Many patients come to us somewhat hesitantly and admit that in photographs they unconsciously tighten their lips or cover their mouth with their hand when they laugh. They are bothered by the fact that during a wide smile, as they say, too much gum is visible and too few teeth.
This is a phenomenon that in dentistry we call a gingival or gummy smile.
We want to emphasize something important right away. A gingival smile in itself is usually not a disease nor a sign that something is wrong with your health. First and foremost, it is an aesthetic characteristic, and whether you will correct it is entirely your personal decision and a matter of personal feeling. Our task is to clearly explain to you why this happens and what options exist today, so that you can make a calm decision that works for you.
What is a gingival (gummy) smile exactly?
A harmonious smile usually means that when smiling, teeth are visible and only a thin line of gum above them. When a smile reveals more than three to four millimeters of gum above the upper teeth, we speak of a gingival smile.
It is important to understand that there is no strict rule or ideal millimeter that everyone must have. It is about harmony and proportion between teeth, gums, lips, and the face as a whole. That is precisely why a gingival smile is not caused by just one factor. Behind it there is almost always a relationship between your teeth, gums, upper lip, and upper jawbone. To achieve a natural result, we must first discover which of these factors is decisive in your case.
Main causes: Why is too much gum visible?
The reason is rarely just one, and in many patients several factors overlap. Here is what most often causes excess gum visibility when smiling.
Delayed passive eruption (elongated gums)
This is a very common cause. When teeth erupt, the gums naturally recede to their place and reveal the full length of the crown. In some people this process remains incomplete, so the gums stay too low over the teeth. The teeth then appear short and small, although they are actually of normal size, and there is excess gingival tissue around them.
Hyperactive upper lip
In some people, the muscles that lift the upper lip work too hard. When smiling, the lip rises more than usual and thus exposes a larger surface of the gum. The teeth and gums are completely normal there, the problem is in the excessive mobility of the lip itself.
Short upper lip
Similar to the previous one, but of an anatomical nature. If the upper lip is naturally shorter, it does not cover enough of the gum even at rest, so the gums are more visible as soon as the person smiles.
Excessive vertical growth of the upper jaw
In some patients the cause is skeletal, that is, in the bone itself. The upper jaw has grown too much in height during development, so the gums are visible even at rest, and especially when smiling. This cause requires a special approach and cooperation with a maxillofacial surgery specialist.
Excessively erupted teeth
Sometimes the front teeth have erupted more than they should (so-called dentoalveolar extrusion), and they carry the level of the gums along with them. The result is that both the teeth and the gums are located lower than what is ideal.
Gum enlargement (gingival hyperplasia)
Gums can be enlarged due to chronic inflammation from the buildup of deposits, hormonal changes, or as a result of taking certain medications (for example, some blood pressure medications, antiepileptics, or immunosuppressants). In this case, we first address the health cause, and only then do we think about aesthetics.
How to recognize a gingival smile?
Unlike diseases, there is no pain or discomfort here. Patients most often notice themselves that when they smile, a wide band of gum is visible and the teeth appear shorter than they would like. Some become uncomfortable in photographs or in social situations and unconsciously restrain their smile.
We emphasize that this is not a reason to worry about your health. Still, if this appearance bothers you and affects how you feel, feel free to contact us, because today there are several safe and predictable ways to harmonize your smile.
Diagnosis: How we determine the real cause
Since the cause can be in the gums, lip, teeth, or bone, an accurate diagnosis is what separates successful correction from mere guessing.
We therefore observe how much gum is visible at rest and how much during a full smile, as well as how much and how your upper lip rises. We measure the length and proportions of the teeth and assess at what height the gum line is located. By probing and if necessary by X-ray or 3D imaging (CBCT), we check the relationship between the gums and bone, as well as any skeletal cause. All of this is often supplemented by photographs and digital smile analysis, so you can see the proposed final look before we do anything.
Treatment: How we correct a gingival smile
Since there are multiple causes, there are also multiple treatment methods. Whether the excess gum originates from the gums themselves, the upper lip, the position of the teeth, or the jawbone determines which method we will use.
Gum contouring (gingivectomy)
When the cause is excess gingival tissue, often due to delayed passive eruption, we reshape the gum line and reveal the full, natural length of the teeth. Today we most often do this with a laser, which means less bleeding, faster healing, and greater precision. After this procedure, the teeth appear longer and more harmonious, and the smile is more open.
Surgical crown lengthening
If, in addition to the gums, the bone itself is also too close to the tooth edge, simply shortening the gums would not provide a lasting result. We then perform crown lengthening, where in addition to the gingival tissue we carefully correct the level of the bone. This ensures that the new, more beautiful gum line is maintained and the tissue does not return to its original position.
Botox for hyperactive lip
When the cause is excessive lifting of the upper lip, we use a targeted application of Botox to gently relax the muscles that lift it. The lip then does not rise excessively when smiling and exposes less gum, while the smile remains completely natural. This is a temporary solution that is renewed every few months, but it is very simple, fast, and requires no downtime.
Lip repositioning
For patients whose lips are very mobile or short, and who want a more lasting solution than Botox, there is also surgical repositioning of the upper lip. This procedure limits how high the lip can rise, thus permanently reducing gum visibility.
Orthodontic therapy
If the cause is excessively erupted or misaligned teeth, the solution is orthodontic, either with transparent aligners or fixed appliances. By moving and retracting the teeth into the correct position, the level of the gums is also corrected, so the smile is harmonized in a natural way.
Orthognathic surgery
In cases where the cause is pronounced skeletal, that is, excessive vertical growth of the upper jaw, aesthetic interventions on the gums are not sufficient. Then, in cooperation with a maxillofacial surgery specialist, surgical repositioning of the upper jaw is planned. This is the most serious form of treatment and we recommend it only when it is truly necessary.
Aesthetic tooth build-up
When gum correction reveals teeth that are mismatched in shape or size, the final appearance is often completed with the creation of composite build-ups, ceramic veneers or crowns. With more extensive corrections, all of this can be part of a complete aesthetic transformation of the smile (Hollywood smile). This way we complete both the gum line and the appearance of the teeth themselves into one harmonious whole.
If the visibility of gums when smiling bothers you and you want to find out what the exact cause is in your case and which solution would best suit you, feel free to contact us and schedule a consultation at 065 8755449. Together we will go through all the options and choose an approach that brings back a smile you can enjoy without hesitation.
Note: This text is for informational purposes and does not replace a dental examination.