Gummy smile: causes of excessive gingival display and treatments

What is a gummy smile?

As you smile, the upper lip lifts and reveals the teeth, along with a variable amount of gum. Gingival display is not in itself a disease. How it is judged aesthetically depends on facial proportions, the teeth, the way the smile moves and your own preferences. You can have visible gums that are perfectly healthy, with no need for treatment.

Published work uses different thresholds to define excessive display, often around 3 to 4 mm. That measurement helps describe a situation; it does not make correction compulsory. The examination also looks at symmetry, the visible length of the teeth and the position of the lips at rest. A single photograph is not enough to understand how the whole smile works.

The term gummy smile therefore covers several anatomical realities. Teeth that look short because they are partly covered by gum are not the same problem as normally sized teeth exposed by a very mobile lip. The clinical review Excessive Gingival Display describes this diversity and how important it is to identify the cause before choosing the treatment.

The main causes of a gummy smile

Gum covering part of the dental crown

As the teeth erupt, the gum tissues change to reveal the crown. In altered passive eruption, part of the anatomical crown stays covered. The teeth then look shorter or squarer. The dentist looks for the position of the boundary between the enamel and the root, and for the position of the bone underneath.

Another situation is an increase in gum volume. It can be linked to inflammation, to certain medicines or to other causes. The tissues are sometimes red, swollen or prone to bleeding. The cause has to be treated and the contour reassessed before deciding on aesthetic reshaping. A swollen gum is not simply excess tissue waiting to be removed.

A short or very mobile upper lip

The length of the lip at rest and how far it moves are two different parameters. A lip of ordinary length can lift a long way under the action of the smiling muscles. This is known as lip hypermobility. Another person may have a relatively short lip without any particularly excessive muscle contraction.

This distinction influences how useful a botulinum toxin injection or repositioning surgery would be. Temporarily reducing muscle activity does not lengthen a bone or a tooth. In the same way, adding volume to the lips does not necessarily treat the mechanism responsible. The analysis has to cover the movement of the smile as much as its appearance at rest.

Tooth position and the height of the upper jaw

Incisors and their supporting bone sitting too low can increase gingival display. The dentist or orthodontist examines the occlusion, in other words the way the teeth meet, as well as their position in relation to the lips. Orthodontic treatment can be relevant when moving the teeth answers the cause identified.

Vertical maxillary excess is a bony component. It can go together with other facial or occlusal features. Orthognathic surgery may then be discussed, sometimes with orthodontic preparation. Reshaping the gum does not correct that skeletal dimension. Several causes can coexist and justify a plan bringing together several disciplines.

How is the diagnosis made?

The first appointment starts from what you are asking for: which part of the smile bothers you, in what circumstances and since when. The practitioner examines the lips at rest, the spontaneous smile and the broader smile. They assess dental and facial proportions. Photographs or a short video can document the movement and serve as a reference for the discussion.

The periodontal examination checks gum health, the presence of plaque, bleeding and the support around the teeth. The position of the bone in relation to the dental crown matters before lengthening surgery. X-rays, further measurements or an orthodontic work-up are offered if the diagnosis requires them. Three-dimensional imaging is not automatically useful in every case.

Your medical treatments, dental history and tobacco use should be reported. Some medicines encourage an increase in gum volume. Any change to them is discussed with whoever prescribed them; you should not stop them on your own. If inflammation is present, treating it can change the appearance of the smile and the procedure considered afterwards.

The medical and surgical analysis published by Laure Frison stresses how dental, periodontal, muscular and skeletal factors can combine. A useful diagnosis should let you understand which tissue will be treated, why, and how much of the smile should change.

Gingivectomy and crown lengthening: working on the gums

When a gingivectomy can be suitable

A gingivectomy removes part of the gum tissue. It can be considered when the display of the teeth is limited by an excess that is appropriate to remove, with a bone architecture and an amount of gum that make this possible. The procedure aims to redefine the contour while respecting the tissue the tooth needs to stay healthy.

The dentist has to work out how much height can be exposed without needlessly uncovering the root or compromising the gum attachments. Wanting longer teeth is not a sufficient goal on its own. Excessive removal can cause sensitivity, an unattractive contour or difficulties with cleaning. The balance with the neighbouring teeth also has to be anticipated.

When the bone has to be taken into account as well

In some configurations, removing only the gum does not leave enough room for the tissues that attach to the tooth above the bone. Crown lengthening with reshaping of the bone contour may then be necessary. This surgery is different from a small superficial touch-up and calls for more complete planning.

