Your smile is one of the first things people notice. For many, it shows confidence, health, and well-being. A gummy smile or excessive gingival display (EGD) is caused by excessive gum tissue display when you smile. It affects how others see you and how you feel about yourself. Fortunately, modern dentistry offers a range of solutions, from simple non-invasive treatments to complex surgeries, aimed at creating balanced, natural results.
Each patient is unique, so the correct diagnosis and treatment plan are key to the best outcome. You may notice cosmetic improvements and better comfort and confidence with the proper treatment. At Agoura Hills Advanced Dentistry, our dentists combine advanced methods with a caring approach to help you improve your smile and comfort.
Understanding the Causes of a Gummy Smile
The first step in treating a gummy smile is identifying its cause. A single problem does not usually cause a gummy smile. It is typically caused by a combination of factors that involve the jaw, teeth, gums, and lips. Due to this, it is critical to provide a proper diagnosis before commencing treatment. The kind of treatment that will be most effective will be dependent on the underlying cause.
Skeletal (Jaw-Related) Causes
Sometimes a gummy smile happens because of how the jaw or facial bones are shaped.
Common jaw- and tooth-related causes include the following:
- Vertical Maxillary Excess (VME)
This is one of the most prevalent causes, and it occurs when the upper jaw grows excessively in a vertical direction. This makes the lower face appear longer and makes the upper teeth and gums more visible when you smile. A sign of VME is that the lower lip partially covers the upper teeth, particularly the canines and premolars.
- Dentoalveolar Extrusion
This occurs when the front teeth move downward. It often happens as a response to worn-down teeth or a deep bite. As the teeth shift lower, the gums come down too, which makes them show more when you smile.
Gum-Related Causes
The condition and status of the gums themselves may also be a factor.
- Altered Passive Eruption (APE)
This happens when gums do not move into position after teeth erupt. As a result, more gum tissues cover the teeth, making them seem shorter than usual. APE can often be improved with gum surgery.
- Gum Overgrowth (Hyperplasia)
This refers to excessive growth of gum tissue that may be caused by inadequate oral care, hormonal shifts (during puberty or pregnancy), or adverse effects of some medications, including some used to treat epilepsy, transplants, or heart conditions.
Muscular (Lip-Related) Causes
The movement of the lips may also cause a gummy smile.
- Hypermobile Upper Lip
This happens when the upper lip elevates approximately 6-8 mm during smiling. In individuals with a hypermobile lip, it can move up almost twice as much, revealing much of the gum tissue.
How the Dentists Diagnose a Gummy Smile
Since various factors may cause a gummy smile, its correct diagnosis is essential when deciding on the treatment.
Medical and Dental History
Your dentist will begin by examining your general health, including any drugs that can lead to enlargement of the gums.
Clinical Examination
- Extraoral (Outside the Mouth): Your dentist will examine your facial proportions, the length of the lips, and the way the lips rest and move during a smile
- Intraoral (Inside the Mouth): Your dentist will also examine the levels of the gums, the size of your teeth, and the appearance of teeth that appear shorter than usual. As an example, in young adults, the central front teeth are typically 10-11 mm in length; shorter teeth can be an indication of a gum-related problem
Examination using Radiographic and Imaging Equipment
- Cephalometric Analysis: This specialized X-ray examines skeletal causes like Vertical Maxillary Excess.
- Periapical X-rays: These are used to determine the level of the bone to the enamel, which is helpful in Altered Passive Eruption cases.
- Cone Beam Computed Tomography (CBCT): This gives a 3D view of the jaw and teeth and is often used in detailed surgical planning.
Why a Holistic Approach Is Essential
A gummy smile can be caused by more than one factor. For example:
A person with an overgrown upper jaw (skeletal) may also have a thin upper lip (muscular), making the gums appear more prominent. A patient with Altered Passive Eruption (gum-related) may also have thicker bone under the gums, which pushes the lip upwards.
Since these factors are interrelated, dentists should look at the entire picture, not just a single cause. This combined treatment ensures that the treatment is effective and long-term in terms of cosmetic appearance and any underlying functional problems.
Treatment Options for a Gummy Smile
A gummy smile is a condition that is corrected in an individualized manner. The most effective treatment varies depending on the cause, the visibility of the gums, and the patient’s comfort level regarding surgery and the recovery period. Options range from simple, temporary solutions to more advanced surgical solutions to create long-term results.
- Short-Term and Non-Surgical Treatments
These are the most suitable options for patients who desire instant results with minimal or no downtime. Nonetheless, they are not permanent, and they need to be maintained.
