A gummy smile, also known as excessive gingival display medically, occurs when too much gum tissue is visible above your upper teeth when you smile. This presentation, although reasonably harmless from a health point of view, often causes considerable cosmetic worry for many and potentially affects self-esteem and socializing.
The perfect relationship between the teeth, gums, and lips helps to create a harmonious and balanced smile. One of these components being out of balance can take away from the overall aesthetics of the face. The first step to treatment is to realize why a person has excess gum display.
If you want to fix a gummy smile and enhance its aesthetics, you can schedule an appointment with The Hawthorne Dentist. Explore personalized cosmetic treatments to improve your smile.
What Exactly Causes a Gummy Smile? Understanding the Underlying Factors
A gummy smile is when your gums look much larger than normal when you smile. Your smile could display excessive gingival display due to disproportionate gum tissue. Though often tied to your anatomy, it is crucial to understand the specific cause, as this influences which treatment will work best. Oral health issues associated with the lips, teeth, gums, or jaw may cause a gummy smile.
Lip-Related Causes of a Gummy Smile
One contributing factor can be the lips. A person has a gummy smile when the shorter upper lip, due to genes, is not long enough to cover their gums when they smile, exposing a larger portion of the gums. Alternatively, if the muscle in the upper lip is overly active, it may lift it too high in a smile, showing excess gum.
Dental Factors Involving the Teeth
The teeth themselves can also play a role. Your teeth could appear small if they are genetically smaller than the gums or if they have been worn down over the years. In either case, the appearance of your teeth will make your gums look more prominent.
One more dental factor is altered passive eruption, with gum tissue not receding as adult teeth break through. As a result, much of the tooth is obscured by gum.
Gum Tissue Overgrowth
Excess gum tissue is another frequent cause. This gum overgrowth (gingival hyperplasia) is inherited due to specific medicines and inflammation. A gummy smile happens when there is too much gum over the teeth.
Jaw Development and Skeletal Factors
Changes in jaw shape could affect the outcome. Vertical maxillary excess (VME) is excessive downward growth of the upper jawbone. The misalignment of facial bones due to skeletal issues lowers the upper teeth and the gum portion of the face.
Given these potential causes, the first step to selecting an effective treatment is to ascertain the leading cause through a proper dental and sometimes medical evaluation. Dental professionals use a range of diagnostic methods. Usually, this means a detailed visual inspection of:
- How your lips move when you smile
- How much gum shows when you smile naturally and when you smile broadly
They will also examine how each tooth looks in relation to the others and how much gum tissue it has to assess issues, including VME. Dentists could take specialized cephalometric X-rays showing the relationship between the jawbones and teeth. By analyzing these factors carefully, the dentist can identify the precise anatomical reason behind your gummy smile, or if it is a combination of reasons, choose the most predictable and appropriate treatment.
Non-Surgical Gummy Smile Treatments
For people with a gummy smile interested in less invasive options, non-surgical treatments provide effective solutions with limited downtime. If a patient does not want surgery, ultra-thin veneers can be placed over their teeth to improve their appearance, but this will not conceal excess gums. If the gum does not need surgery, they could qualify for treatment. Some standard treatment options include:
Botox Treatment
One popular nonsurgical method is Botox for a gummy smile. This treatment involves injecting botulinum toxin directly into the upper lip or elevator muscle that pulls the lip too high with a smile. The primary treatment muscle is the levator labii superioris alaeque nasi muscle. When these muscles are calmed down, the upper lip is softened upward, so less gum shows when we smile. It is a good option for those whose gummy smile is caused by a hyperactive muscle in the upper lip, which is evident during the first diagnostic assessment.
The treatment option is a quick, few-minute procedure involving a few minor injections in the area between the nose and the upper lip. You will not see results immediately after the injections, but most people tend to see results after a few days or up to a week. The full effect will be seen after about two weeks.
The effects of Botox for a gummy smile usually last for about three to six months, but this may vary based on individual metabolism and muscle activity. Repeat treatments are needed to achieve the desired aesthetic outcome. Experts who recommend Botox cite several advantages, notably:
- Botox is non-invasive
- It is a quick procedure
- Has no downtime
- The results are reversible, so you can assess your appearance before proceeding with a more permanent solution.
Drawbacks include:
- The results are temporary, so you must spend more time visiting the clinic.
- A slight risk of asymmetry, meaning one side may be more than the other, if the injection was not administered accurately
The price of gummy smile Botox is typically between $200 and $800 per treatment session. This depends on the number of Botox units required and the practitioner’s fees. Dentists, dermatologists, and plastic surgeons with specialized training in facial aesthetic injections can perform Botox for a gummy smile. Some practitioners also offer a related technique called the “Botox lip flip” that enhances the upper lip’s appearance. This could be an option if you experience a gummy smile.
Laser Gum Contouring
Laser gum contouring, or laser gingivectomy, is another non-surgical treatment available. This procedure uses a soft tissue laser to carefully and accurately remove the soft tissue covering part of the teeth. This type of gummy smile is altered by passive eruption or gum overgrowth. The laser uses concentrated light energy to remove (or ablate) excess gum tissue and seals the blood vessels below. This minimizes bleeding and promotes a quicker recovery than traditional surgical procedures, where scalpels are used.
