Spaces between baby teeth are indeed normal as well as helpful. However, occasionally a child has a much larger than normal space between the upper two front teeth. This large space is what we call a “diastema,” which really just means a large space or gap. They are usually caused by the presence of a little extra muscle tissue between the underside of the top lip. This muscle attaches the lip to the gum tissue between the top two front teeth. We all have this muscle attachment, but occasionally the attachment may be a little excessive or attach a little further down toward/in between the teeth than usual. This slightly different attachment is sometimes just enough to keep the two front teeth from coming together. If not corrected, this attachment can stay present as an adult and may or may not cause other problems.

In general however, this is not something to be overly concerned about until the child is older. Your dentist may choose to have your child evaluated by the orthodontist, as sometimes the space will not close on its own. It is fairly easy to fix, sometimes requiring reshaping and or relocating of the attachment to a better cosmetic place with or without the help of orthodontics. Typically no treatment is performed to fix it until the child has all or almost all of their permanent teeth. If you and your child decide not to fix it, there is usually no problem associated with leaving it other than having the space there permanently. Occasionally if left alone, (this is usually when the problem is on the lower front teeth) the attachment can cause a defect in the bone and gums, causing a host of other problems. So, it is always best to have your dentist evaluate the area regularly during check-ups or if you have concerns about the space.

Of course, we already discussed earlier in the When should I first take my child to the dentist? post that your child should start seeing the dentist early and we also learned that they should go for check-ups and cleaning every six months. At the check up appointment, the dentist may want take a few x-rays.  There are many different types of x-rays that are considered acceptable for a child, and it really depends on what the dental team is looking to evaluate.

Generally speaking, usually around three or four years old, check-up x-rays (also called bite wing x-rays) may be taken if the child does not have spaces or has limited spaces between the baby teeth or if decay is suspected in an area between the teeth. Children at this age have very small mouths, and so typically all is needed are two of these films (understand that this may vary depending on the child).  These films are done every year to eighteen months, again depending on the child.  There really isn’t a minimum age requirement for these check-up x-rays, it is really dependent on the spaces between their teeth and the visibility between them.  These x-rays are done to look for cavities in between the teeth, thus the reason they may not be necessary to take if the child has adequate spaces between their teeth.  If spaces are present, the dentist can usually see the tooth directly without the use of x-rays.

At around age 5 or older, your dentist may choose to take another x-ray called a panorex or “panoramic film.”  This film does not look for cavities but rather is a tool for evaluating possible missing teeth, disorders of the jaw including cysts, tumors (cancerous and non-cancerous) and a myriad of other things.  It may also be used to aid in orthodontic evaluation in the future.  This is a film that is typically done every three to five years or even less depending on the use for the x-ray.

There are other x-rays sometimes done for other reasons.  One more commonly done x-ray is called a “P.A.”, which stands for a periapical x-ray.  It is just a fancy dental word for an x-ray that shows the entire tooth, including the root and the surrounding bone and is usually done on children to evaluate a possible abscess or to determine the length of time until a permanent tooth will erupt.  This is an acceptable x-ray for children at any age if the dentist has a concern about a specific tooth.

Another film that a parent may encounter at the dentist is called an occlusal film.  This is a film that may be taken of either the upper or lower teeth and is meant to see a better three dimensional view of erupting teeth or pinpoint pathology within the jaws.  This kind of x-ray is not done that often, but is very important when trying to determine very specific details that would otherwise not show up.  It is usually only done if the dentist has a very specific reason for taking it.

One question I am frequently asked regarding x-rays and children are about the relative danger to the child.  In general, x-rays in moderation are considered to be safe when precautions are taken to minimize radiation exposure.  This is the same for adults.  In fact, we are often taught in school that we receive more radiation exposure from the sun on a single day then we do in a set of yearly x-rays.

For children, it is especially important that the areas sensitive to radiation are covered during x-rays.  These areas include the thyroid/neck area as well as the reproductive areas of the child.  This shielding is done with a lead apron.  Dental offices are also required to undergo annual testing and evaluation of the radiation equipment (this varies by state) to be sure they are in compliance with state radiation regulations.  In addition, most states require that the staff taking x-rays have completed a regulated x-ray dental safety and technique course in order to take x-rays.  These certificates will usually be posted for patients to see.

With this in mind, I strongly suggest that you see your dentist prior to attempting to conceive. If you are a planner of course! The best scenario is to have a check up and complete any necessary work before getting pregnant. In general, once you become pregnant, no dental treatment is done unless it is a true emergency. This is because we use certain medications and x-rays which can be harmful to the baby, especially during the first trimester. It is not to say that if we have to use them in an emergency that they will definitely cause damage to the developing baby, however, we would rather not take any chances. So, x-rays and routine dental work are often postponed until after delivery. If you see your dentist before conception, you may abate any emergencies by performing the needed care before it actually becomes an emergency.

Also, any dentist worth a pinch of puppy poo should ask if you may be pregnant. If they don’t, make sure to tell them. Or go find a more conscientious dentist!