What are the Black Triangles (Gaps) between my Teeth and Gums?
Have you noticed a gap or a space which resembles a triangle between your teeth? Well, these gaps are called black triangles. [1] Normally, part of your gums should sit in the space between your teeth (this area of gum is also known as papilla). However, due to some reasons, this area of gum can be lost, causing a triangular gap between your teeth to be visible. [1]
You must be asking if this condition is common and dangerous. This is a relatively common condition. Studies have shown that black triangles were discovered in up to 67% of the population above the age of 20 years old. [2]
It is not dangerous, but they can lead to further problems if not managed in the right way. For instance, these gaps can lead to an unpleasant smile and an overall older facial appearance. Also, you may find some of your favourite food getting stuck in these areas, which may cause gum disease and tooth decay if not being cleaned properly. In fact, at times, you may not be able to speak accurately as air may flow through these gaps. [1,3]
Can Flossing, Braces, or Scaling Cause Black Triangles (Gaps)?
Dental cleaning habits
Can flossing lead to black triangles? This is a tricky question as flossing itself will not cause black triangles, BUT if you floss aggressively, then yes, it will. Your gums are naturally sensitive, so be sure to treat them gently to prevent them from getting shrunk and damaged. [1] The same concept goes when you’re brushing. You can have a look at this article to find out more about the different toothbrush bristle designs that will BEST suit you.
Braces treatment
The next burning issue would be that whether braces can lead to black triangles. Based on a study conducted in 2018, only 22-36% of adults with braces developed black triangles. [4] The reason is that during braces treatment, your teeth will start moving into a new, well-aligned position as forces are applied to it. However, the gums may not be able to relocate into the new position, hence creating the small black gaps. [5]
Gum disease
Another question that is commonly asked is “Will scaling (professional dental cleaning) result in gaps between my teeth?” Well, it may cause gaps especially if the gaps were already present in the first place. Before scaling, you won’t be able to see any gaps between your teeth as they are all covered by tartar. However, these gaps are visible after scaling as your dentist removes this tartar during the procedure. Check out this article where we clear up the myths: “does scaling damages your teeth?”.
Most likely the reason for the above scenario is that you are having gum disease. In gum diseases, the gum could shrink and the black triangles will show up. Gum diseases often cause inflammation of the gum, which is also called “gingivitis”. This inflammation could cause the gums to swell and bleed at first. However, over time, it will start to damage the gums and underlying bone. When the gums and bone slowly become destroyed, the gums appear shrunk and so, the gaps near the gums start appearing as black triangles. [6]
Other Causes of Black Triangles (Gaps)
Other causes which may lead to black triangles include the natural shape of your teeth and the type of gum tissue you are having. If your teeth are triangular-shaped and if your gums are of a thin type, your gums are more likely to shrink easily, causing black triangles. [3]
Do Black Triangles (Gaps) Go Away Naturally?
Usually, the black triangles won’t resolve by themselves because the gums don’t grow back. However, if the size of the black triangles between your teeth is very small and your gums are in a healthy condition, you should improve your dental cleaning habits as this may allow your gums to return to normal. [1] Do take note that there is no guarantee that the black triangles will disappear even after the improvement of your dental cleaning habits. If there is worsening or persistence of the black triangles, talk to your dentist to discuss the different interventions in your case.
Ways to Get Rid of Black Triangles (Gaps)?
The management of black triangles can be divided into two main categories: non-surgical and surgical methods. Black triangles are quite complex, and your condition may differ from others. So, the management listed below is just to give you an idea of what methods are available now in the dental field. The decision on which method to use will be made after discussing with your dentist.
