An attractive smile does not depend solely on the condition of the teeth: the appearance of the gums can also play a part. For example, if more gum is visible than usual when smiling, this is known as a ‘gummy smile’.
This is a particularly common, yet often misunderstood condition, which can be triggered by a variety of factors; it may have a dental cause, or indeed an anatomical one. It does not require emergency treatment, as it is primarily a cosmetic issue, yet it makes life miserable for a great many people.
State-of-the-art dental solutions – such as, for example, the Laser gum contouring – they can help to correct a gummy smile quickly, effectively and safely, but there may also be severe cases where complex surgical intervention is required to achieve the desired result.
In this professional article, we have not only compiled the precise definition and causes of a gummy smile, but have also outlined the available treatment options, with a view to helping patients who suffer from this cosmetic dental problem.
What is a gummy smile?
We can speak of a gummy smile when, when a person smiles, more gum tissue than usual is visible above the teeth.
It can be diagnosed when more than 3–4 mm of gum tissue is measured above the upper dentition. Dentists measure this distance from the gum line to the tip of the upper lip.
There are several recognised stages of gingival recession:
- a gum thickness of 3–4 mm is typically only the threshold value; whilst this is noticeable, it does not necessarily require treatment;
- However, a gum smile of 5 mm or more exposes such a significant area of gum tissue that it bothers the majority of people, and often requires treatment for reasons other than purely aesthetic ones.
The assessment of a gummy smile always depends on the individual patient
Although there are reference ranges, it is important to bear in mind, when it comes to gingival smile, that the figures alone do not provide a complete picture of the patient’s condition.
To this end, the following must be taken into account, for example
- the structure of the face,
- the dimensions and proportions of the teeth,
- and even the lip line.
All these factors influence whether the gum line appears balanced or excessive. This means that one person may have a perfect smile even with 4 mm of visible gum, whilst for another, even 3 mm may be noticeable, for example because of smaller teeth.
The fundamental principle of smile aesthetics
Smile aesthetics is a highly delicate field, often based on subjective judgement; therefore, in addition to measurements, it is always necessary to take the diagnosis into account when selecting the appropriate treatment.
A smile is generally considered perfect when the teeth make up 75–80 per cent of the overall appearance and the gums the remaining 20–25 per cent.
We can only speak of the ‘gummy smile’ phenomenon if these proportions change.
The causes of a gummy smile
When treating a gummy smile, it is always necessary to identify the underlying causes. This is often difficult because, although dental problems are the underlying cause in the vast majority of cases, anatomical factors – or even a combination of factors – can also trigger it.
Below, we have compiled a list of the most common causes of a gummy smile:
Gum enlargement
Gingival enlargement, or gingival hyperplasia, is one of the most common dental causes of this condition.
In such cases, the teeth erupt correctly, but the gums either do not recede or begin to grow excessively; this may be due to genetic factors, certain medicines, or even inflammation.
In this case, the teeth are of normal length, but because the gums protrude excessively, they appear shorter and stumpier; in other words, a significantly larger area of gum is visible when the patient smiles.
Short or hyperactive upper lip
Problems associated with the upper lip (mainly of anatomical and muscular origin) also frequently cause a gummy smile.
For example, there are people whose upper lip is simply too short, which means that even with a normal tooth-to-gum ratio, it retracts so far when they smile that it results in the gums being overly visible.
The length of the upper lip can be influenced by genetics, ethnicity and even injuries; therefore, particular attention must be paid to the diagnosis of a gummy smile in such cases.
As well as anatomical differences, hyperactive muscles in the upper lip can also cause this phenomenon. When smiling, speaking or making facial expressions, the muscles that move the upper lip contract too strongly, thereby lifting it higher than necessary.
In such cases, the gums, teeth and jawbone are completely normal; the problem stems purely from a muscular cause.
Jaw development problem
A gummy smile may also be caused by a jaw development disorder. This includes vertical maxillary overgrowth, which means that the upper jaw has grown longer than normal in the vertical direction.
What happens in such cases is that the entire upper jaw is positioned lower, overhangs the lower jaw more, and when smiling or during natural lip movement, a greater amount of gum tissue becomes visible to the naked eye.
This developmental problem is often accompanied by other abnormalities, such as jaw misalignment or malocclusion, which can cause functional difficulties and even problems with chewing.
Abnormal tooth development
As our bodies develop, tooth growth can encounter a number of obstacles, and abnormalities such as delayed eruption, gaps between teeth or misalignment can also cause problems that lead to a gummy smile.
If, for example, the permanent teeth do not erupt fully or erupt at an incorrect angle, they appear shorter from an aesthetic point of view, whilst the gum tissue appears abnormally long, even though the patient does not actually have any such problem.
Passive protrusion, or the position and alignment of the teeth, generally gives rise to orthodontic problems, whilst it is a very common cause of a gummy smile.
In some cases, a combination of factors causes gum recession
Last but not least, we must certainly also discuss those cases where there is no single specific cause behind the development of a gummy smile, but rather it arises as the combined effect of a number of problems.
Taken individually, these may often be negligible, but, for example, a slightly short upper lip, slightly enlarged gum tissue or a minor jaw problem can, when combined, result in a significant gummy smile.
This type of defect is significant because each one must be treated individually in order to restore the aesthetics of a healthy smile.
Diagnosis of a gum smile
An accurate diagnosis of a gum smile and an understanding of its causes are crucial, as these always determine the treatment options.
As every patient and every lesion is different, the diagnosis of a gummy smile may vary from person to person; however, the examination generally consists of the following elements:
- Assessment:A thorough understanding and analysis of the condition of the teeth and gums is essential for making a diagnosis; indeed, in the case of a gummy smile, it is also important to observe lip movement as well as the oral cavity.
