The gummy smile is a facial alteration that is defined by the excessive exposure of the gums when smiling. Its causes and treatments are diverse. Here we tell everything about this aesthetic problem.
A) What is a gummy smile?
In general, the ideal smile line should be a curve parallel to the lower lip, and the upper lip should reach the gumline of the maxillary central incisors. But there are various situations in which this line can be altered. It is said that a person has a gummy smile when a disproportion between the teeth and the gums is appreciated when smiling.
B) Causes of gummy smile
This disproportion between the size of the teeth and the gum can have various causes. These are some of the most common:
B1) Short upper lip, one of the reasons for the gummy smile
An upper lip that is too short can cause more gum to show than normal. This may also be due to a very prominent frenulum that prevents the lip from lowering to its natural resting position.
B2) Developed levator muscle
This small flat muscle attached to the maxilla is tasked with pulling on the upper lip. An excessive development of this muscle or its hyperactivity can be another cause of a gummy smile.
B3) Excessive upper jaw
The bony piece located at the top of the mouth where the teeth are housed is known as the upper jaw or maxilla. Excessive growth of this maxilla can cause more gum to be exposed than normal.
B4) Altered passive eruption, a common cause of gummy smile
Tooth eruption consists of two phases: active and passive. In an active eruption, the tooth emerges through the gum into its final position in the mouth, but part of the crown is still covered by the gum. In the passive eruption phase, the gum that covers the crown moves towards the root of the tooth until it is completely exposed. We speak of altered passive eruption when the gum does not recede to its normal level once the dental eruption process is complete, giving rise to a gummy smile.
B5) Tooth malocclusion
Occlusion is the way the teeth fit together in the mouth. We speak of malocclusion when there is a problem in this fit, something that can also favor the presence of a gummy smile, especially when the incisor teeth are lower than the neighboring teeth.
B6) Worn teeth, another cause of gummy smile
Tooth wear is the loss of enamel, the outermost structure of the teeth. In more advanced cases of wear, the dentin of the tooth can also be affected. This wear can unbalance the proportion between the tooth and the gum, a factor that causes the gummy smile.
C) How to correct gummy smile
In general, the gummy smile is normally an aesthetic problem, that is, it does not pose any risk to oral health. However, this anomaly affects the patient's physical appearance, which can end up triggering self-esteem problems. It is also true that in cases where the cause is a malocclusion, a bone problem or a consequence of dental wear, this can affect oral health. Whether for purely aesthetic or functional reasons, there are various treatments to correct it:
C1) Orthodontics
It is recommended to make a correct craniofacial diagnosis if the gummy smile is related to a dental occlusion problem. Orthodontic treatment can be scheduled based on this diagnosis, since it is possible that the gum levels vary when moving the position of the teeth.
C2) Gingivectomy, a way to correct the gummy smile
Gingivectomy consists of cutting the excess gum that covers the crown of the tooth, exposing a larger amount of tooth and achieving an aesthetic improvement. Keep in mind that the healing time of the gum after gingivectomy can go from two to three weeks, although it is a common and generally simple intervention.
C3) Aesthetic gum surgery or gingivoplasty
Gingivoplasty is a plastic gum surgery that consists of shaping the gums to restore their normal architecture and physiology. In this case, the gum is not cut, but it is about repositioning it or even modifying the position of the mucosa, reducing the path that the lip has to make when smiling.
C4) Crown lengthening and ostectomy
Another solution for gums that are too big can be tooth crown lengthening. This contours the excess gum and bone tissue to expose more of the natural tooth. It can be done on one tooth to even out the gum line or multiple teeth to expose a wide natural smile. This lengthening requires an ostectomy or osteotomy, two surgical techniques that consist of removing or remodeling the bone that surrounds the tooth, respectively.
C5) Botox and hyaluronic acid to treat gummy smile
The use of botox and hyaluronic acid can also be a solution for those cases of gummy smile whose origin is due to the hyperactivity of the upper lip levator muscle. These injectables can regulate the functioning of this muscle and prevent excess gum from showing when smiling. Filling with hyaluronic acid can also help modify the path that the lip has to take when smiling.
C6) Orthognathic surgery, another solution for excess gum
Orthognathic surgery groups together all those treatments that allow correcting the conditions of the jaws and face due to skeletal disharmony and that can cause problems. One of these surgeries is the anterior impaction of the maxillary bone, which can solve those cases of gummy smile caused by the excess of the maxilla. This procedure is usually coupled with orthodontic treatment.
