Gummy Smile
A smile that shows a little too much gum and not enough teeth is more common than you’d think. Read on to find out what makes a gummy smile and how it can be corrected.
A smile that shows a little too much gum and not enough teeth is more common than you’d think. Read on to find out what makes a gummy smile and how it can be corrected.
What causes it
Top treatments
Other options to consider
Before we delve into how to get rid of too much gum tissue, let’s address the basics: What exactly is a gummy smile?
“When some people smile, they show the gums over their upper teeth—this is what’s known as a ‘gummy smile,’” says board-certified facial plastic surgeon Dr. Theda Kontis, who serves as both secretary of the American Academy of Facial Plastic and Reconstructive Surgery and an associate professor of otolaryngology-head and neck surgery at Johns Hopkins.
In the most excessive cases, the gummy smile also reveals the oral mucosa of the maxilla or upper jawbone, notes Dr. Manolis Manolakakis, a board-certified oral and maxillofacial surgeon in Shrewsbury, New Jersey.
According to Dr. Sivan Finkel, a dentist and adjunct clinical instructor at the NYU Advanced Program for International Dentists in Esthetic Dentistry, “gummy smile is a blanket term for several different issues—and identifying the underlying cause will dictate what the proper treatment should be.”
“Many of the underlying causes of a gummy smile are hereditary conditions resulting from genetics,” says Dr. Matthew Nejad, an aesthetic dentist in Beverly Hills, California. In some cases, “multiple conditions can combine to form the gummy smile.”
The root of the problem can be the gums, the jaw, and/or the surrounding tissue and muscles—primarily those of the upper lip.
"When the gum is in excess, a portion of the teeth is typically covered by the gums, making the teeth look small. This can result from the normal eruption of the teeth and can involve the gums, the bone surrounding the teeth, or both,” Dr. Nejad explains.
In other instances, excessive gingival display may be due to a short or hyperactive upper lip or the overdevelopment of the maxilla, or upper jaw.
These are the most common causes, according to Dr. Finkel:
- A hypermobile upper lip
- Too much gum tissue growing down as the teeth themselves get worn, something known as compensatory eruption
- An inability of the gums to pull back and reveal the entire tooth as the adult teeth develop, aka altered passive eruption
- A skeletal problem relating to the upper jawbone called vertical maxillary excess
Once your provider diagnoses the underlying cause of your excess gum show, they can recommend the best treatment option for you. This could range from a noninvasive treatment to plastic surgery.
“In a nutshell, when I'm faced with a gummy smile case, the first question I ask is, ‘Is it a gummy smile with normal-size teeth, or are the teeth actually short?’” says Dr. Finkel. The answer determines the best treatment option.
| Worth It Rating | 96% | 96% | 83% | 82% |
|---|---|---|---|---|
| Average Cost | $554 | $2049 | $7325 | $17425 |
| Downtime | No downtime | Minimal downtime | No downtime | 4 weeks of downtime |
| Anesthesia | No anesthesia | Local anesthesia | Local anesthesia | General anesthesia |
- Botox, along with other neuromodulators like Dysport or Xeomin, can “address gummy smile issues that arise from muscle hyperactivity and high mobility of the upper lips,” says Dr. Nejad. “They work by minimizing the contraction of the muscles that raise the upper lip, minimizing excess gum display.” In Dr. Kontis’s opinion, treating gummy smiles is one of the best uses of Botox, and studies confirm it’s safe and effective. “Only a few units, injected alongside the nostrils, will relax the muscle that pulls up the lip when smiling,” she explains. “The results are natural in appearance and last about four to six months.” This option works best for people whose teeth are well-proportioned. Find providers who offer Botox
- Gingivectomy (aka a gum lift), with or without crown lengthening, is typically performed by cosmetic dentists and/or periodontists. Sometimes called gum contouring, this treatment reshapes the gum line with a laser, to correct gum overgrowth and reveal more of your teeth. “When the gum is overgrown or in excess, it can be recontoured surgically, to expose more of the natural tooth crown. [We’re] literally removing the excess gum tissue, to correct the gummy smile,” explains Dr. Nejad. When the procedure involves only the removal of extra gum tissue, it’s known as a gingivectomy, he adds. In certain cases, however, the underlying bone needs to be raised as well—a procedure called crown lengthening. (This terminology is a bit fluid, and some experts use the terms gingivectomy and crown lengthening interchangeably when referring to the removal of excess gum and/or bone.) Find doctors who offer gum lifts
