A gummy smile, also known as excessive gingival display, is when a noticeably large amount of gum shows above the upper teeth during smiling. In the literature, it is generally defined as more than about 3–4 mm of visible gum. It does not have a single cause; this is why treatment is planned individually, based on correctly identifying the cause.
What is a gummy smile?
A gummy smile is when an excessive amount of gum shows above the upper front teeth during smiling, and it is an aesthetic concern rather than a medical disease. It is natural for some gum to show when smiling; how much is perceived as "too much," however, varies from person to person.
The aesthetics of a smile depend on the balance between the position and movement of the lips, the length and proportions of the teeth, the level of the gum margin and the structure of the jaws. For this reason, when a gummy smile is assessed, not only the gums but all of these structures are examined together.
A gummy smile can sometimes also be a sign of health problems such as inflammation or overgrowth of the gums. This is why gum health needs to be assessed before any aesthetic procedure is planned.
What causes a gummy smile?
The main causes of a gummy smile are the gum covering the tooth more than normal, an upper lip that is overly mobile or short, and excessive vertical growth of the upper jaw. More than one cause is often present at the same time:
- Delayed (altered) passive eruption: After the tooth has finished erupting, the gum does not recede to the level it should. The teeth look short and square, and the gum covers part of the tooth.
- Gum overgrowth: Plaque-induced inflammation, the period of fixed orthodontic treatment, or certain medications (for example, some epilepsy and blood pressure medications and some immunosuppressants) can cause the gums to overgrow.
- Hypermobile upper lip: The muscles that raise the upper lip when smiling work more than normal.
- Short upper lip: When the lip is short, more of the gum shows.
- Dentoalveolar extrusion: Excessive downward development of the front teeth and the bone that supports them.
- Vertical maxillary excess: Excessive vertical growth of the upper jawbone; this is a skeletal cause.
How is the cause of a gummy smile determined?
The cause of a gummy smile is determined through clinical examination, smile and facial analysis and, when necessary, X-rays. Choosing the right treatment depends on this assessment. The examination usually looks at:
- The amount of gum that shows at rest and when smiling,
- The length-to-width proportions of the teeth and the symmetry of the gum margins,
- Gum thickness and the distance between the gum margin and the bone level,
- The length of the upper lip and how much it moves when smiling,
- The vertical proportions of the face and the relationship between the jaws,
- Whether there is inflammation, bleeding or overgrowth in the gums.
If a skeletal cause is suspected, the assessment may be carried out together with orthodontic and jaw surgery specialists. If the shape and color of the teeth will also be part of the plan, the process is handled together with smile design.
What methods are used to correct a gummy smile?
The method used to correct a gummy smile is chosen according to the cause: aesthetic crown lengthening may be considered when the cause is the gums, lip repositioning or botulinum toxin when the cause is the lip, and orthodontics and jaw surgery when the cause is skeletal. Some people need a combination of these methods.
Gingivectomy and aesthetic crown lengthening
If the gum covers too much of the tooth, the gum margin is reshaped to increase the visible length of the tooth. If the bone level is suitable, reshaping the gum alone (gingivectomy) may be enough. If the bone is very close to the gum margin, aesthetic crown lengthening, in which the bone is also recontoured, is performed so that the gum can stay at a healthy level. The procedure is performed under local anesthesia, with the aim that you do not feel pain during the procedure. In suitable cases, gum contouring can also be done with a laser. For details, see our gum aesthetics and laser gum treatment pages.
Lip repositioning
For a hypermobile upper lip, a thin strip of mucosa is removed from the inner surface of the lip to limit how far the lip rises when smiling. Because it has been reported that the effect may diminish somewhat over time, appropriate patient selection is important.
Botulinum toxin
By temporarily relaxing the muscles that raise the upper lip, the amount of gum visible when smiling can be reduced. The effect lasts a few months, and the application needs to be repeated to maintain it. It should be administered by a doctor who is qualified in this area.
Orthodontics and jaw surgery
When the cause is over-eruption of the front teeth, orthodontic treatment can reposition the teeth and the gum level. For skeletal causes such as vertical maxillary excess, orthognathic surgery may be considered.
If restorations such as veneers or crowns are also planned while correcting a gummy smile, the gum level is generally corrected first. Restorations are started after waiting for the gum margin to heal and settle; the waiting period is determined by your dentist according to the procedure performed.
What is the recovery process like?
Mild tenderness and swelling may occur in the first days after gum contouring procedures; these symptoms usually ease within a few days. The healing process varies depending on the method used and the person's tissue characteristics.
- Use the pain reliever and mouth rinse recommended by your dentist as directed.
- In the first days, choose soft, lukewarm foods; avoid very hot, spicy and hard foods.
- Clean the treated area gently with a very soft brush, as your dentist has instructed.
- Smoking can have a negative effect on healing; it is recommended that you take a break during this period.
- Do not miss your follow-up appointments.
It can take from several weeks to several months for the gum margin to reach its final form. Results vary from person to person; especially in cases where no bone recontouring was performed, the gum margin may creep back to some extent over time. Regular oral care and gum health are decisive in maintaining the appearance achieved.
When should you see a dentist?
If you feel that too much of your gum shows when you smile and this bothers you, a periodontal examination is helpful to determine the cause. It is recommended that you do not delay an examination in the following situations:
- If your teeth look short and the gum seems to cover part of the tooth,
- If there is swelling, redness or bleeding in your gums,
- If you have noticed your gums overgrowing after starting a medication,
- If you are planning an aesthetic treatment such as smile design, veneers or crowns.
Periodontist Dr. Nadin Gemrekoğlu, DDS, PhD, plans treatment options for a gummy smile individually after an examination and any necessary tests. To make an appointment, you can reach us through our contact page.