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Too Much Gum Tissue Shows When I Smile: What Can Be Done?

Before – After

One of the things we notice when meeting a person for the first time is their smile. A smile does not just involve the teeth themselves, but also the gum tissues that act as the frame around the teeth. If either the teeth or the gum tissue are out of proportion, unwanted attention may be brought to these areas. Our eyes tend to be drawn to things that “do not seem” right. Imagine purchasing the latest, greatest TV and noticing a big dent in the frame around the television. Very typically, our attention will be brought to the dent and not the beautiful picture on the screen. We frequently see this type of issue in dentistry with patients who are bothered by a “Gummy Smile”.

Gummy Smile Treatments:
A variety of treatment options exist based on the cause of a “Gummy Smile”. In the case of inflamed gums due to excess plaque, initial periodontal treatment including scaling and root planning (deep cleaning) may be all that is needed.

In the case of excess gum tissue, the proper amount of visible tooth and gum can be restored to a more natural and esthetically pleasing ratio to fit the frame of your smile with a “Gum Lift”. This procedure, also known as esthetic crown lengthening, can help reshape your gums to reveal the part of the tooth covered by excess gum tissue. Depending on the specific situation, this procedure may be performed in conjunction with cosmetic dental procedures (such as veneers or crowns) on the teeth being treated. In either case, the outcome is to provide you with a more pleasing smile. This type of procedure may be possible with a laser alone in certain circumstances.

It is possible to have the appearance of excess gum tissue, even if the appropriate amount exists, due to a very mobile upper lip. In these cases, the “curtain” or lip moves very high towards the nose when one smiles. A variety of treatment options exist for this type of situation. Use of Botox® can help prevent the excess lip movement, but must be repeated every number of months. Small periodontal procedures to help reduce lip movement are also an option. In some extreme cases, more involved surgical procedures may be recommended.

Causes Of Excess Visible Gum Tissue:
It is fairly common to see excess gum tissue around one’s teeth. This type of problem can give the appearance of very short teeth or a smile dominated by gum tissue.
A variety of reasons exist why a “Gummy Smile” may appear. In some situations, a skeletal deformity may exist, but more typically a number of very treatable issues cause this presentation.

One common condition leading to this appearance is called “altered-passive eruption”. This type of problem occurs as the teeth erupt through the gums and descend toward their final position. The gum tissue does not completely retract upwards to its ideal position, leaving excess gum covering part of the tooth that should be visible.

Inflamed gum tissue can also appear due to plaque and bacteria accumulation around the teeth. This excessive, puffy, red-blue tissue can occur from ineffective oral hygiene. Often, plaque retention from appliances like braces make proper home care more difficult and this situation more likely to occur. In addition, certain medications make the gums more sensitive to plaque and increase the chance of gum inflammation becoming a concern.

Another common reason for the appearance of excess gums is the presence of a “big smile” or a “high lip line”. If we think of the lip as a curtain, the amount of tooth and gum that will show depends on how high the curtain is pulled up. Many individuals have an upper lip that barely moves even with the biggest of smiles (showing almost no gum and minimal teeth during smiling), while others with a broad smile reveal every part of their tooth and gum tissue up to their nose.

Lastly, the appearance of excess gum tissue can occur when teeth become significantly worn down, altering the balance between the visible tooth structure and the gum tissue.

It is important to realize that there is no one treatment to fit all the possible situations. A complete periodontal evaluation, with a recent set of dental x-rays, is needed to determine the unique dental needs of each individual gummy smile. Fortunately, many patients who do not like their smile or appearance due to this issue, can be treated in a fairly simple manner once the exact cause of the appearance of the excess gum has been diagnosed.



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