gum disease requires treatment to stop the infection and prevent complications such as tooth loss.

Treatment may include scaling to remove tartar from the gums. Scaling also removes the bacteria causing the infection. In addition, topical or oral antibiotics may help.

In severe cases, surgery may be necessary to remove deep tartar from beneath the gums.

Once the gums are healthy again, the dentist may use one of the above treatments to close the gap.

Prevention

It is not possible to prevent all cases of diastema.

However, if gum disease or habits are the cause, it can help to practice good oral hygiene, by:

  • brushing the teeth twice daily
  • flossing daily
  • seeing a dentist for regular examinations and cleanings
  • avoiding thumb sucking and helping children break the habit
  • correcting improper swallowing reflexes

Outlook

The outlook varies, depending on the underlying cause. However, treatment can eliminate or reduce most diastemas.

The gap will typically remain closed after treatment, unless the individual returns to habits such as thumb sucking or does not follow their dentist’s instructions.

When to see a dentist

People should speak to their dentists if they or their child have a diastema and are concerned about it.

The American Association of Orthodontists recommend that orthodontists evaluate all children by the age of 7.

A dentist or orthodontist can diagnose the underlying cause and, if necessary, recommend a course of treatment.

Summary

A diastema is a gap between the teeth.

A range of factors can cause a diastema — from gum disease to the ratio of tooth size to jawbone size. A dentist can determine the exact cause.

In many cases, treatment is not necessary. Some people decide to have treatment anyway, for aesthetic reasons.

There are many methods of treating a diastema, and the results are usually permanent.

Article source: https://www.medicalnewstoday.com/articles/diastema#prevention

Vaping changes oral microbiome and raises infection risk

By: Eleanor Bird, M.S., Medical News Today

Researchers from New York University (NYU) College of Dentistry are the first to show that the use of e-cigarettes may allow infection-causing bacteria to flourish in the mouth.

An increasing number of people are turning to e-cigarettes, or vapes, as an alternative to conventional cigarettes. However, questions remain about the safety of these devices and their long-term health effects.

Now, research from NYU College of Dentistry shows that vaping changes the community of bacteria in the mouth — the oral microbiome — in a way that puts users at higher risk of infection than cigarette smokers and nonsmokers.

The new study appears in the open-access journal iScience.

Toxic components

E-cigarettes are popular among cigarette smokers because they offer a way of getting a nicotine hit without the health risks of tobacco, such as lung damage and a higher risk of cancer.

Data from the Centers for Disease Control and Prevention (CDC) show that almost 55% of former cigarette smokers and 48% of current cigarette smokers have turned to vaping.

However, e-cigarettes have also become popular with people who have never smoked, especially among those between the ages of 18 and 24 years. More than 20% of high school students and 5% of middle school students use vapes, according to 2018 CDC data.

The rise in vaping, particularly among young people, has raised concerns, as no long-term data are available on its health effects.

Reports of lung disease among teen and young adult users, as well as the identification of diethylene glycol (a toxic compound present in antifreeze) and potentially cancer-causing agents, such as aldehydes, in e-cigarette cartridges, have highlighted the need for more research in this area.

Oral bacteria

The new research assessed the effects of these compounds on the first part of the body that they reach: the mouth. As well as being a route for air to enter the lungs, the mouth is also a gateway for microbes.

Having microbes in the mouth is not necessarily a bad thing. There are trillions of bacteria living in the body — on the skin, in the gut, and in the mouth — where they help us fight infections and digest food.

In this paper, researchers evaluated the effect of vaping on the bacterial community in the mouth, which exists in a delicate balance. Changes to this microbial community can contribute to oral disease.

The researchers compared the oral microbiome of three groups of people: e-cigarette users, cigarette smokers, and nonsmokers.

“Given the popularity of vaping, it is critical that we learn more about the effects of e-cigarette aerosols on the oral microbiome and host inflammatory responses in order to better understand the impact of vaping on human health,” explains co-senior author Xin Li, Ph.D.

Periodontal pathogens

The scientists profiled the microbial communities present in the saliva of 119 people across the three groups, using a specialized type of genetic sequencing.

