Gummy Smile

Gummy Smile

What is a Gummy Smile?

A gummy smile (Excessive Gingival Display) occurs when too much gum tissue is visible above the upper teeth when smiling and people may feel self-conscious about their smile.  In some situations, excessive gum tissue may allow food and bacteria to become trapped under the gum line, increasing the risk of tooth decay and gum disease.

Causes of a Gummy Smile

A gummy smile may occur due to Lip, Jawbone, Tooth and Gum factors either independently or in combination.

1. Lip factors The upper lip may be too short and unable to cover the gum tissue and upper teeth at rest and when smiling.  Sometimes, the upper lip may be of normal length but the lip muscles are too strong, resulting in hypermobile lips that reveal more gum tissue than usual when smiling.

2. Jawbone factors The upper jaw may be genetically longer than normal compared to the rest of the face and lips, resulting in more gum tissue display at rest and when smiling.

3. Tooth Factors If the upper front teeth are over-erupted, they may bring the supporting bone and gum tissue down with them resulting in excessive gum tissue on display.  Tooth over-eruption may be genetic or may occur as teeth are worn down with use and they continue to erupt to maintain the bite.  Occasionally, orthodontic treatment to move the upper front teeth into the jawbone may also lead to increased gum tissue display with the gum tissue being too high on the tooth.

4. Gum Factors Gum tissues may be swollen and enlarged due to inflammation because of mouth breathing, poor oral hygiene, and gum disease.  In some situations, excessive gum tissue growth can also occur due to genetic factors or as a side effect of some medications. These include some blood pressure, anti-epileptic, and post-organ transplant medications. Incomplete tooth eruption may also result in the teeth appearing short and the gum tissue being too high on the tooth with increased gum tissue display.

Treatment of a Gummy Smile

Treatment options may vary depending on the cause.  If multiple factors are involved, sometimes more than one type of treatment is required.

• Orthodontic Treatment: To correct the position of over-erupted teeth.
• Periodontal Treatment: Professional cleaning of the teeth and root surfaces to treat gum swelling due to gum disease. Medication associated gum overgrowth may require a Medical Practitioner to assess alternative medication options. 
• Crown Lengthening Surgery: In certain situations, the gum tissue and/or bone will be reshaped to expose more tooth and reposition the gum tissue to the correct position. Figures 10A and 10B show before and after results of such procedures.
• Prosthodontic Treatment: Once the teeth and gums are in the correct position, teeth may need veneers/crowns to restore them to the correct shape and length, particularly if teeth have been worn down.
• Jaw (Orthognathic) Surgery: If the upper jaw size/position is incorrect, jaw surgery may be required. This is performed by an Oral and Maxillofacial Surgeon combined with Orthodontic treatment performed by an Orthodontist.
• Plastic Lip Surgery: A plastic surgical procedure can be performed on the lip muscles to lengthen a short lip or to restrict the motion of a hypermobile lip.
• Botox: Injectable muscle relaxants such as Botulinum Toxin can be a temporary measure to reduce the movement of hypermobile lips.

Authors:
Dr Charles Snyman
Dr Raymond Chan