Short answer: A gummy smile is when a noticeable amount of gum shows above the upper teeth when you smile; it is also known as excessive gingival display. Causes include vertical overgrowth of the upper jaw, a short or hyperactive upper lip, gums covering too much of the teeth or the position of the teeth. Botox, gum contouring, orthodontics and surgical options are planned according to the cause.
Showing too much gum when smiling can lead some people to cover their mouth with their lips in photos or to try to control their smile. A gummy smile is not a medical disease but a feature that affects the aesthetic balance of the smile. However, the underlying causes vary greatly from person to person, and choosing the right treatment depends on identifying the cause. In this article we look at what a gummy smile is, its causes and the treatment options.
What is a gummy smile?
A gummy smile is when a noticeable amount of gum shows above the upper front teeth during a natural smile; generally, more than three to four millimeters of visible gum falls under this definition. Showing some gum when smiling is completely natural and is perceived by many as a youthful, lively expression. How much gum counts as "too much," however, depends on personal perception, facial structure and cultural ideas of beauty.
Gum display also changes with age. As we get older, the lip muscles relax and the upper lip droops slightly; that is why a gummy smile that is prominent in young people may become less noticeable in later years. This natural change is also taken into account when deciding on treatment.
What causes a gummy smile?
A gummy smile does not have a single cause; often several factors are present together. The main causes are:
- Vertical overgrowth of the upper jaw: If the upper jawbone has grown too far downward relative to the height of the face, a significant part of the gums shows even when the lip moves normally. This is a skeletal cause.
- Hyperactive upper lip: When the muscles that lift the upper lip work too strongly during a smile, the lip rises higher than usual and exposes the gums.
- Short upper lip: When the upper lip is short relative to the face's other proportions, the teeth and gums may show more even at rest.
- Gums covering too much of the teeth: In some people, after the teeth have fully erupted, the gums do not recede to their proper level and continue to cover part of the tooth. In this case the teeth look short and square, and the gums cover a large area.
- Gum overgrowth: Gum inflammation, certain medications or poor oral hygiene during orthodontic treatment can cause the gums to grow.
- Position of the teeth: When the upper front teeth sit lower than they should, often together with a deep bite, the gumline also moves down.
For an accurate diagnosis, lip movements, the amount of tooth visible at rest and when smiling, the length and proportions of the teeth, gum thickness and jaw structure are assessed together. If needed, X-rays and photo analysis are carried out.
How is a gummy smile treated with Botox?
When the cause of a gummy smile is a hyperactive upper lip, a small amount of botulinum toxin (Botox) can be injected into the muscles that lift the upper lip so that the lip rises less when smiling. The procedure is quick, is done with a fine needle and usually allows a return to daily life the same day.
The effect of Botox is not permanent; in most cases it lasts a few months, and the injections need to be repeated to maintain the effect. In addition, this method is only effective for a muscle-related gummy smile; it is not enough on its own when the cause is skeletal or the gums cover too much of the tooth. After the injection, a temporary asymmetry or a less natural-feeling smile may be noticed. That is why it is important for the injection to be done by a doctor who knows facial anatomy well and adjusts the dose to the individual.
What are gingivectomy and lip repositioning?
A gingivectomy is the surgical reshaping of gum tissue that covers too much of the teeth, revealing the teeth's natural length. It is also called gum contouring or aesthetic crown lengthening. It is preferred when the gums cover too much of the teeth or when there is gum overgrowth. In some cases, not only the gums but also the underlying bone level needs to be adjusted; in that case the procedure is done together with bone recontouring. It is performed under local anesthesia, and the gums usually heal within a few weeks.
Lip repositioning, on the other hand, is a minor surgical procedure on the inner surface of the upper lip that limits how far the lip rises when smiling. For a gummy smile caused by a hyperactive upper lip, it may be considered a longer-lasting alternative to Botox. However, it is not suitable for every patient, and it should be kept in mind that the results may change somewhat over time. Because the incision is made inside the mouth, no visible scar is left.
What are the orthodontic and surgical solutions?
When the cause of a gummy smile is the position of the teeth or the structure of the jaw, orthodontic treatment and, if needed, jaw surgery come into consideration.
Orthodontic treatment: In cases where the upper front teeth sit low and a deep bite is present, moving the front teeth upward within the bone can also move the gumline up. This movement can be done with braces or, in suitable cases, with Invisalign clear aligners; in some cases, small screws placed in the mouth support the orthodontic movement. Orthodontic treatment also helps refine tooth proportions and the smile line.
Orthognathic surgery: For a gummy smile caused by marked vertical overgrowth of the upper jaw, jaw surgery may be needed for a lasting and balanced result. In this surgery, the upper jaw is moved up by a planned amount. This treatment, planned jointly with orthodontics and jaw surgery, is performed in people whose growth is complete and is an extensive process. We discuss in detail whether clear aligners can change skeletal structure in our can clear aligners correct jaw structure article.
Many patients need a combination of methods. For example, gum contouring can be done after orthodontic treatment, or a mild skeletal problem can be supported with Botox. The treatment plan is tailored to the individual by assessing all components of the smile.
How do you find out which treatment is right for you?
Because the choice of treatment for a gummy smile depends entirely on the cause, the first step is a detailed examination and smile analysis. Treatment done without assessing lip movements, the length and position of the teeth, gum structure and jaw proportions together may not meet expectations. You can find answers to general questions about gum and cosmetic treatments on our frequently asked questions page.
Gummy smile assessment in Ankara
If you feel too much gum shows when you smile and want to know why, at our polyclinic in Park Oran Ofis in Oran, Çankaya, our orthodontist and other dentists assess your teeth, gums and jaw structure together. After the examination, the possible options are explained to you along with their benefits and limitations.
Frequently asked questions
Does a gummy smile go away on its own?
A gummy smile usually does not correct itself, but it may become less noticeable with age as the upper lip droops slightly. In cases related to gum overgrowth, treating the inflammation and good oral hygiene can improve how the gums look. A lasting change requires treatment aimed at the cause.
How long does Botox for a gummy smile last?
The effect of Botox is not permanent and lasts a few months in most cases. The injections need to be repeated at regular intervals to maintain the effect. The duration can vary from person to person.
Will the gums grow back after a gingivectomy?
After a correctly planned procedure in which the bone level is also adjusted if needed, the gums usually keep their new position. In cases where bone recontouring is needed, skipping this step can cause the gums to return to their former position over time. Good oral hygiene helps maintain the result.