Botox Injections
Botox is sometimes used for gummy smiles caused by an overactive upper lip. The injection works by relaxing the muscles of the lips so that your lips do not rise as high when smiling, which reduces how much gum shows.
The procedure typically takes 10-30 minutes and is performed in the dental clinic. A topical numbing cream can be applied, and an excellent needle injects a small amount of Botox into the lip area. The results can be seen in 2-3 days and the full effect in approximately 2 weeks.
The results are temporary and last only 3–6 months. You will have to repeat the treatment to maintain the results. The side effects are mild and temporary, including slight bruising or swelling. Rarely, if the injection is not placed correctly, it can result in uneven smiles or drooping lips.
Hyaluronic Acid (HA Fillers)
Another nonsurgical alternative is HA fillers. They fill in the lips, which gives them more volume and less tension on the upward pull of the lip, resulting in a smoother, more balanced smile. The effects are instant and can last 6-10 months, longer than Botox.
Although relatively safe, fillers can be dangerous without a skilled practitioner. In extreme circumstances, complications such as the blockage of blood vessels may arise, which may cause severe effects such as tissue damage or even blindness. That is why visiting a qualified and board-certified provider is essential.
- Minimally Invasive Surgical Options
These treatments last longer than injections but are minimally invasive surgical procedures with shorter recovery times than major surgery.
Crown Lengthening and Gum Contouring
When the gum tissue is in excess and makes the teeth appear small or square, a crown lengthening/gum reshaping procedure can be done. Local anesthesia is used, and a specialist carefully removes and reshapes the excess gum tissue with a scalpel, laser, or other instruments. The bone beneath may also be manipulated to achieve better outcomes.
Recovery is usually fast. Most patients resume normal functioning within a few days, although it can take weeks before the gums heal. To recover, a patient is expected to adhere to a soft diet, avoid alcohol and cigarettes, and practice proper oral hygiene. Risks include bleeding, infection, sensitivity to hot or cold, or uneven gum lines in case of excessive tissue removal.
Lip Repositioning Surgery
Lip repositioning is an alternative for those whose lips move too high when smiling. It is performed in less than an hour and under local anesthesia. During surgery, a strip of tissue is taken out of the inside of the upper lip, and the lip is sewn into a lower position. This helps it not to lift too much, revealing less gum.
Most patients notice results quickly and resume their everyday lives within 2-3 days. The first week is characterized by mild swelling and tightness, but the recovery period is only 1-2 weeks. The risks are minimal and may include discomfort, temporary stiffness, or (rarely) recurrence.
Orthodontic Treatment with Temporary Anchorage Devices (TADs)
TADs are small screws inserted in the jawbone by an orthodontist. They are used as anchors to move teeth into a better position, particularly when teeth erupt too far down and result in too much gum display.
TADs are applied together with braces to reposition the teeth back up, and this minimizes the exposure of the gums. Their placement is fast and almost painless under local anesthesia. Patients can experience slight soreness in the short term. Oral hygiene is also essential to avoid infection.
Although TADs are less invasive than jaw surgery, they risk loosening or irritating the surrounding tissues.
Major Surgery Options
In extreme cases, when the issue is caused by the structure of the jawbones, surgery might be the only possible solution, even an advanced one.
Orthognathic (Jaw) Surgery
This is typically advised in patients with severe jaw problems, including vertical maxillary excess (VME), in which the upper jaw is too long. This surgery can improve appearance and help with chewing, speech, or breathing problems.
The full treatment process usually takes 2–3 years and involves orthodontists and oral surgeons. First, the teeth are aligned with the help of braces. Next, during the surgery, the upper jaw is moved upwards (Le Fort I osteotomy). In other instances, the lower jaw or chin is also corrected to balance.
The procedure is carried out in a hospital under general anesthesia. Healing requires a 1-4 day hospital stay, weeks of swelling, a limited diet (liquids and purees at first), and slow healing. It takes 6-12 weeks to recover, but it can take up to a year to heal.
The risks include the following:
- Infection
- Bleeding
- Recurrence of the jaw position
- Nerve damage (causing numbness in the lips or the chin)
- A second surgery
Due to the physical and emotional requirements of such a procedure, patients are usually screened before the procedure to ensure they have realistic expectations.
Combination of Treatments
Since a gummy smile can have multiple causes, combining treatments is essential for a more balanced smile. For example, if a patient has an overgrown upper jaw and an upper lip that rises excessively, treating one cause could lead to some improvement. Still, to achieve a balanced smile, your dentist would have to perform a TAD to correct the excessive gum tissue. Also, gum reshaping can be used along with Botox to achieve a more balanced result, or jaw surgery can be used in conjunction with orthodontics to achieve a complete result.