- Porcelain veneers or crowns attach to your natural teeth, to improve their size, shape, and color. They can last a decade or more. While veneers are thin shells that affix to just the front surface of your tooth, dental crowns encase the whole tooth. Once gums and, possibly, bone have been recontoured, veneers or crowns can be placed in order to create an ideal teeth-to-gum ratio. “Each tooth has its own ideal proportion,” Dr. Finkel notes. For the upper front tooth, for example, it’s about 80% width to height—meaning a tooth that’s eight millimeters wide should be about 10 millimeters tall, he says, to avoid the unnatural square shape that results from a tooth having equal height and width. When pairing veneers or crowns with gum and/or bone work, timing is important. “When the bone doesn't have to be raised, I [reshape the gums] with a laser, and the timeline of the veneer case doesn't get delayed—it’s three weeks, start to finish,” Dr. Finkel says. “But when the bone does have to be raised, I work with a periodontist, and it adds two months of healing time to the timeline of the case.” He goes on to say, “One of the most common complications I see in veneer redo cases is when the previous dentist raised the gums before placing the veneers but did not raise the bone [when they should have]. This results in chronic inflammation at the gumline, known as a biologic width invasion, and is extremely unaesthetic.” Find dentists who offer veneers Related: What It’s Really Like to Get Veneers
- Orthognathic or corrective jaw surgery is the most permanent solution for this concern. “This is a very complex procedure that requires a combination of orthodontic care and surgery—a process that typically takes one and a half years to complete,” says Dr. Manolakakis. As he explains, in aiming to correct excessive gingival display via jaw surgery, the upper jaw is osteotomized (deliberately fractured) and repositioned after bone is removed from the maxilla. “This shortens the length of the upper jaw and decreases the amount of gingival show,” he says. Downtime is about six weeks. “Most patients who decide to have this procedure done have other issues that bother them beyond just the gummy smile, although that is typically what brings them in for consultation.” While this surgery is the most invasive fix, in Dr. Finkel’s experience, “these cases are life-changing and can improve the patient’s entire face and profile.” Find doctors who offer orthognathic surgery
- Lip fillers. In cases of mild gum protrusion, judicious use of dermal fillers can help temporarily mask the amount of gum tissue by making the upper lip more voluminous, notes Dr. Nejad. While “it’s not advisable to use fillers when the fullness of the lips is already appropriate,” he stresses, “this can help with any cases that result from [or are exacerbated by] thin upper lips.” Lip fillers generally last about six months. Doctors will commonly combine Botox and fillers, for optimal results. “If the patient has a thin upper lip and hypermobile upper lip, I’ll usually do a combination treatment of filler and neuromodulator,” says Dr. Manolakakis. “This treatment can also be performed on those who need orthognathic surgery but don’t want to go through it or want to just get by for now. Fillers and neuromodulators provide an easy short-term solution, with no downtime.” Find providers who offer lip fillers
- Lip repositioning surgery. More invasive and long-lasting than injectables, lip repositioning involves separating your top lip's attachment to the gums inside the mouth and reattaching it in a way that minimizes its mobility, "keeping the lips close to your teeth and showing less gum when you smile,” explains Dr. Nejad. According to Carmel, Indiana, plastic surgeon Dr. Barry Eppley, the procedure “has a good track history of success, with only minimal to moderate relapse.” When relapse does occur, it tends to happen within the first three months of surgery. A 2019 study also found that patients who underwent this surgery still reported satisfactory results two years after undergoing the procedure. Find doctors who offer lip repositioning
Let’s not overlook another approach to gummy smiles: acceptance. In discussing this concern, it’s important to acknowledge that “the stigma around gummy smiles has been disappearing in the dental literature recently,” Dr. Finkel points out. “It’s become apparent that most of the population, when smiling or laughing naturally in a social setting, easily displays two to three millimeters of gum above their teeth—which used to be the definition of a gummy smile.”
Oftentimes, exposed gums aren’t even the true cause of smile dissatisfaction. Instead, it's often poor oral health or incorrect teeth positioning, which can be fixed with an orthodontic treatment, like Invisalign. “The real issue is often uneven gum levels, unhealthy gums, misaligned teeth, or improper tooth proportions,” he says. “Once these issues are addressed, a gummy smile is suddenly beautiful.”
Related: What Is Dental Anxiety, and Can You Overcome Your Fear?
Updated July 6, 2021