Do you show too much gum tissue when you smile? What causes this and how can it be fixed?

The three variables that can cause a gummy smile
The official term for a “gummy smile” is excessive gingival display. Excessive gingival display can be the result of several different conditions and the most appropriate way to correct it depends upon the underlying cause. There are three primary components of the smile that determine how much gum tissue is visible, 1) the lips, 2) the teeth and supporting bone, and 3) the gums themselves.

The upper lip may be too short
If all other factors are normal, the upper lip may be responsible for a gummy smile if 1) it is too short, or 2) it is too active. It is not hard to imagine that if your upper lip is too short to cover the teeth and gums at rest, your gummy smile may be a result of the inadequate lip length. If your lip length is normal at rest but lifts up too high when you smile, you may have a hyperactive or “hypertonic” lip. It is important to consider the length of the upper lip before moving the teeth or jaws to match it. If the rest of the face is normal, changing it to match a short lip may make the face look too short. There are now surgical procedures that can be done to both lengthen the lip and reduce its tonicity (usually by relaxing the associated muscles). There are also other less invasive procedures (like Botox), but these usually provide only temporary results (whereas the surgical procedures are more permanent).

The upper jaw may be too long
If your lip length and muscle activity are normal, and the length of the gum tissue over the crowns of your teeth is also normal, the problem may be with position of your teeth or jaws. Sometimes, the jaws are in a normal position but the teeth are just too long. Alternatively, the teeth may be the right length but the entire upper jaw is overdeveloped (maxillary skeletal excess). If the teeth or jaws are only slightly long, braces alone or braces with TADS (temporary anchorage devices) may be enough to intrude the long teeth and “tuck” the attached gum tissue back under your upper lip. If the amount of excessive gum displayed due to the elongation of the teeth or upper jaw is more than 2mm or 3mm, moving the entire jaw upward may be the only remedy. Again, it is very important that the teeth or jaws are only repositioned if it had been determined that the lips and amount of gum tissue are normal.

The gums may be too long
Lastly, if your lips, tooth length, and upper jaw size are all normal, it may be that the gums themselves are just too long (gingival hypertrophy or teeth that just haven’t fully erupted). This can be determined by an orthodontist using a periodontal probe. He can tell where your gums lie on the teeth and if they really are too long. If so, the remedy is to have a periodontist surgically remove the excessive gum tissue. This procedure is referred to as a gingivectomy.

Key to correction is determining the actual cause
Since there are so many variables that come into play, it is important that your gummy smile be diagnosed by a specialist (an orthodontist) before any fix is prescribed. If you show too much gum tissue because your upper lip is too short or overly active, the treatment should address your lips and not the teeth or jaws. If, however, the problem lies with your teeth or jaws, you should correct those and not try to fix the problem by changing the lip or gum position. Orthodontic specialists are experts in evaluating the lips, teeth and jaws, gums, and how they all work together to create an attractive smile.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 30,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.