Recovery after a laser gingivectomy tends to be quicker and more comfortable than surgical methods that rely on scalpels. You will be given local anesthesia before the procedure. The dentist or periodontist uses a handheld laser to gently reshape the gum line, exposing more of the natural tooth crown and creating a more balanced and aesthetically pleasing smile. When the excess gum tissue is removed, the results of laser gum contouring tend to be permanent.
Benefits of this treatment include:
- The procedure’s precision
- The procedure reduces the chances of bleeding and infections due to the laser’s ability to cauterize the area.
- The healing time is usually quicker, and stitches are rarely needed.
Laser gum contouring also has its share of downsides, including:
- Minor postoperative swelling or discomfort
- It is not suitable for gummy smiles caused by skeletal problems or hyperactive lip muscles
Laser gum treatment in California can cost between $400 and $3,000 per arch. Alternatively, it can also cost $50 to $400 per tooth. All this depends on the severity of the shape that is being reshaped and how much work is being done.
Minor Surgical Procedures for the Gummy Smile
There are a few minor surgical options if you are looking for a more definitive and permanent solution for your gummy smile. Some options offer permanent results by modifying the gum tissue, namely:
Gingivectomy or Gingivoplasty
Gingivectomy is the surgical removal of gum tissue, while gingivoplasty contours and reshapes healthy gum tissue. This gum surgery helps trim the excess gum tissue on the teeth. Thus, it enhances the display of the tooth crown. It is best for gummy smiles due to excessive gum from genetic causes or altered passive eruption (normal bone level), but not for significant bone excess or hyperactive lip.
Surgery is done under local anesthesia. Removal of excessive tissue is done with scalpels, lasers, or radiosurgery, and then reshaping. Sutures may or may not be needed.
You can expect a quick recovery, mild discomfort, and swelling for a few days. Complete gum healing takes weeks. Outcomes are long-lasting, as tissue is removed, helping make teeth look longer. However, it will not help treat any issues in the jaw or lip muscles and presents a slight risk of infection or sensitivity.
A periodontist or experienced cosmetic dentist performs a gingivectomy that costs between $200 and $400/tooth.
Lip Repositioning Surgery
The surgery that limits the movement of the upper lip, which is hyperactive, is called lip repositioning surgery. This surgery is done for gummy smiles and is better known as lip surgery.
The procedure takes a small strip of connective tissue from the underside of your upper lip and sutures it to the lower. The lip movement on the upper side is restricted. This reduces gum exposure. This treatment can help gummy smiles from an overly enthusiastic upper lip muscle. After injecting local anesthesia inside the lip, an incision is made, tissue is removed, and the lip is sutured in a lower position. You will experience some swelling or discomfort for the first week of recovery. You should be able to return to regular activity after 7 to 10 days.
Complete healing takes weeks. A soft diet is advised initially. This procedure allows for a permanent gummy smile correction for lip hyperactivity to avoid using ongoing injectables. The potential drawbacks include:
- Surgical recovery
- A slight risk of transient lip movement or speech troubles
- A rare chance of relapse
The gummy smile lip repositioning surgery cost is $1,500 to $5,000.
Crown Lengthening
Crown lengthening reshapes gum tissue and often bone tissue to expose more of a tooth. This treatment is necessary for a simple gum removal when the bone resides too close to the tooth. The process involves removing or reshaping excess gum and bone to expose a larger tooth crown. It is for gummy smiles from excess gum and a high bone level or short teeth from altered passive eruption with bone involvement. It also prepares teeth for crowns or veneers.
The gum flap is lifted using local anesthesia to access the bone, which is then removed or reshaped. Flaps are repositioned lower and sutured. After the procedure, the swelling, bruising, and discomfort will last 1 to 2 weeks, and it will take months for complete soft tissue and bone healing. Pain medication, a soft diet, and careful hygiene are needed. The outcomes are permanent.
Crown lengthening can benefit the health of gums and is vital for restorative work on short teeth. On the downside, they are more invasive and have a longer recovery.
The gummy smile crown lengthening procedure in California costs $1,000 to $4,000 per tooth or quadrant, depending on the complexity of bone reshaping. Due to bone involvement, periodontists mainly perform it.
How Orthodontics Can Align Teeth and Bite and Improve a Gummy Smile
Orthodontic treatment can effectively treat gummy smiles, with or without surgery. The remedy aims to change the position of the teeth in a way that alters the gum line. It is mainly effective for vertically off-position upper teeth or a bite that is not right. A gummy smile can occur due to the upper front teeth that are over-erupted (dentoalveolar extrusion) or due to a misaligned bite. Through orthodontics, controlled forces are applied to move these teeth into a more normal position. One of the main techniques is the intrusion of the anterior teeth, whereby the upper incisors are slowly but gradually moved upwards into the jawbone to reduce gum display. Fixing bite problems can restore your smile’s balance and may make your gummy smile less noticeable.
