Causes of a Gummy Smile and How to Fix It

What is a Gummy Smile?

A gummy smile (GS), which dentists call excessive gingival display, is when too much gum tissue shows above the top teeth when smiling. There must be at least 2 millimeters of excess gum tissue showing to be considered GS.

Gummy smiles often make people feel self-conscious, and they end up seeking treatment electively for cosmetic reasons. In other cases, a patient may need to fix his or her gummy smile for dental health reasons. 

There are four types of gummy smiles, including:

1. Anterior — when too much gum tissue shows above the front teeth (typically in between the two canines) in the upper jaw. 
2. Posterior — when too much gum tissue shows above the back teeth in the upper jaw. 
3. Mixed — when excess gum tissue shows above the front teeth and back teeth in the upper jaw. 
4. Asymmetric — when excess gum tissue shows on just one side of the mouth in the upper jaw. 

Causes of a Gummy Smile

There are a few causes of GS. Some people are born with irregularities that can cause a gummy smile, while others may develop it due to improper tooth eruption during childhood or tooth wear over time. Common causes of GS include, but are not limited to:

Genetic Factors

If your teeth are naturally smaller in comparison to your gums, a gummy smile can form. Some people are also born with a short upper lip or excess gum tissue, all of which can cause GS. 

Gum & Upper Lip Irregularities

There are a few genetic gum and lip irregularities that can cause a gummy smile, such as:

• Gingival hypertrophy, which is when the gums are enlarged or too long. 
• When the upper jaw overgrows (maxillary excess), making the gums appear too long. 
• A hyperactive upper lip, which is when your upper lip appears normal while resting but lifts higher when smiling, resulting in the exposure of more gum tissue.

Improper Tooth Eruption

Tooth eruption problems that occur during childhood can also create a gummy smile. For example, teeth can appear too short or remain partly covered by your gums if a tooth erupts improperly. 

How to Fix a Gummy Smile

People of all ages can get treatment to fix GS. Most patients who invest in gummy smile treatment do so to improve their smile and boost their confidence. However, the type of treatment depends on the cause and severity of your gummy smile. Common treatment options for this condition include:  

Orthodontic Treatment: Braces or Clear Aligners

Orthodontic treatment, such as braces or clear aligners (e.g., Invisalign), is a great option for mild cases of GS caused by a misalignment in the jaws and teeth. Orthodontic devices move the teeth into the correct position and fix a patient’s bite, resulting in less gum tissue showing above the upper teeth.

Some orthodontists also anchor small titanium implants (TADS) into the patient’s bone during orthodontic treatment. This helps move the teeth into their ideal locations and also fixes more severe cases of GS. 

Botox Injections 

Botox is a common cosmetic treatment that reduces the appearance of wrinkles and fine lines. However, botulinum toxin (BT or botox) injections can also reduce the visibility of excess gum tissue at rest and while smiling. When treating a gummy smile, BT is injected in smaller doses to limit the over-contraction of your upper lip muscles. You will also be asked to smile at full capacity before the BT is injected to ensure the treatment is effective. 

How many injections are needed and where they will be injected depends on the type of gummy smile you have. For example, patients with deep nasolabial folds (smile lines) and short upper lips typically receive two to three botox injections per treatment. 

Botox injections are an ongoing gummy smile treatment. They must be completed every three to six months. 

Restorative and Cosmetic Treatments

Certain restorative and cosmetic dental procedures can also treat some cases of GS. These include:

• Dental Crown Lengthening — Dental (tooth) crown lengthening can fix the appearance of a gummy smile. This treatment is also used to fix decayed or broken teeth below the gum line. During the procedure, a periodontist reshapes your gum tissue, exposing more of your natural tooth or teeth. As a result, the excess gum tissue above your upper teeth is less visible. Lengthening can fix one tooth, a few teeth, or your entire gum line.
• Veneers — veneers are thin, tooth-colored shells that fit over your front teeth to improve their appearance, shape, and size. Veneers are typically performed after the gum recontouring or crown lengthening surgery to improve the appearance of the exposed tooth.  This treatment can be used to fix a gummy smile. However, it is also the most expensive form of treatment if you want to fix more than one tooth. Porcelain veneers can cost between $900 and $2,500 per tooth. 
• Gingivectomy — if your gummy smile is caused by gum tissue overgrowth, a gingivectomy is a great treatment option. During the procedure, your general dentist either uses a laser or scalpel to remove the excess gum tissue. 

Lip or Jaw Surgery

If GS is caused by moderate to severe upper jaw protrusion, orthognathic (jaw) surgery is generally the most effective treatment option available. If jaw misalignment is the cause of your gummy smile, surgery is necessary to improve your oral health. 

During jaw surgery, an oral surgeon recontours your upper jaw to the correct size and moves it into the correct position. Then they secure the jaw in with screws and plates. General anesthesia is administered before the surgery, and you may need to stay at a hospital afterward.

Jaw surgery is always used in combination with orthodontic treatment, such as braces.

If you do not want to undergo jaw surgery, lip repositioning surgery may be a better option. Lip surgery can only fix a gummy smile if the cause is due to a hyperactive upper lip, not jaw issues.