A gummy smile is when a lot of gum shows in your smile. It can be caused by many different things. It can happen because of the shape of your jaws or because of gum growing over your teeth. Often a gummy smile is not a problem but patients regularly ask us if it can be changed. So we’ve asked Zainab Malaki to talk you through it. Zainab is a gum specialist. She regularly helps patients with a gummy smile that is being caused by gum problems.

It’s common to see some gum when smiling. The average amount of gums that you can see while smiling is 1-2mm around the upper front teeth. Showing more gum than this can be called a gummy smile.

There are several factors that cause a gummy smile:

• Short teeth (maybe due to tooth damage or grinding)
• Jaw shape (such as a long upper jaw)
• Short upper lip
• Swollen gums (due to poor toothbrushing or medications)
• Failure of the gum to fully uncover the teeth as they come through (known as delayed passive eruption)

Some medications could lead to gummy smile. These include the following:
• Blood pressure medications like Calcium channel blockers (e.g. Amlodipine, Felodipine, Adalat)
• Medications after organ transplants (e.g. Cyclosporin)
• Epileptic medications (e.g. Phenytoin)

The good news with these medications is that you can reduce the overgrowth of gum if you keep your teeth perfectly clean. Cleaning away plaque is the key.

And lets not forget that the most common cause of swollen gums is poor brushing. If brushing improves, swelling reduces and the amount of gum you show will reduce. For tips on caring for your mouth, read our article.

But if there isn’t an easy solution to your gummy smile, a dentist first needs to work out what is causing it. This involves a detailed examination of the teeth but also face proportions and the length of your lips.

Treatment depends on the cause of the gummy smile. The main aim of any treatment is to ensure comfort, function and appearance. Treatment needs to give the appearance that you want with a stable outcome that you can keep clean.

The following is a list of factors that need to be considered by your dentist as part of any treatment:

1. Good toothbrushing and a balanced, healthy diet are key to getting a stable end result.
2. Treatment of gum disease and tooth decay must happen before moving onto the more complicated stuff.
3. It is important that patients are healthy enough to have treatment and that they do not smoke.
4. If it is necessary to remove some gum surgically, the dentist may also need to carefully remove a little bit of bone so that the end result is stable.
5. Occasionally, swollen gums could be due to poorly contoured crowns previously made that are making the gums inflamed. If this is the case, the crowns may need replacement.
6. If the gummy smile is being caused by the shape of the jaws, you may need to see a maxillofacial surgeon and orthodontist (braces specialist). For example, a very long upper jaw may require surgery.
7. If the gummy smile is caused by medications, you may need to speak to you doctor. Blood pressure medications can often be changed simply. It’s not as easy with immunosuppressant drugs that are required after an organ transplant.
8. A gummy smile can be caused if your upper lip is pulled up a lot when you smile. This can be caused by the tension and strength in the muscles of the face. If this is the case, botox could be used to stop the lip coming up so far.

Before treatment of gummy smile
After treatment of gummy smile

Before and after treatment of a gummy smile

As dentists, we are able to change the shape and position of the teeth involved. We can change the position of the gum line as well as the position of the upper lip. However, treatment of gummy smiles could involve a team of dentists and specialists with different skills to get the best result.

The key is working out why so much gum is showing in the smile. Once you know the cause, you can choose the appropriate treatment to get the best outcome.

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