- Smile analysis:The essence of smile analysis is that, based on photographic records and measurements, it is possible to determine the dimensions of the teeth and gums, as well as their characteristics in relation to the smile.
- Imaging examinations:As anatomical abnormalities are often the underlying cause, appropriate imaging tests (primarily Panoramic X-ray or 3D CBCT) are of particular importance for diagnosis.
It is often the case that, even at the time of diagnosis – to support the treatment plan – a facial and profile analysis is required, as well as, where necessary, an orthodontic consultation or smile design.
Treatment options for a gummy smile
In most cases, a gummy smile can be treated effectively; however, it is important to note that dental procedures alone are not always sufficient.
As NaturaDent Dentistry in Budapest It is only from this perspective that the treatment of a gummy smile can be ensured; in what follows, we will focus primarily on dental treatment options, whilst therapies belonging to other specialities will be touched upon only briefly.
Gum grafting
Gum contouring – particularly when combined with laser technology – is a particularly effective and safe way of correcting a gummy smile in certain cases.
This is recommended when there is too much gum tissue covering the teeth. In such cases, a form of contouring can be used to remove the excess gum tissue, making the natural crown of the tooth more visible and restoring aesthetic proportions.
In addition to gum contouring, crown lengthening can also be carried out during gum reshaping; this procedure goes even deeper and removes and reshapes not only the gum tissue but, where necessary, part of the underlying bone as well, thereby creating a more natural gum line. The aim of this is to create an appropriate gum line and to increase the visible crown length of the tooth.
A major advantage is that it provides a long-lasting, permanent correction; furthermore, laser treatment not only achieves outstanding precision but also results in less bleeding and faster healing compared with traditional methods.
Orthodontics
If the diagnosis reveals that the gum recession is caused by misaligned teeth, then conventional or invisible braces provides the basis for treatment.
With their help, the teeth can be moved in such a way and to such an extent that the amount of gum visible is reduced, thereby creating a much more natural gum line that is less visible when smiling.
As it is suitable not only for treating teeth but also, to a certain extent, for correcting the jawbone, it can be used to treat both minor anatomical abnormalities and malocclusions.
Dental restorations
If a gummy smile is caused by teeth that are genetically too short or too worn, or perhaps by abnormal tooth development, the problem can be treated very effectively in the smile zone using targeted dental restorations.
Dental veneers offer an excellent alternative for this, but more severe cases can even be treated with full crowns. In such cases, short teeth can be lengthened, and a much more aesthetically pleasing tooth-to-gum ratio can be achieved without the need to alter the gum tissue.
This is also a long-lasting result; however, it is only applicable in the cases mentioned above, or where crown lengthening does not adversely affect the structure of the jaw – that is, it does not place unnecessary strain on the joints or the bite, nor does it result in a change to the shape of the face.
Other treatment options for gummy smiles
As mentioned above, a gummy smile cannot be treated using dental methods alone. In particular, where the problem is caused by anatomical or muscular factors, the patient’s condition can also be improved through surgical or cosmetic procedures, for example:
- Surgical procedures:Particularly in cases where the cause is skeletal, a gummy smile can be corrected by surgically reshaping the jaw structure, but plastic surgeons can also achieve dramatic results by adjusting the position of the lips.
- Botulinum toxin treatment:Botulinum toxin plays an important role in cosmetic procedures; however, it can also have a beneficial effect on overactive lip muscles, as it reduces the activity of the lip-raising muscles, thereby reducing the extent of the gummy smile.
Frequently asked questions
Is a gummy smile bad for dental health?
Not if you practise good oral hygiene. It is mainly a cosmetic issue that does not adversely affect the health of your teeth, but if left unchecked, it can increase your susceptibility to tartar build-up and tooth decay.
Can a gummy smile be corrected without surgery?
Yes, in many cases that is true, but the treatment is always determined by the causes of the gummy smile. From a dental perspective, laser gum reshaping, orthodontic treatment or dental restorations are not considered surgical procedures.
Can a gummy smile be completely cured?
In most cases, yes. However, the specific treatments required and the duration of the entire process always depend on the individual patient. A dental restoration, for example, can be completed quickly, but orthodontic treatment often takes months.
How common is a gummy smile?
It is impossible to quantify, but it is a common dental aesthetic problem, particularly amongst young adult women. In most cases, however, it is mild, which is why many people do not even notice a slight discrepancy.
Does a gummy smile always require treatment?
If it does not cause any aesthetic concerns and there is no underlying periodontal disease or other health problem, treatment is generally not required. Most patients usually undergo the procedure for aesthetic reasons, rather than because the problem has a direct negative impact on their daily lives, for example.
Can a gummy smile be inherited?
As the structure of the jawbone and the length of the lips are determined by genetic factors, a tendency to have a gummy smile can be inherited. In most cases, however, its development is not of genetic origin.
Can it develop in childhood?
Yes, the development of a gummy smile can often be observed as early as childhood. However, intervention should only be considered in very severe cases, as the oral cavity and lip movement can change significantly, particularly during puberty, with the emergence of permanent teeth.
Can gummy smile treatments be combined?
In certain cases, yes; in fact, it is often necessary for a complete reconstruction. It is common, for example, for orthodontic treatment and gum surgery to be carried out together, but this is always decided by a specialist.
Could the gummy smile make a comeback?
Dental and surgical treatments produce permanent results, so in these cases a gummy smile cannot return. However, the same cannot be said of cosmetic procedures.