Non-surgical methods
1. Correction of traumatic dental cleaning habits
What does it mean by traumatic dental cleaning habits? I believe you have been taught since young to brush your teeth twice daily and to floss once daily to keep your teeth clean. However, did you know that your brushing technique, your type of toothbrush bristle, the coarseness of your toothpaste, and your method of flossing could affect your gum’s health? It is never about snapping the floss down between your gums or brushing your teeth hard and fast. It is always about practicing the right technique. Hence, it is very important to understand these factors as they help to keep your gums healthy and may reduce the chances of black triangles from forming and progressing. [1,3]
2. Gingival Veneers And Dental Veneers
A normal dental veneer is a thin tooth-coloured covering/shell that is placed over the front (visible) part of your tooth. This type of veneer cannot be removed as your dentist will stick this shell with a special glue to the front part of your tooth. They may work well for black triangles as they will change the tooth’s shape and bulk, hence filling in the gaps between your teeth. Usually, dental veneers require some shaving of your natural tooth so the veneer and tooth can form a strong bond. [3]
Meanwhile, a gingival veneer is a pink, gum-coloured-material, which can be used to cover your black triangles. Gingival veneers are usually made of acrylic or soft silicone. Since this is a removable device, just like a denture, it will require excellent oral hygiene and handling. [9] Discuss with your dentist which veneer will suit best for your condition.
3. Composite fillings
Some of these gaps can be filled up freehand by your dentist with normal dental fillings (composite). Your dentist might recommend using a pink filling, a tooth-coloured filling or even both to fill in the gaps between your teeth so that they will be more natural-looking. This procedure doesn’t involve surgery and is cost-effective. Yet, it can take a longer time to complete (sometimes months as both the gums and teeth require stabilisation). [10]
4. Braces
Yes, you are seeing it right! It is mentioned above that braces may sometimes cause black triangles. However, the braces can also be used to move the teeth intentionally to close up those gaps. Nevertheless, braces are only effective in selected cases where the black triangles are formed as a result of a procedure or process that has moved your teeth. This procedure may be costly and requires time, but the great appearance achieved will be worthwhile. [9]
5. Hyaluronic acid treatment
Depending on the suitability of your case, your dentist may be able to regrow the gums at the black triangle area using hyaluronic acid. This treatment is quite preferred by patients as the procedure is less painful and has a quick recovery period. [7] A study also showed that the results of this procedure seem promising as there was no relapse even after 25 months. [8]
Surgical Methods
Surgery acts as an alternative to some cases of black triangles. A variety of surgical techniques have been discovered to ensure the proper closure of black triangles. These procedures are technique sensitive and should be performed by gum specialists, also known as “periodontists”.
The main concept that is used in gum surgery is called tissue grafting. In this procedure, your periodontist will remove a small amount of gum from the roof of your mouth after numbing it. Then, he/she will place this piece of gum over the black triangles around your teeth. At times, bone grafting may be necessary to rebuild the bone, so that it can support this new piece of gum. [1,9]
Take-Home Message
Ultimately, if you want to prevent black triangles from forming in between your teeth, make sure to practice excellent dental cleaning habits. Brushing twice daily, flossing once daily with the correct technique will make the difference. Also, attend dental check-up regularly so that your dentist will be able to detect any dental problems earlier. If you’re already having black triangles between your teeth, consult your dentist to discuss the best treatment that will suit your condition.
References
1. Singh VP, Uppoor AS, Nayak DG, Shah D. Black triangle dilemma and its management in esthetic dentistry. Dental Research Journal (Isfahan). 2013 May;10(3):296-301.
2. Roy A, Kashyap B, Nakra P. Black Triangles and its Management- A Review. SSR Institute of International Journal of Life Sciences. 2019;5(3):2278-2283.
3. Al-Zarea K, Sghaireen M, Alomari W, Bheran H, Taher I. Black Triangles Causes and Management: A Review of Literature. British Journal of Applied Science & Technology. 2015;6(1):1-7.
4. An SS, Choi YJ, Kim JY, Chung CJ, Kim KH. Risk factors associated with open gingival embrasures after orthodontic treatment. Angle Orthod. 2018 May;88(3):267-274.
5. Athar S, Jayadev S. Black gingival triangle in orthodontics: Its etiology, management and contemporary literature review. The Saint’s International Dental Journal. 2020;4(1):17.
6. Rathee M, Jain P. Gingivitis. 2021 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
7. Tanwar J, Hungund SA. Hyaluronic acid: Hope of light to black triangles. J Int Soc Prev Community Dent. 2016 Sep-Oct;6(5):497-500.
8. Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res. 2010 Mar;12(1):1-8.
9. Ziahosseini P, Hussain F, Millar B. Management of gingival black triangles. British Dental Journal. 2014;217(10):559-563.
10. Wahbi M, Al Sharief H, Tayeb H, Bokhari A. Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: Case report. The Saudi Dental Journal. 2013;25(2):83-89.
