What Causes a Gummy Smile and Can You Fix It? 

Smiles are essential to human connection. They’re an important form of emotional and personal expression.

When you don’t love your smile, though, you might feel less inclined to display it genuinely. Certain aspects of a smile can cause people to feel self-conscious.

If your smile reveals more of your gums than you’d like, it’s considered a gummy smile. There are several causes of a gummy smile and multiple treatment options available.

What is a Gummy Smile?

A gummy smile, which dentists call excessive gingival display, is when more gum tissue than you would like shows above the top teeth when smiling. 

Since it’s based on personal preference, there’s no set definition of how much gum needs to show to be considered a gummy smile. Generally, 3 to 4 millimeters of your gums need to be shown to rank as a gummy smile.¹

Some people dislike their gummy smiles and may seek elective treatment for cosmetic reasons. Sometimes, they may need to fix their gummy smiles 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 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. 

3 Potential Causes of a Gummy Smile

A few factors may cause a gummy smile. Some people are born with irregularities that can cause excessive gingival display, while others may develop it due to improper tooth eruption during childhood or tooth wear over time.

Common causes of a gummy smile include, but are not limited to:

1. How Your Teeth Grow In

The size and shape of your teeth and the way they grew in can cause a gummy smile. For instance, if your teeth are naturally smaller than your gums, you might feel like you have a gummy smile. Other conditions include:

• Altered passive eruption – When the gums cover more of your teeth as they grow in
• Dentoalveolar extrusion – When your front teeth grow in too far, your gums might do the same
• Vertical maxillary excess – When the bones in your upper jaw grow longer than normal

2. Gum and Upper Lip Irregularities

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

• Gingival hypertrophy – when the gums are enlarged or too long 
• A hyperactive upper lip – when your upper lip appears normal while resting but lifts higher when smiling, resulting in the exposure of more gum tissue

3. Medications

Certain medications can cause an overgrowth of gum tissue, known as drug-induced gingival overgrowth (DIGO).² These medications include:

• Anti-convulsants used to treat seizures
• Immunosuppressants, such as those prescribed after an organ transplant
• Calcium channel blockers, which treat hypertension 

If you have DIGO, you should discuss possible solutions with your dentist, as it can cause periodontal disease when left untreated.

How to Fix a Gummy Smile

People of all ages can get treatment to fix a gummy smile. Most patients who invest in gummy smile treatment do so to improve their smile and boost their confidence. 

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 a gummy smile 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 use braces or clear aligners, along with temporary anchorage devices (TADS). These are small titanium implants anchored into the bone. They help move the teeth into ideal locations and fix more severe cases. 

Botox Injections 

Botulinum toxin (BT or botox) injections are a common cosmetic treatment that reduces the appearance of wrinkles and fine lines. Botox paralyzes the hyperactive lip muscle and prevents the upper lip from lifting too high when you smile. Botox can also reduce the visibility of excess gum tissue at rest.

When treating a gummy smile, BT is injected in small 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 only an option for those with a high upper lip, and are an ongoing treatment for a gummy smile. They must be completed every 3 to 6 months. 

Hyaluronic Acid

Like botox, hyaluronic acid injections can reduce the hypermobility of your upper lip. These fillers can reduce your lip's mobility for 6 months to a year. 

Hyaluronic acid injections can be a less expensive option than surgery, but they come with rare but possible complications:

• Damage to your blood supply, potentially leading to stroke, tissue loss, or even blindness
• An immune system reaction that forms a nodule

Always discuss the possible outcomes with your doctor before pursuing treatment.

Restorative and Cosmetic Treatments

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

Dental Crown Lengthening

Dental crown lengthening can fix the appearance of a gummy smile. This treatment also fixes decayed or broken teeth below the gum line.

If the teeth aren’t fully erupted, a crown lengthening procedure is an option. During the procedure, a dentist or periodontist removes your gum tissue and/or bone, 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.

Root Planing and Scaling

Scaling and root planing (SRP) treats gummy smile cases caused by infection or inflammation. 

SRP is a procedure in which your dentist removes the plaque from your tooth all the way to the root, even under the gumline. Once they do that, they can smooth out the roots to help the gums reattach in a way that reshapes your gumline. 

Veneers

Veneers are thin, tooth-colored shells that fit over your front teeth to improve their appearance, shape, and size.

Veneers are typically applied after the gum recontouring or crown lengthening surgery to improve the appearance of the exposed tooth. 

However, they are the most expensive option if you want to fix more than one tooth, costing between $900 and $2,500 per tooth. 

Gingivectomy

A gingivectomy is a great treatment option if your gummy smile is caused by gum tissue overgrowth.

During the procedure, your general dentist or periodontist uses a laser or scalpel to remove the excess gum tissue. This will reveal more of the teeth’s surface. You may have to undergo more than one session.

Lip or Jaw Surgery

If your gummy smile is caused by moderate to severe upper jaw protrusion, orthognathic (jaw) surgery is generally the most effective treatment option. It is often combined with orthodontic treatment, such as braces. 

Jaw surgery is a comprehensive treatment modality. It starts with braces, followed by surgery, and finishes with braces to fine-tune the bite and occlusion. 

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.

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.

Lip repositioning surgery involves removing some of the connective tissue from the underside of your upper lip. This will stop your lip from lifting so high when you smile, thus revealing less of your gums.

Summary

A gummy smile occurs when 3 to 4 millimeters of gum show when you smile. Its causes include genetic factors, such as how your teeth grow in, gum and upper lip irregularities, and side effects from certain medications.

Treatments for a gummy smile range from jaw surgery to botox injections, depending on the cause and severity. Treating a gummy smile is not always necessary and is largely a matter of aesthetic preference.