They found significant changes to the oral microbiome of the vapers.

In comparison with the cigarette smokers and nonsmokers, vapers had higher numbers of bacteria called Porphyromonas and Veillonella, which have an association with gum disease and are a reflection of “compromised periodontal health,” according to Li.

They also found higher levels of two inflammatory markers in the group of vapers, which suggests that vaping affects the local immune system.

Vulnerable cells

To look at the effects of e-cigarette fumes on individual cells, the scientists cultured cells from a human pharynx with bacteria and exposed them either to the aerosol from an e-cigarette or to air.

They found that many more cells became infected by the bacteria when they were exposed to e-cigarette aerosols. These cells were also more likely to become inflamed.

“Our study suggests that vaping electronic cigarettes causes shifts in the oral environment and highly influences the colonization of complex microbial biofilms, which raises the risk for oral inflammation and infection.”

– Co-senior author Deepak Saxena, Ph.D.

What is the risk?

Experts have linked oral microbiome changes with diseases ranging from tooth decay and bad breath (halitosis) to diabetes, heart disease, and even cancer.

Although this study does not show that vaping can cause these diseases, it does show that it is associated with significant changes to the bacterial community in the mouth.

These findings also suggest that, like smoking conventional cigarettes, vaping increases the risk of oral infections.

However, it is important to remember that some of these findings came from cells that the scientists had cultured under controlled conditions, which do not behave in the same way as cells in the human body.

The scientists say that more detailed studies are necessary to understand how e-cigarette aerosols interact with so-called good bacteria and the implications that this may have for oral, respiratory, and cardiovascular health.

Source: https://www.medicalnewstoday.com/articles/vaping-changes-oral-microbiome-and-raises-infection-risk#What-is-the-risk?

Notice: Rescheduling Elective Dental Procedures

The Maryland State Dental Association and the American Dental Association issued guidelines that elective dental procedures should be put off until at least April 1st.

If you have an upcoming appointment before that date, we will need to reschedule. Our office will be in contact with you in the coming days.

We apologize for any inconvenience, but we believe this approach is the best way to protect each other and our community during this time.

– The Woodview Oral Surgery Team


Here is the message we received from the CDC Division of Oral Health:

Dear Colleagues,

As the expanding global outbreak of Coronavirus Disease 2019 (COVID-19) continues, the federal government continues to work closely with state, local, tribal, and territorial partners, as well as public health partners across the globe to respond to this public health threat.

The Centers for Disease Control and Prevention (CDC) Division of Oral Health (DOH) is diligently working with CDC’s Emergency Operations Center to develop tailored COVID-19 guidance for dental health care personnel (DHCP). Once this guidance is available online, DOH and partners will promote these resources as well as any related events (e.g., informational webinar, Clinician Outreach and Communication Activity) to the dental community. 

It’s unknown at this time what the full impact of COVID-19 will be in a U.S., however CDC is preparing as if this were the beginning of a pandemic. All healthcare facilities should take steps now to prepare for the possibility of a widespread and severe COVID-19 outbreak to prepare their practices and protect both their patients and staff. CDC urges providers to be familiar with the information on CDC’s 

COVID-19 website. Specific information is available for Healthcare Professionals, including a Healthcare Professional Preparedness Checklist, instructions on Evaluating and Reporting Persons Under Investigation (PUI), and a page on What Healthcare Personnel Should Know. DHCP can also consider signing up for communications from CDC’s Health Alert Network, which is CDC’s primary method of sharing cleared information about urgent public health incidents.

Standard precautions, including the use of proper personal protective equipment, should be followed when caring for any patient. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.

CDC’s guidelines note that, if not clinically urgent, DHCP should consider postponing non-emergency or elective dental procedures in patients who have signs or symptoms of respiratory illness. For procedures which are considered clinically urgent, dental health care personnel and medical providers should work together to determine an appropriate facility for treatment. The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis.

The Division of Oral Health will communicate through partners as soon as tailored guidance is available for the dental community. Thank you for all you are doing to keep our country safe and healthy.

Sincerely,

CDC Division of Oral Health