What's a Gingival Smile and How's It Treated?

A gingival smile can be uncomfortable for the person who suffers from it. Although it's not a health problem, it can be an aesthetic inconvenience. Here, we'll tell you why it can happen and how to solve it.
What's a Gingival Smile and How's It Treated?

Last update: 11 May, 2021

Smiling is a healthy act – a demonstration of joy and connection with other people. But for some, the presence of a gingival smile can affect this simple action.

This is a condition in which a person’s smile exposes more gum tissue than normal. People who suffer from it think that their gums are too big, that their teeth are too small, or that their lips move too much when they laugh.

Below, we’ll tell you what this alteration consists of and why it occurs. Also, we’ll tell you what solutions exist.

What’s considered a gingival smile?

A gingival smile, or gummy smile, is a condition in which the gum tissue predominates over the teeth. The perception depends on each patient and the characteristics of their face. But, in general terms, it’s when more than 3 or 4 millimeters of gum are displayed when smiling.

This lack of proportion between teeth and gums can produce visual effects such as very large gums, very small teeth, or small lips. Although it doesn’t represent a health problem, it’s an aesthetic issue that can affect the well-being of those who suffer from it.

A man and a woman smiling at one another on the street.
Smiling is an important social act, which is why some people can feel self-conscious regarding the appearance of their smile.

What causes a gingival smile?

The origin of a gingival smile can be dental, osseous, or muscular. It can also be due to the presence of occlusal or skeletal pathologies. Below, we’ll detail the most common causes.

Excess gingival tissue

This is the presence of more gum tissue. The gums look long and the teeth, although they are normal in size, appear to be small due to the lack of proportion between the two tissues.

Some patients present increased growth of idiopathic gingival tissue (this means that the cause is unknown). But the increased volume of the gums can also be due to gum inflammation or gingivitis and the use of some medications.

Medication to prevent seizures, antihypertensives drugs, or immune system inhibitors can cause gingival hyperplasia. Gums grow too much around the teeth and require treatment because they can completely cover the teeth and cause periodontal problems.

Short lip or with greater mobility

If the lip is smaller, it’s not wide enough to cover the gums when a person smiles. In the case of hypertonic or hyperactive lips, which are more mobile, they stretch and lift too much. As a result, they reveal an excessive amount of gum tissue.

Differences in the growth of the teeth

Sometimes a gingival smile is due to the way permanent teeth elements emerge. In these cases, there’s usually a family hereditary factor involved.

The altered passive eruption happens when the gums cover more of the tooth surface than normal when the teeth emerge, leaving part of the crown of the tooth covered by the gum. This produces a gingival smile.

Dental over eruption is the excessive extrusion of a tooth. In general, it occurs when a dental element seeks contact with its antagonist, which has lowered its level due to excessive wear or which is no longer there because of an extraction. The gum accompanies this dental movement by increasing its thickness and showing through during the smile.

Occlusal problems

In cases where the upper teeth almost completely cover the lower teeth when occluding, we’re talking about an overbite. In these cases, a gingival smile can appear, as the height of the teeth and upper gums are below normal and are visualized when smiling.

An open bite can also be the origin of a gingival smile. When the height of the front sector increases and can’t occlude, the lips don’t cover the gum, leaving it exposed.

Bone causes

When the upper jaw grows more than normal, a condition called maxillary vertical excess occurs. The level of the gums and upper teeth is lower than the rest of the face, making them more visible when smiling.

Available treatments for a gingival smile

There are several options when it comes to resolving this condition and improving the appearance of a person’s smile. The choice of treatment will depend on the causes that are producing the issue.

Here are some of the options for solving this aesthetic problem.

Gum surgery

Gingivectomy is an oral surgery that consists of contouring the gums by removing excess tissue. It’s a simple intervention under local anesthesia performed by the periodontist in the dental office.

With a scalpel or a laser, the gum margins are trimmed, eliminating the excess tissue. A larger surface area of the teeth is left uncovered. It may also be necessary to trim the bone.

The gums may bleed and hurt after surgery. But recovery is quick, simple, and leaves no scars.

Lip repositioning surgery

When the cause of the gingival smile is labial, surgical intervention may be necessary to change the position of the lips concerning the teeth. It consists of removing a portion of connective tissue from the lower part of the upper lip to prevent the muscles involved in laughter from elevating it too much.

Again, it’s performed under local anesthesia. The cuts are made in the lip for the removal of the connective tissue and then sutured. Recovery is usually quick and the results permanent, although there are cases of recurrence.

Orthognathic surgery

Orthognathic surgery is used in cases where the origin of the gingival smile is bone growth. Through surgery of the jaws, the height of the jaws can be balanced.

These cases must be approached in an interdisciplinary manner, require a lot of previous planning, and are accompanied by orthodontic treatment. The change in the patient’s face is very noticeable.

It involves the use of general anesthesia in the operating room. The surgeon sections a fraction of the upper or lower jaw bone and then reattaches the ends with plates or screws.

The hospitalization lasts several days and the recovery process is slow. Elastic bands and appliances are used to keep the jaw immobile while it heals. Then, it must be complemented with orthodontic treatment. It’s a slow process that takes several years.

Orthodontics

The use of attached or removable appliances will help to align the dental elements in the correct position. It serves to relocate teeth with over eruption, for example.

It’s also useful to treat occlusal problems, such as open bites and overbites, which produce the visual effect of the gingival smile.

A woman undergoing and orthodontal procedure.
Orthodontics can be useful in treating a gummy smile in specific cases.

Botulinum toxin injections

Botulinum toxin (botox) injections can be the solution for cases where the gum shows excessively due to excessive movement of the lips upwards during the smile.

The injections are placed at the base of the nose. This paralyzes the lip-lifting muscles, leaving them with less force to lift them completely when smiling.

The disadvantage of this treatment is that it requires repetition every 3 or 4 months to maintain the effects. Also, if too much is injected, the smile will become distorted.

Hyaluronic acid

This substance is also useful for gingival smiles due to hypermobile lips. It consists of the application of filler injections in the lip. This restricts the movement of the muscle fibers.

Its effect can last up to 8 months. Although doses are usually small and complications from its use are rare, it’s important to know the adverse effects of this substance.

Smile without shame

A gummy smile, in general, isn’t due to an oral health problem, but it can be annoying for those who suffer from it. Complexes, embarrassment, and habits such as covering one’s mouth when laughing are common in these people.

It’s important to recognize their origin to arrive at a proper diagnosis and thus choose an appropriate solution. Treatments are varied, so a consultation with a dental professional is the first step in solving this problem.

Smiling must be pleasant for everyone. If a gingival smile impedes doing so freely, professional help should be sought. As we mentioned, there are many possibilities for achieving a smile that suits the personality and interests of each person.

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