A smile has the ability to light up a person’s entire face. While everyone’s smile is unique, not everyone is happy with how their smile looks. There can be a wide variety of reasons that you may not be happy with your smile, often related to the appearance of your teeth. This could be that they are too small, chipped, crooked, and yellow or have gaps between them. Another common concern occurs other than the teeth themselves. If you feel like you show too much gum when you smile, chances are you may actually have a condition known as ‘gummy smile’ or excessive gingival/gum display. The harmony of the smile is determined not only by the shape, the position, and the color of teeth but also by the gingival tissues.
What is a Gummy Smile?
Having a “gummy smile” is not a specific diagnosis, but a matter of each individual’s perception. It is seen when a larger than proportionate amount of gum tissue shows above the upper teeth when smiling. Commonly, though, if you can see more than 4 millimeters of gum tissue between the neck of your teeth and the edge of your lip as you smile, that smile is considered “gummy.”
Excessive gum visibility during smiling can sometimes divert attention away from a beautiful set of teeth. Visible gum tissues when smiling can leave some individuals feeling self-conscious about a “gummy looking” smile. Some individuals might even stop smiling altogether, especially for photographs. Some people even teach themselves to keep their lips together. This limits their natural facial expressiveness and they may even stop communicating as much as they’d like!
If you believe you have a gummy smile, it’s best to visit our periodontist “gum specialist” Dr. Raed Abutteen, who can perform a thorough examination and listen to all your concerns to determine the cause of your gummy smile, before deciding which type of treatment will be most suitable for you for designing the beautiful smile you have always wanted.
Causes of Gummy Smile
There are several reasons a gummy smile can occur, relating to:
• Tooth Issues
Teeth may be too small, which can be genetic or as a result of use. If teeth become worn down over time, the top teeth will attempt to maintain the correct bite by erupting down further, or for some people, the teeth may also have erupted further down naturally.
Another issue may occur where the upper teeth erupt further forward than they should in relation to the lower teeth. Instead of touching, they move past each other and erupt too far.
With each of these scenarios, as the teeth move downwards, the gums also move down as they are attached to the teeth, which makes the teeth appear shorter and the gums longer.
• Gum Issues
Gums can grow too far over the teeth as a result of mouth breathing, some medications or inadequate dental hygiene which can also happen while having orthodontic treatment with all the wires and brackets at the teeth. Another condition caused by the gums, is when the teeth do not fully emerge from gums to their full actual length. This means there is still a significant amount of tooth concealed underneath the gum. When you smile, so much gum tissue is apparent that your teeth appear smaller and having a squared look like appearance than their actual hidden height and form. This condition is called Altered Passive Eruption (APE) is a clinical situation produced by excessive gum overlapping over the tooth enamel limits, resulting in a short clinical crown appearance, that gives the sensation of hidden teeth APE is a factor that frequently contributes to the presence of a gummy or gingival smile.
• Lip Issues
A hypermobile or hyperactive lip occurs when the muscles around the lips are too strong, which pull the lips up to reveal more gum tissue than usual when smiling. Normally, the lip moves 6-8mm from its resting position to a complete smile position, but hyperactive lips travel further than this. Another lip issue involves the lip being too short or actually too thin, showing too much gum even when the jaw and teeth size are standard.
• Jaw Issues
One of the common cause of a gummy smile is that the upper jaw is longer than it should be, in relation to the size of the face and lip tissue available to cover the gums, so there is an excessive amount of gum tissue visible on both sides of the teeth.
Gummy Smile Treatment Options
Depending on the root cause of your gummy smile (which can be multiple), our approach to correct the amount of gum exposed when smiling will be different. These options will vary in cost, complexity, longevity of results and possible risks. Here is a brief introduction to the treatment options for a gummy smile.
• Professional Teeth Cleaning
Gums can swell due to gum disease or as a side effect to particular medications. Such swellings cause gum puffiness can cover a portion of the tooth/teeth structure and make them look short and contribute to a gummy smile. Swellings can be treated by professionally cleaning the teeth and root surfaces. We consult your doctor to find out if there are alternative medication options that do not produce such side effect.
• Gingivectomy/Gum Lift & Crown Lengthening
If the cause of the gummy smile is overgrown gums, a gingivectomy can be the best treatment option. This is a type of periodontal gum surgery also known as a ‘gum lift’. The procedure can be completed in the dental chair as quickly as one appointment. Gum lifting involves reshaping
excessive gum tissue to reveal more of the teeth, create more symmetry to the gum line while revealing more of the tooth to improve the appearance of a smile. Once teeth’s’ bone is also reshaped with gum tissue excision, the procedure is called crown lengthening to expose the full length of your teeth. Crowns and/or veneers can be used to complement this procedure once needed.
• Lip Surgery
A hyperactive or hypermobile lip can be treated successfully with permanent surgery by an oral or plastic surgeon to restrict the motion of the upper lip. Alternatively, a less invasive procedure called lip repositioning procedure restricts the muscle pull of the elevator lip muscles thereby reducing the gingival display while smiling. This procedure is
performed at the dental unit with localized anesthesia, is safe and predictable with minimal risk or side effects. Although the results of lip repositioning surgery appear stable for some time, its utility as a long term treatment option remains questionable.
• Lip Fillers
Lip filler injections work by volumizing the lips to help cover the gums.They can also help temporarily reduce fine lines above the lips. The use of muscle relaxant injectables or dermal fillers is not, however, permanent.
Depending on the patient, it may involve recurring cosmetic injecting treatments to help maintain your new smile.
• Muscle Relaxant Injections (Botox)
Muscle relaxants (Botox anti-wrinkle injections) are the simplest gummy smile treatment option when the issue is related to overactive muscles surrounding the lips. When injected into the right area, they temporarily paralyze the muscle, which lifts the lip too high, with the results lasting
approximately 6 months. It is however proven that once the procedure is performed at young ages and repeated few times, a neuromuscular adaption to the new lip position often happens eliminating the need for its injections constant repetition.
• Orthodontic Treatment
If a gummy smile has been caused by tooth issues as mentioned above where teeth have erupted too far, orthodontic braces can be used to push the teeth back to their correct position into the gums. Once the teeth and gums
have moved up to the optimal placement, cosmetic dental treatments such as veneers or crowns can then be added to restore the tooth structure so the bite still matches between the top and bottom teeth.
• Jaw Surgery
In certain cases where the jaw is severely too large (usually more than 7mm of gum exposed), a bone shortening procedure known as orthognathic surgery may be performed by a specialist oral surgeon and an orthodontist. This involves surgically moving the entire jaw upwards. Unlike gingivectomy and crown lengthening procedures, orthognathic surgery is performed in a hospital under general anesthesia.
Do you have what you consider to be a gummy smile that you wish looked different? Ask our gum specialist, Dr. Raed to take a close look at your gums and determine the underlying cause of what you’d like to change. We will recommend the best options for reducing your gummy smile and perfecting the appearance of your smile.
Here at
Dr. Raed M. Abutteen Dental Center, we want you to have top notch oral hygiene, but we also want you to be confident in your smile. When you have a “gummy smile” that is of concern to you, it can be hard to love your smile and we here to help you fix this issue.