The position of the gum keeps changing during healing. The result cannot be judged simply when you walk out of the practice. Any prosthetic correction has to wait for sufficient stability, following the practitioner’s advice. If veneers or crowns are planned, ask how their timing fits with the healing of the gums.

Does the laser treat every form of gummy smile?

The laser can be used as an instrument for certain procedures on the soft tissues. It does not determine the indication. A gingivectomy carried out with a laser is still surgery that removes gum; it does not reposition an upper jaw and it does not on its own correct a hypermobile lip.

The words ‘laser’ and ‘incision-free’ can make the procedure sound trivial. Yet the tissue treated still heals, and excessive removal is still possible. The benefit has to be compared with that of other instruments for your situation, with no promise of a universally better result. The practitioner explains the anaesthetic, the recovery and the check-up planned.

Above all, ask whether the plan rests on an analysis of the bone and of the attachments around the teeth. A laser does not remove the need for that assessment. If the cause is bony or orthodontic, choosing superficial reshaping alone because it is quick can leave you with significant discomfort or create a disproportionate tooth contour.

Botulinum toxin: a temporary option for some hypermobile lips

Botulinum toxin temporarily reduces the activity of targeted muscles. In certain forms of gummy smile linked to excessive lifting of the lip, it can reduce the amount of gum on show. It does not treat gum inflammation, a partly covered tooth or a significant bony excess.

The practitioner assesses the movement, the symmetry and the muscular component before proposing the injection. The effect appears gradually and then fades, which can lead to repeat sessions if you want to maintain it. How long it lasts varies with the product, the individual response and the treatment. This solution should not be presented as permanent.

The systematic review by Razmaitė and Trakinienė finds favourable results, based on a limited number of studies. It does not allow anyone to promise the same effect in every person, nor to set a universal protocol. Your practitioner should specify the product, the status of its use in your country and the arrangements for follow-up.

Asymmetry, an unwanted change to the smile or functional discomfort can occur. The anatomy of the muscles around the mouth calls for a well-controlled medical procedure. Report your illnesses, treatments and any history of injections. If you find it hard to swallow, speak or breathe after an injection, seek urgent medical help. These effects are very rare, but they are among the risks of botulinum toxin set out by the American Academy of Dermatology.

Lip repositioning: indications and limits

Lip repositioning surgery aims to limit the lifting of the upper lip by altering its attachments in the vestibule, inside the mouth. Various techniques exist. It can be discussed for certain lip-related components, after analysing how much tissue is available and how far the bone is involved.

It should not be confused with the lip lift, which shortens the skin distance between the nose and the lip in order to change the position of the lip. The goals differ; a procedure that increases how much of the teeth shows can be unsuitable if you want to reduce a gummy smile. The exact name of the procedure and how it works therefore need to be explained.

After repositioning, tightness and swelling can appear. Restrictions on movement may be prescribed while healing takes place. The risk of recurrence varies with anatomy and technique. A significant skeletal component can limit the result. Ask what follow-up will be offered and how persistent gingival display would be interpreted.

A surgical result does not mean the lip becomes immobile or that every smile is perfectly symmetrical. The goal has to remain compatible with natural expression and with the functions of the mouth. Before choosing, compare the expected benefit with that of a temporary solution, a dental treatment or doing nothing at all.

Orthodontics and orthognathic surgery

When tooth position contributes to gingival display, orthodontics can move the teeth and their supporting bone towards a precise goal. Anchorage devices may be needed in some plans. This treatment extends over time and calls for monitoring of the roots, the gums and the occlusion. It is not equivalent to a cosmetic touch-up carried out in a single session.

Where there is vertical maxillary excess, orthognathic surgery can reposition the bone and act on the skeletal cause. It requires a specialist work-up, often coordination between an orthodontist and a maxillofacial surgeon, and preparation of the occlusion. The plan concerns facial balance and function, well beyond the gum line alone.

The anaesthetic, the hospital stay, eating afterwards and recovery all depend on the surgical plan. The risks include bleeding, infection, altered sensation, occlusal difficulties or the need for a second adjustment. These constraints have to be weighed against how much the problem bothers you and against any other issues being corrected at the same time.

Treatment confined to the soft tissues can sometimes improve the appearance of a bony component without correcting it completely. That compromise has to be stated clearly. You need to know whether the plan treats the main cause or only reduces part of how it shows, and whether the expected result suits you within those limits.