Costs of Gummy Smile Treatment
The cost of gummy smile repair varies according to the cause and the treatment used. The following are the costs of the various procedures:
Crown Lengthening (Gum Contouring)
This is done to reform the gum line and, sometimes, the underlying bone to reveal more of the natural tooth. It usually costs between $300 and $3,000, depending on the number of teeth being treated and the necessity of bone recontouring. Dental insurance can cover part of the cost if done on functional grounds (such as to enhance oral health or prepare a crown). Cosmetic cases are not as likely to be covered.
Orthognathic Surgery (Jaw Surgery)
Being the most complicated, invasive, and expensive of the options, orthognathic surgery typically ranges between $20,000 and $40,000. This procedure usually involves the surgeon’s cost, anesthesia, hospital, and aftercare. Although expensive, it offers long-term outcomes, enhancing the beauty and functionality of the face. Insurance can assist if the surgery is used to correct chewing or breathing issues.
Lip Repositioning Surgery
This is a minimally invasive surgery that pulls the upper lip down to minimize the gums on show. Prices tend to be between $500 and $5,000, depending on the provider’s experience, the case’s complexity, and the location. It provides a long-term fix to hypermobile lips at an average cost relative to jaw surgery.
Temporary Anchorage Devices (TADs) in Orthodontics
TADs are applied in orthodontics to assist in moving teeth more accurately, including intruding over-erupted teeth. A TAD alone can cost between $300 and $600 per device but is usually included in a more comprehensive orthodontic package, costing between $3,000 and $8,000+.
Botox Injections
If the gummy smile is due to hyperactivity of the upper lip, your doctor may apply the non-surgical procedure known as Botox injections. Each session costs $200-$500, and the results last about 3-4 months. Because the results are short-lived, patients must anticipate continuous therapies to keep their smile.
Hyaluronic Acid (HA) Injections (Dermal Fillers)
Dermal fillers may add volume to the upper lip to minimize gum show. It costs approximately $600-$700 per vial on average, and the results last 6-10 months. Like Botox, it is a recurrent cost if you desire to sustain your results.
A thorough consultation with your dental professional will provide personalized cost estimates and a detailed recovery plan tailored to your treatment.
Follow-Up Care and Management
No matter what treatment you choose, the most essential part of the healing process is to follow up with diligence to ensure optimal healing, reduction of complications, and the long-term viability of your outcomes. What you specifically need to do will depend on your unique needs, but general directions may include:
- Over-the-Counter Pain Relief: Most procedures, particularly surgical procedures, are associated with mild discomfort. This can usually be managed by non-prescription pain relievers such as ibuprofen or acetaminophen.
- Restrict Physical Activities: To avoid swelling, bleeding, or dislodging sutures, it is advised to restrict vigorous physical activities for at least one week, and in more invasive surgeries, even longer. Rest is key to healing.
- Dietary Changes: It is critical to avoid hard, crunchy, or seeded foods, especially following gum or jaw surgery. These may irritate surgical areas, dislodge sutures, or become lodged in healing sites, causing pain or infection. A soft-food diet, occasionally liquid during the first jaw surgery recovery, is recommended.
- Keep the Mouth Clean: Although it is essential to be gentle, regular oral care is necessary. Your dentist will give you specific guidelines for brushing and flossing around the treated areas. A soft-bristle brush, special rinses, or special methods are often recommended to keep the mouth clean without causing irritation.
- Follow-Up Appointments with Your Dentist/Specialist: These visits are essential to check your progress in healing, remove sutures when needed, and discuss any concerns. Not seeing the dentist regularly can undermine your performance.
- Get Help When Swelling, Pain, or Bleeding Does Not Improve: Although post-operative pain is normal, persistent swelling, intense pain that cannot be relieved by painkillers, or unusual bleeding are symptoms that require your dental professional to be contacted at once. Minor problems can be avoided by early intervention and turned into significant issues.
Find Efficient Dental Services Near Me
Treating a gummy smile can improve your appearance and may boost your self-confidence. You now have more personalized options, including temporary solutions such as Botox to lasting surgical treatments and new advances such as lasers and TADs. The key to a successful procedure is proper diagnosis, expectations, and a treatment regimen that fits your needs. At Agoura Hills Advanced Dentistry, our dentists are dedicated to offering advanced, personalized care to help improve your smile and confidence. To learn more about the best option available to you, contact us today at 818-878-7300.