Gummy smile: causes and solutions for showing less gum

What is a gummy smile? The short answer

A gummy smile is when a clearly visible band of gum shows above the upper teeth during a broad smile, to the point that it bothers the person. It is not a disease but a question of balance between four elements: the gum, the length of the teeth, the upper lip and the jawbone. Treatment depends on which of these is responsible: reshaping the gum when it covers too much of the tooth, other approaches when the lip or the skeleton is the cause.

Showing a little gum is perfectly normal and is often seen as a sign of youth. There is no strict rule that separates a normal smile from a gummy one: it depends on the harmony of the face and on how you feel about it.

The most common mistake is trying to correct it without a diagnosis, for example by fitting longer veneers when the gum is covering the tooth, or removing gum when the real issue is a very mobile lip.

The four possible causes

The same appearance can hide very different mechanisms, sometimes combined in the same person:

• The gum covers too much of the tooth. As teeth erupt, the gum and bone normally move back towards the root. In some people this does not fully happen: this is called altered passive eruption. The teeth look short and square, although their real size is normal, simply hidden under the gum.
• The teeth really are short. Wear (from grinding or acid erosion) or fractures shorten the edges, so the gum appears more prominent. In this case the teeth have sometimes also moved down slightly with their bone to compensate for the wear.
• The upper lip is short or very mobile. A lip that rises a lot when smiling exposes gum even when teeth and gum are perfectly proportioned.
• The upper jaw has grown more in height. This is a skeletal cause, often associated with a long face and lips that are hard to close at rest.

There are also gums enlarged by inflammation or by certain medicines (some anti-epileptic drugs, some blood pressure medicines or immunosuppressants). In that case, treating the gum comes first, in agreement with your doctor if a medicine is involved.

Diagnosis: measure before correcting

A gummy smile is analysed as a whole, at rest and in motion. At the consultation, the dentist observes and measures several things:

• how much tooth shows at rest, with the lips slightly apart;
• how much gum is exposed in a full smile;
• the length and width of the teeth, and the ratio between them (a very square incisor suggests gum covering it);
• the position of the bone under the gum, checked with a probe after local anaesthetic and on X-ray;
• the length and mobility of the lip;
• gum health: bleeding, pockets, tartar.

Photos and a short video of your smile complete the examination, because a spontaneous smile is different from a photo smile. These records also form the basis of a visual plan, as in the digital smile design approach, which can simulate the effect of reshaping before any procedure.

At the end of this assessment, your dentist can tell you how much of the problem comes from the gum and how much from something else, which shapes everything that follows.

Reshaping the gum: gingivectomy and crown lengthening

When the gum covers too much of the tooth, two periodontal surgery procedures are used, as part of gum treatment.

Gingivectomy (or gingivoplasty) removes and redesigns a thin strip of gum to uncover the part of the tooth that was hidden. It is suitable when the bone sits at a safe distance from the gum margin and the gum is thick enough. It is done under local anaesthetic with a scalpel or, depending on the practitioner, with other instruments such as a laser, whose uses are described in our article on dental lasers.

Aesthetic crown lengthening is needed when the bone is too close to the edge of the tooth. If only the gum were removed, it would grow back towards its original position, because the tissues need a minimum space between bone and gum margin to stay healthy. The surgeon therefore lifts the gum, slightly reshapes the bone and then repositions the tissues.

In both cases, the new outline is designed in advance, tooth by tooth, to respect symmetry and natural heights: central incisors and canines slightly higher, lateral incisors a little lower. Veneers or composite can then complete the result if the shape of the teeth also needs to change.

Other approaches when the gum is not the cause

If the cause is the lip, the position of the teeth or the bone, gum reshaping alone is not enough. Other approaches exist, described here in general terms; whether they are suitable requires a specialist assessment.

• Botulinum toxin injections into certain muscles of the upper lip can temporarily reduce how far it rises when you smile. The effect wears off and must be repeated; it should be carried out by practitioners trained and authorised to do so.
• Surgical lip repositioning aims to limit how far the lip rises by changing the attachment of the lining tissue. Its results and stability vary from person to person.
• Orthodontics can correct front teeth that have dropped too far or an unbalanced smile line, through intrusion movements. Some of these movements are difficult to achieve with aligners alone, and an orthodontist will tell you which appliance is appropriate.
• Orthognathic (jaw) surgery, performed by a maxillofacial surgeon together with orthodontic treatment, is intended for significant vertical excess of the jaw, often with bite or breathing problems.

A gummy smile often has several components: a coherent plan may combine modest gum reshaping with another approach, rather than expecting a single technique to do everything.

Recovery, healing and stability of the result

After a gingivectomy or crown lengthening, recovery is usually moderate: tender gums, mild swelling, sometimes discomfort when brushing the area for a few days. You are given painkillers and clear instructions.

A few practical points:

• Soft, non-spicy food for the first days, avoiding chewing directly on the treated area.
• Gentle brushing with a very soft brush, and a mouthwash if prescribed.
• Removal of stitches, if there are any, generally after one to two weeks.
• Tissue maturation: the gum keeps settling for several weeks, or even a few months after crown lengthening with bone reshaping. Any veneers or crowns are therefore placed after this period, so that their edges match a stable gum line.

The result of a well-indicated correction is generally long-lasting, provided the gums stay healthy. Chronic inflammation, aggressive brushing or smoking can alter the outline achieved. In teenagers, eruption may still be in progress, so cosmetic gum surgery is usually postponed until growth is complete.

Having your smile assessed in Rabat

The first step is not surgery but a precise analysis of your smile. At German Dental Clinic in Agdal, the examination combines gum health, tooth measurements, photos and digital X-rays to separate what comes from the gum, the lip or the skeleton. The wider framework of a cosmetic plan is presented on our smile design page.

If the cause is the gum, the options and their recovery are explained to you. If it belongs to another field (orthodontics, maxillofacial surgery, aesthetic medicine), you are told so honestly.

If your gums bother you when you smile and you live in or around Rabat, you can book an appointment for a smile analysis.