Are veneers and crowns necessary?

A gummy smile on healthy teeth does not automatically justify veneers or crowns. These restorations change the shape, the colour or the visible structure of the teeth; they do not replace a diagnosis of the gum and the lip. Preparing them can involve removing tooth tissue, which must have an indication of its own.

If the teeth are worn, fractured or show some other abnormality, a restoration can form part of an overall plan. The practitioner has to keep that need separate from the gum correction. Ask what improvement would be obtained by treating the tissues or the tooth position alone, and then what each restoration would add.

Dental care can bring several treatments together, but stacking them up is not a goal in itself. A digital simulation helps discuss proportions; it does not predict healing or the movement of the smile exactly. The choice should preserve healthy structures as far as possible and plan for future maintenance.

Recovery, healing and monitoring

Recovery varies widely between an injection, gum surgery and a bone procedure. After a periodontal procedure, limited bleeding, sensitivity or swelling can occur. The practitioner sets out what to eat, how to keep the area clean, which products are prescribed and how to brush while healing takes place. Do not apply advice meant for a different procedure.

Pain that intensifies, persistent bleeding, fever or swelling that gets worse should be reported. After more extensive surgery, the warning signs and the contact details should be given to you in writing. Follow-up checks healing, gum health and how symmetry develops, with adjustments if they are needed.

Photographic comparison should be done far enough after the procedure and in similar conditions. Lighting, head position and how broadly you smile can markedly change the impression of a result. A photograph taken with the lip lifted less does not on its own demonstrate that a treatment works.

In the long run, periodontal maintenance remains important. Recurring inflammation can make the gum contour vary. Ageing and lip mobility can also change the smile. A lasting result means an improvement that holds within a monitored context, without any guarantee that the appearance will stay strictly identical for life.

Cost of treatment: why quotes vary so much

The budget depends first on the cause and on the procedure chosen. A repeatable injection, a gingivectomy on a few teeth, lengthening with bone reshaping and a combined orthodontic and surgical pathway are very different forms of care. Comparing them purely on a ‘gummy smile’ price does not tell you what will actually be treated.

A detailed quote states the assessment, the teeth concerned, the fees, the anaesthetic and the follow-up appointments. For an injection, also consider the cost of repeat sessions if you want to maintain the effect. For surgery, ask about the costs linked to the examinations and to any separate orthodontic or prosthetic phase.

Whether any of it is covered depends on the indication and on the care setting. A mainly aesthetic goal and the treatment of a functional abnormality do not necessarily fall under the same rules. Have the possibilities confirmed by the professionals involved and by your insurer before you commit. No single price can describe the whole range of gummy smile treatments.

If you are considering care far from home, plan for the check-ups and for the chance to see the practitioner again once healing is complete. A reshaped gum should not be judged during a short stay alone. Your records, the photographs and the instructions should be transferable to the professional who will look after you when you get back.

Choosing a solution suited to your smile

A well-prepared decision rests on an anatomical explanation you can follow. You need to know whether the gum, the lip, the teeth or the upper jaw plays the main part, and which limits will remain after the treatment considered. When several causes are combined, ask why the procedures are being carried out together or one after another.

The plan should also set out what would be seen without treatment. A stable aesthetic feature and healthy gums often mean you can take your time to think. If periodontal disease or inflammation is found, it needs care regardless of your aesthetic choice.

Finally, say what change you genuinely want. Reducing gingival display can be a sufficient goal without trying to hide the gum entirely. The most relevant treatment is the one that matches your anatomy, protects your oral health and leaves you able to accept its constraints. You can ask for a second opinion when a major procedure is proposed for limited discomfort, or when the diagnosis remains hard to follow.

Sources

1. Brizuela, M., & Ines, D. (2023, 19 mars). Excessive gingival display. Dans StatPearls. StatPearls Publishing.
2. Frison, L. (2022). Analyse et prise en charge médico chirurgicale du sourire gingival. Revue d’Orthopédie Dento-Faciale, 56(1), 49–62. DOI : 10.1051/odf/2022007.
3. Razmaitė, A., & Trakinienė, G. (2021). The effect of botox for the correction of the gummy smile: A systematic review. Stomatologija, 23(3), 63–68.
4. American Academy of Dermatology Association. (s. d.). Botulinum toxin therapy: FAQs.