When you smile, the height of the exposed gum tissue (gingiva) above your upper front teeth is known as the gingival level. The higher your upper lip goes, the greater the gingival display.
The gingival level varies from person to person. In proportion to tooth height, it may seem too great or prominent. You may see this when someone else smiles, and say to yourself, “Gee, that’s a happy person,” because their smile is expansive, and they seem socially confident. You may see this when you smile in the mirror and say to yourself, “This doesn’t look right. I wish my gums weren’t so large.”
People react in different ways, but a research study found that, in general, people (who are not dentists or dental specialists) thought a gingival level of 3mm or more is unattractive.
My philosophy is if it bothers the patient, and the patient wants to have it treated, then yes, I should help the patient have treatment to decrease the gingival level.
Treatment for a gummy smile depends on the cause of the gummy smile. A gummy smile may be the result of a short upper lip, an upper lip that moves too much, upper teeth having descended too far (over erupted) or not having descended far enough (under erupted), gum tissue that has overgrown, or the shape of the maxilla.
Orthodontics can be used to move over erupted upper teeth back into the maxilla some. Orthodontics can be used to move under erupted upper teeth downward. Periodontal surgery can be done to remove some of the periodontal tissue. This is called root crown lengthening and is usually done on short teeth. Orthognathic surgery can be performed to modify the maxilla (upper jaw). In the case of a hypermobile (overactive) upper lip, lip positioning surgery or Botox injection have been known to help.
A close friend of mine had a gummy smile and malocclusion that was causing premature wear on her teeth. Her treatment plan was designed to improve her bite, so her molars could be predictably restored with long-lasting crowns and in the process eliminate the TMD discomfort she experienced. Another goal was to improve the appearance of her smile. In her case, orthodontics was followed by orthognathic surgery to modify the shape and angle of her maxilla. After this, her molars were crowned, and she also had root crown lengthening to reduce the gingival height. This was a “big case,” but extensive treatment saved all her natural teeth, provided a harmonious bite, eliminated TMD pain, and greatly improved her smile.
Fortunately, for most patients, orthodontics or root crown lengthening is the only treatment needed. Sometimes, the gum tissue around only a couple of teeth needs to be recontoured, and that is very simple. The solution might be that simple for you.
If you are concerned about your smile, I encourage you to talk about it. Let’s explore your concerns, your oral health circumstances, and what treatment is possible. It may not be a gummy smile that drives you to seek solutions, but if the appearance of your gingiva does concern you, please speak up. I work in collaboration with the Boynton Beach area’s finest specialists for my patients who need orthodontics or oral surgery. They, in turn, do their best to make sure my patients have a comfortable experience and exceptional results.
You are invited to schedule a smile consultation with me or speak up about your smile appearance concerns when you next come in for a checkup and dental cleaning. I promise to be a good listener!
– Jamie J. Alexander, D.D.S.