There are many causes of gummy smiles but genetics most certainly plays a part. Genetics may be involved in a short upper lip, diminished tooth size, the muscles around your mouth, or excessive gum tissue and there is a slight proclivity for females in greater numbers than males. Perfect smiles are considered to show 2 millimeters of gum tissue. Another causative factor may be the abnormal position of the teeth when and where they erupt or severe overbite. Other areas should be considered, such as failure of teeth to completely erupt, narrow upper lip, over-active lip which lifts too high, front teeth erupt too far or grow too long, and the gums not receding properly during normal growth. Swollen gums due to poor oral hygiene, or certain medications such as dilantin, or even malocclusion (your teeth coming together poorly) may result in a gummy smile.

A gummy smile affects relationships with mates, personality profiles, first impressions, job interviews, self-confidence, obviously aesthetics, peer pressure, and as well as many other psychological situations. The smile may be covered with the hand or even be tight-lipped and this problem is consciously hidden in photographs. In order to obviate any of the aforementioned, the gummy smile must be improved aesthetically. We all know that a beautiful smile is very important.

To effectively reduce a gummy smile and perform the optimum result, a proper diagnosis of the cause is mandatory.The diagnosis usually determines the best treatment options as well as the success in completely eliminating or radically improving a gummy smile.

Somehow, in order to create a more aesthetic appearance when you smile, the distance between the bottom edge of the upper lip and the upper part of the tooth (the part showing closest to the root tip) which emerges from the gums must be reduced or minimized. There are several techniques for doing this which will be discussed below.

I. Gingivectomy. This procedure is fairly quick, costs less, and has excellent results and having excellent results. The excess gum tissue is simply removed under local anesthetic with very minimal surgery. The gum tissue is arched higher and the result is to remove a millimeter or so of the gum tissue above the tooth. This leaves a more aesthetic smile and a more attractive tooth. There is very minimum discomfort to the patient and the end results are excellent. Whether this simple procedure is possible is determined by the actual depth of the cul-de-sac area around each tooth. This is easily measured by a periodontal probe and the results are in millimeters. This minor surgical procedure is done with a scalpel.

II. Laser. The laser, especially the CO2 laser, performs the exact same procedure as the gingivectomy by scalpel, and also requires only local anesthetic. Excellent results may be achieved by this method which is probably a little more costly.

III. Electrosurgery. This is also a gingivectomy achieved by a different method. The results are excellent. The procedure is performed under local anesthetic and the excess tissue is removed by electrosurgery. There is minimum bleeding, if any, and little or no soreness. The procedure will probably cost more than the

gingivectomy by scalpel.

IV. Apically Repositioned Flaps. This is a procedure in which the gums are loosened and then sutured higher up on the tooth. This is usually performed by a periodontist (gum specialist). The healing process is rather quick, as is the procedure is, but a little more costly.

V. Botox Injections. This involves a miniscule amount of botox injected into the muscles of the upper lip. This will lessen the amount the lip comes up upon smiling. The botox treatment requires retreatment 2-3 times per year and will not work well on extreme cases.

VI. Lip Surgery. This is the removal of a horizontal strip of tissue from under the upper and sutured back together. This makes the upper lip lift not quite as high which lessens the gummy smile look.

VII. Crown Lengthening. Special cases may require crown lengthening. This is fairly straight-forward and usually involves slight removal of some of the bone around the tooth along with apically repositioned flaps. This makes the tooth look longer in an upward direction.

VIII. Orthodontic Treatment. In some cases, a combined treatment of orthodontics and some type of surgery may be necessary to get favorable results. This may also add to the expense.

IX. Orthognathic Surgery. This involves a significantly more involved surgery in which the bone above the front teeth is reduced in height which moves all the teeth up higher and reduces the gummy smile. The patient usually has a long face or excess vertical height in the upper jaw. This is more involved surgery, performed by an oral surgeon, and is more costly. This procedure is only necessary if this part of the upper jaw (the section above the front teeth) is abnormal in size. It has nothing to do with the lips or gums. The “long” length of the bone gives the gummy smile appearance.

In some cases, up to 50% of the tooth is covered by gum tissue. If that is true, the tooth can easily be made to extend upwards under the lip twice as far. Imagine if you only extended the appearance of the tooth just 25%. It is just a matter of uncovering the tooth and ridding the patient of a gummy smile. Failure to do so leaves the patient with a pocket around the tooth which they are unable to properly clean. This can lead to gingivitis or periodontitis.

At any rate, there are many options for the patient to reduce that gummy smile. Remember that aesthetics is in the eyes of the beholder, and this leads to various opinions on the subject of gummy smiles.

Today’s Dentist

Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Academy of Implant Dentists