A gummy smile, professionally known as excessive gingival display, occurs when more than a small amount of gum tissue is visible above the upper teeth while smiling. A display of three to four millimeters or more of gum tissue is often considered unaesthetic and can affect a person’s confidence. Since a smile involves a precise balance between the lips, gums, and teeth, any disproportionate feature can create a gummy appearance. This article explores the causes of a gummy smile and examines the effectiveness of traditional braces and other treatments in achieving a balanced smile aesthetic.
Defining the Root Causes of a Gummy Smile
The underlying reason for excessive gum display is rarely singular, making accurate identification the first step toward effective correction. Causes generally fall into three main categories: skeletal, dentoalveolar, and soft tissue or muscular.
A skeletal cause, known as Vertical Maxillary Excess (VME), is an overgrowth of the upper jawbone that extends too far downward. This disproportionate bone structure pushes the gums down, making them prominent when smiling. VME is often diagnosed using specialized X-rays.
Dentoalveolar causes relate to the teeth and the bone structure immediately surrounding them. This includes teeth that have over-erupted (dentoalveolar extrusion) or teeth that appear short because they did not fully emerge from the gum line (altered passive eruption). The relative shortness of the teeth can also make the gum tissue look prominent.
Soft tissue or muscular factors involve the lips and gums themselves. Some people have hyperactive upper lip muscles that lift the lip too high when smiling, exposing a large band of gum tissue. Excessive gum tissue (gingival hypertrophy) can also be a factor, sometimes due to genetics, certain medications, or inflammation.
How Orthodontics Addresses Gum Display
Traditional orthodontic treatment, using braces or clear aligners, can be an effective solution for gummy smiles caused by dentoalveolar issues or mild jaw misalignment. The primary way braces address a gummy smile is through dental intrusion, which involves pushing the upper front teeth and surrounding bone upward into the jaw. This movement shortens the vertical dimension of the tooth-and-gum segment, reducing gum visibility.
For more precise intrusion, orthodontists often use Temporary Anchorage Devices (TADs), which are small, temporary titanium screws placed into the jawbone. TADs provide a stable, immovable anchor point from which to apply force, unlike traditional braces that rely on other teeth for support. This allows for controlled and efficient upward movement of the teeth, useful in moderate cases of gummy smile.
Braces can also correct an overbite, or deep bite, where the upper teeth excessively overlap the lower teeth. Moving the teeth into a more aligned position improves the overall bite relationship, which can secondarily reduce the appearance of excess gum. However, conventional braces alone are not sufficient to correct severe skeletal issues, such as VME, or problems related to a hyperactive lip muscle.
Non-Brace Treatments for Gummy Smiles
For causes that braces cannot fix, several alternative and complementary treatments are available, often used in conjunction with orthodontics. If the cause is excessive gum tissue, a gingivectomy (gum contouring) uses a laser or scalpel to remove the excess tissue and reshape the gum line. When the underlying bone contributes to the problem, crown lengthening surgery is performed to remove both gum tissue and a small amount of bone, providing a permanent result.
For a hyperactive upper lip, a temporary solution is the injection of Botulinum Toxin (Botox) into the muscles controlling the lip. This relaxes the muscles, causing the lip to sit lower over the gums when smiling, with effects lasting approximately three to six months. A more permanent option is lip repositioning surgery, which restricts the upward movement of the lip.
When excessive gum display is due to severe Vertical Maxillary Excess, the definitive treatment is orthognathic surgery (jaw surgery). This procedure involves an oral surgeon physically moving the upper jaw upward and securing it in the correct position. Jaw surgery is often performed after a patient has completed a phase of orthodontic treatment to align the teeth.
Determining the Right Treatment Path
Choosing the correct treatment depends entirely on accurately diagnosing the specific underlying cause or combination of causes. A proper diagnosis requires a comprehensive assessment that includes a visual examination, measurements of the lips and teeth, and diagnostic imaging like X-rays. These tools help differentiate between skeletal, dental, or muscular/soft tissue issues.
It is beneficial to consult with a multidisciplinary team of specialists to determine the optimal treatment plan. This team typically includes:
- An orthodontist, who specializes in tooth movement.
- A periodontist, who specializes in gum health and surgery.
- An oral and maxillofacial surgeon, for complex cases involving jaw structure.
The final treatment path is a tailored approach, which may involve a single procedure or a combination of methods like braces and gum contouring.