Fixing a Gummy Smile

Just what is a “gummy smile?” Simply put, it’s when a person’s gums are a more pronounced part of their smile than they would like. Some folks like to assign measurements. A few years ago, the New York Times reported on a study that found two millimeters or less of gum above the teeth to be ideal. At three to four millimeters, study participants took notice of the exposed gums. But if you’re wondering whether you have a gummy smile, there’s no need to take out a ruler. If you notice your gums when you smile and YOU don’t like the way it looks, you’ve got a gummy smile.

So what causes the gums to be so pronounced that they take attention away from your teeth?
In some cases, the eruption of the teeth—the process by which they first emerged from underneath the gums—was abnormal, leaving more exposed gum than is typical. In other cases, the muscle that is responsible for moving your lip may be positioned higher, causing your upper lip to rise higher than normal. For some folks, it’s simply the way in which the jaw bone grew and developed that’s to blame. You also may simply have more gum tissue than most people. Whatever the cause, the outcome is the same: You have a smile you’re not happy with.

Crown lengthening may require revision of soft tissue only or require revision of soft tissue and bone. Gingivectomy/ gingivoplasty is a tried and tested way to remedy a gummy smile. It involves removing excess gum tissue to expose the desired amount of tooth underneath the gum. Crown lengthening is a routine periodontal surgery procedure that involves revising the hard and soft tissue adjacent to the tooth. In addition to being used to revise and improve a gummy smile, it often precedes other dental procedures such as placing a bridge or crown. In these cases, in addition to gum removal, the crown lengthening may involve removing bone close to the roots of the teeth.

Following the ‘numbing’ of the area, the soft tissue procedure begins with the periodontist making incisions into the gum tissue with a laser. After the appropriate outline is trimmed in the gum, the excess tissue is removed. From this point the periodontist will begin recontouring and smoothing the tissues adjacent to the new gum line.

If the teeth are ‘stubby’ looking, the gum and the bone may need to be revised. After numbing the gum can revised with a laser or scalpel. This gum is then ‘lifted’ to access the excess bone so that it can be ‘shaved’ down allowing the revised gum to lay into the new position further away from the crown of the tooth. This is held in place with stitches and allowed to heal for 5-6 weeks. That last part is important. Regardless of the reasons for a crown lengthening, there is a cosmetic component to every crown lengthening procedure. Care and consideration are given not just to the teeth, but to the gums themselves. This way, when everything heals, the gum line will have a straight, well-formed appearance. You don’t want to have excess gum tissue removed only to find that your gums are uneven, drawing attention for a whole new reason.

If the gummy smile is due to the position of the base of the gum and the muscle attachment being ‘too high’, the gum may need to be removed from the base of the gum opposite the crown of the teeth and the muscle attachment may need to b e repositioned to the new gum margin at the base of the gum. This reduces the amount of ‘vestibule’, the area between your cheeks and lips and the teeth. This will lower the height to which you can raise your lips when you smile and reduce the amount of ‘gum show’

Lastly, the gummy smile may be due to the upper jaw projecting too far forward. This is a skeletal defect that requires orthodontics to reposition the teeth and an oral and maxillofacial surgeon to reset the jaw into a more ‘retruded’ position.

For any questions regarding the remediation of a gummy smile, crown lengthening, or crown lengthening recovery, don’t hesitate to contact Specialty Dental Care at 402.704.3171. For more than 40 years, Dr. Tim McVaney has been helping patients throughout Omaha, NE take charge of their dental health and achieve smiles that leave them beaming from ear to ear.