Gummy smile

WHAT IS A GUMMY SMILE?

You might be surprised to hear that there is a definition of a gummy smile and it’s mainly based on perception. You likely know a gummy smile when you see one. In fact, there have been studies done to determine what people consider excessive gingival display. In most cases, subjects rated smiles as attractive when two millimeters or less of gum tissue was exposed. At around three millimeters or more, the smile was thought to be gummy. Interestingly, the condition is more common in women than men. Some experts predict that about 14% of women and 7% of men have excessive gingival displays.

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WHAT CAUSES A GUMMY SMILE?

There are a number of causes of a gummy smile, however, the most common ones are:

• Teeth that appear short because they erupted improperly and remain partially covered by gum tissue
• Teeth that are small in comparison to the gums due to genetics or wear
• An upper lip that is too short
• A hyperactive upper lip that is normal in length when the face is resting but lifts too high when smiling exposing a lot of gum tissue
• Gums that are long or enlarged, known as gingival hypertrophy
• An overgrowth of the upper jaw, called vertical maxillary excess, that makes gums bulge out

You may notice that the causes are all related to the teeth, lips, jaws or gums, which happen to be the key components that dictate your smile aesthetics. It’s all about proportion and positioning and when one piece of the smile puzzle is not correct, it can throw everything off. In the majority of instances, the condition behind a gummy smile is genetic sons nothing you can do to prevent it.

GUMMY SMILE TREATMENT

As we mentioned previously, the appropriate gummy smile correction will depend on what is causing it.

Options include:

- If the underlying reason for excessive gingival display is mild and due to the jaws or teeth, it can sometimes be fixed with orthodontics alone to shift the bite into the correct position and make the gums appear less prominent. When we perform gummy smile treatment at Marina Dentists, we often use braces, Invisalign, or braces along with temporary anchorage devices (TADS), which are little titanium implants that are anchored into the bone above the teeth to provide a stable, immovable point from which to apply force. They are sort of like headgear that is placed inside of the mouth. It might sound scary but don’t worry, the procedure is very simple and, as the name implies, they are only temporary.

- For moderate to severe jaw protrusion, the best course of action is orthognathic surgery, or jaw surgery, combined with orthodontic treatment. An oral surgeon will recontour the upper jaw so that's the correct size and then move it upward into its ideal position before securing it with plates and screws. This is done under general anesthesia and requires a hospital stay. 

- Veneers or crowns can make the teeth appear longer and improve the tooth-to-gum ratio if the teeth are too short thanks to wear or genetics.

- If too much gum tissue is the issue, a periodontist can perform a gingivectomy. In this procedure, they remove the extra gum tissue and reshape it to expose more of the teeth and improve your smile aesthetics.

- If the teeth are not fully erupted, crown-lengthening surgery, which involves removing gum tissue and/or bone to expose more teeth and let the gums retract back to their correct position is a viable option.

Lip repositioning surgery followed by orthodontic treatment can be a good alternative to jaw surgery if the excessive gingival display is the result of a short or hyperactive upper lip.

Laser gum contouring procedure can remove extra gum tissue without the need to go under the knife for those with gums that extend too far down covering their teeth.

- Botox is a newer contender and a much cheaper gummy smile treatment option than surgery. However, the results are temporary and last about three to four months and it will only work when the upper lip is the culprit. A doctor injects the lip with Botox, which paralyzes the muscle and prevents it from lifting too high when you smile.

Receiving a correct diagnosis is key to finding the correct treatment for a gummy smile. Dentists, like Dr. Mechkov, have the specialized training and experience necessary to get to the bottom of excessive gingival display and to look at all of the components of a smile and ensure they receive the best solution.