Gummy Smile
If you have a gummy smile and it bothers you, please read this! Many patients think that the only way to fix a gummy smile is with painful gum surgery, but this is completely false, and the gum surgery can create new problems. Gum surgery is only appropriate for a small percentage of patients with gummy smiles. There are many potential cause of the gummy smile, and your doctor must understand what the cause of yours is before offering treatment.
A gummy smile is actually very normal and natural, and is considered to be a youthful feature. Kids are supposed to show their gums when they smile. For an adult female, showing between 0 and 2 millimeters of gums is considered normal. For adult men, around 0 millimeters is normal. As we age, the upper lip begins to sag, and so more of the upper teeth are concealed. This is why, in older patients, it is typical to see only the lower teeth at rest. And this is why more gingival (gum) display is considered youthful. However, there are some patients who truly do show excessive gingiva on smile, and these patients must be carefully evaluated to uncover the reason, so that the appropriate treatment is offered.
When a patient complains of a gummy smile, the first step is to very carefully evaluate the face. Accurate measurements must be taken, measuring the patient’s facial thirds and their subdivisions. The lips and the teeth must be measured at rest, and of course, during both posed and spontaneous smiles. This is the first step to understanding the reason for the gummy smile.
A gummy smile can result from any number of situations.
Hyperactive upper lip: Normal tooth, gum, and lip length at rest, but excess gingival show on smile only. This situation is caused by excessive upper lip shortening on smile, and is amenable to Botox® injections (or similar medication) so that the upper lip doesn’t shorten quite so much.
Short upper lip: Normal tooth and upper gums and jaw dimensions, but the lip is just shorter than normal, causing a greater than normal tooth display at rest and greater than normal gingival display on smile. For this situation, I would recommend no treatment, since gingival show is considered youthful and the upper lip will lengthen over time. If the gumminess is very bothersome, you may consider dermal filler injections into the lip to increase the lip length, which will decrease the gingival show.
Short upper teeth/gingival overgrowth: Normal everything else, but the upper teeth are short, so that when the patient smiles, there is more gum showing than normal. This situation is amenable to gum surgery, in which your doctor shortens the gums (called a gingivectomy) to reveal more of the upper teeth when you smile.
Long upper jaw (vertical maxillary excess): Normal teeth and lip dimensions, but there is excessive show of upper teeth at rest, and excessive show of gingival on smile. This situation can only be fixed properly with upper jaw surgery. In this surgery, called a Lefort I osteotomy, a wedge of bone is removed from the upper jaw and then the upper jaw is repositioned higher up, so that it is shorter relative to the lip. This surgery may seem very invasive, but it is really no different than a rhinoplasty, in that a bone is purposely broken and then placed into a new position, and allowed to heal in its new position.
As you can see, the treatment for a gummy smile can differ tremendously, depending on what its cause is. Your face is a very important asset, and we might argue that your smile is the most valuable asset of your face. Make sure your doctor takes the time to perform a thorough evaluation and makes the correct diagnosis before jumping into treatment.
If you would like to know more, contact our office today to schedule your consultation!