Gaps between teeth: What causes it and how tooth loss is treated

More than one in 12 people are born with fewer teeth than normal, causing their teeth to appear more spaced out or smaller and sharper. This condition is called oligodontia, and in many cases, it is hereditary.

Since the lack of teeth often affects the most aesthetically sensitive area of the human face, the middle of the face, it is extremely important to address it properly.

The lack of teeth is usually noticed in childhood, when the permanent teeth begin to erupt, and it becomes evident that there are gaps between them.

The difference in appearance from their peers may affect the confidence and self-esteem of children with oligodontia, especially if their spaced-out teeth become the subject of teasing and negative comments. It has been observed that this is more likely to happen around the age of 9, when children begin to realize their differences and feel discouraged.

However, apart from the consequences on the psychosocial sphere, the lack of teeth may also have functional limitations, especially if several teeth are missing.

As explained by Dr. Katerina Douma-Michelaki, DDS, PhD, Specialist Orthodontist for Children & Adults, oligodontia is the most common developmental disorder of the permanent dentition, and the scientific term is “congenital absence of teeth.” In the Caucasian race, it has a prevalence of 2-10%, with a higher frequency in women. The teeth with the highest rates of congenital absence are the 3^rd molars (wisdom teeth), the 2^nd lower premolars (located at the sides of the mouth), and the upper lateral incisors (these are the teeth to the right and left of the central teeth in the upper jaw).

There are also cases with a large number of missing teeth, many of which are linked to ectodermal dysplasia syndrome or systemic diseases such as syphilis, Ricketts disease, and others.

Oligodontia can easily be diagnosed with a panoramic X-ray, which reveals whether the missing teeth are impacted in the jawbone or absent altogether.

But what causes the congenital (genetic) absence of teeth? “The exact cause is unknown, but it is believed to be a multifactorial condition with genetic and environmental components,” answers Dr. Douma-Michelaki. “The current scientific data show that multiple genes play a role in its development (more than 200 have been linked), with the most frequently associated ones being MSX1, PAX9, AXIN2, etc. Significant environmental factors that may contribute to its development include severe nutritional disorders during pregnancy or infancy, as well as maternal smoking during pregnancy, according to recent studies. In many cases, there is a family history of oligodontia, while in others, no cause is found.”

Although exact data on its frequency are not available, a study conducted years ago at Aristotle University of Thessaloniki concluded that 8.4% of the Greek population has oligodontia.

The therapeutic management of oligodontia depends on the age of the affected person and the number and position of the missing teeth. “Definitive decisions for treatment are usually not made until the replacement of the primary teeth with the permanent ones is completed, which typically occurs by the early years of adolescence (12-14 years),” explains Dr. Douma-Michelaki.

The aesthetic disturbance caused by the congenital absence of anterior teeth is usually very bothersome, and most of the time, cooperation between multiple dental specialties is necessary to achieve an excellent result.

Since every case is different, it must be decided early whether a prosthetic restoration (which will be done later) or an approximation of the adjacent teeth to fill the gaps is better for the specific face type. The decision involves the patient, the orthodontist, and the dentist or prosthodontist.

Orthodontic treatment is done to straighten the teeth and reduce the gap between them or to create space for a dental bridge or implant.

When the gap between the teeth is sufficiently reduced, prosthetic intervention with resins or porcelain veneers can follow to make the dentition more symmetrical, fully fill the gaps, and give the moved teeth a morphology similar to that of the missing teeth.

If the solution of placing a dental bridge or implants is chosen, the child must wait until they reach adulthood. In the meantime, the gap between their teeth is managed either with a removable orthodontic appliance (in which an acrylic tooth is secured) or by attaching an acrylic tooth to the fixed orthodontic mechanism, or with mild prosthetic restorations like Maryland bridges.

With the significant advancement of orthodontics in “invisible” technologies, even if no orthodontic treatment is done in childhood and the person reaches adulthood, they can later address the absence of teeth with a combination of orthodontics and prosthetics to achieve the healthy smile they desire, concludes Dr. Douma-Michelaki.