Orthodontics may be the first approach to treat gummy smiles. You may need to do it with another treatment for excess gum tissue, a hyperactive lip, or jaw issues. TADs, or temporary anchorage devices, can be used with braces or aligners so the tooth has a more stable and efficient upward movement when the tooth intrudes quite a bit. Both traditional braces and clear aligners (Invisalign for gummy smile correction) can treat gummy smiles that arise due to the positioning of teeth.
Which one is better for you between these two options? Well, it depends on the complexity of your case, your orthodontist’s recommendation, and, of course, your preference.
The duration of treatments will vary based on severity and complexity, as well as your adherence to the aftercare instructions. In most cases, the treatment period ranges from 18 to 30+ months. The main benefits of orthodontic treatments include:
- Solving the underlying issue of tooth positioning
- Restoring bite function
- The treatment can be used in conjunction with other plans
The cost of gummy smile correction in California by an orthodontist varies widely based on complexity, appliance type, and duration. It can range from $3,000 to $8,000+. Orthodontics is an option for gummy smiles caused by the position of teeth or bite, and, when used in a well-considered plan, enhances both function and aesthetics.
Major Surgical Intervention
Having orthognathic surgery performed on the jaw is a major surgery to fix a gummy smile. For cases that arise due to fundamental skeletal discrepancies, like an excessive vertical growth of the upper jaw, also referred to as vertical maxillary excess (VME), orthognathic surgery, or jaw surgery, may be required. Jaw surgery for excessive gingival display is a significant procedure that requires a lot of planning and a good surgical team.
Usually, gummy smiles with a substantial amount of gum show are caused by the position and size of the upper jawbone. Hence, in these cases, orthognathic surgery is usually the only solution. Further, the reason for surgery is that non-surgical or minor surgical procedures usually cannot correct the underlying problem. VME’s most common surgery is the Le Fort I osteotomy. This surgery separates the upper jawbone (maxilla) from the remaining skull surgically. The surgeon lifts the upper jaw to a better position. This will shorten the midface’s vertical height and lessen the gum display on the smile. The jaw is held in position with plates and screws, usually through incisions made inside the mouth.
It is a long-term commitment rather than a quick fix. The treatment has a few steps. There is an orthodontic treatment to align the teeth in each jaw. A surgery phase to correct the jaw. A post-surgery orthodontic treatment to finalize the bite in the corrected jaw position. Enjoying the final result from the first consultation may take many years.
Orthognathic surgery for VME usually offers significant and life-changing benefits, showing marked and almost permanent improvement in gummy smile, greater jaw-facial harmony, and often improvement in chewing and speaking function. Although there are risks associated with any major procedure, like infection, bleeding, or nerve damage, which may cause temporary or permanent numbness, revision surgery may be necessary.
This surgery requires a very special team. It involves an oral surgeon who works with an orthodontist in their office and plans the movements of the teeth before and after surgery. To prepare the necessary movements and estimate the expected result, the team often requires extensive planning of the facial features and their measurements. 3D CT scans will also usually be needed in the pre-surgical planning process. The experience and collaboration of the surgical team play a critical role in the success and safety.
The average cost of corrective jaw surgery for VME ranges from $20,000 to $40,000 or more, depending on complexity, the surgeon’s fee, the hospital’s fee, and orthodontic treatment. While a significant undertaking, orthognathic surgery can provide the most complete and lasting correction for more severe jaw-related gummy smiles.
Finding the Most Suitable Treatment for Your Gummy Smile
Choosing the proper treatment for a gummy smile is vital to achieve your desired look. Gummy smile treatment is unique to you. The best treatment for a gummy smile is personalized according to your condition and goals. Knowing the decision-making factors that a gummy smile consultation process takes you to is important.
Many factors help choose a treatment for your gummy smile, including:
- The identified primary cause (lip, teeth, gum, or jaw)
- The severity of the excessive gingival display
- Your personal aesthetic goals and expectations
- Your tolerance for recovery time and potential discomfort
- Your budget
The initial consultation is vital for gaining clarity. Consultation for a gummy smile will be conducted by a qualified expert who will perform a thorough examination and use diagnostics to confirm the cause and severity. They must clearly state causal factors and offer relevant options. They should explain mechanisms, procedures, anticipated outcomes, risks, and benefits. You should maintain realistic expectations based on your anatomy and the treatment you will settle for.
Does Insurance Cover a Gummy Smile Treatment?
Insurance companies usually will not cover gummy smile treatment since it is often considered a cosmetic procedure. Dental insurance typically covers services to fix decay, injury, or other issues affecting your mouth (medically necessary treatments).
However, there can be exceptions. The cost may be covered if the gummy smile is due to something functional underneath. For instance, insurance would cover the cost if the patient has gum disease, which requires gum shaping (gingivectomy) for health reasons. Similarly, if the patient requires orthognathic surgery to fix a bite or jaw issue, that may be covered, too.
Gum surgery coverage differs depending on the insurance plan and the diagnosed cause. It is essential to call your insurance company and your dentist to discuss the treatment and see what is covered.
Find a Dentist Near Me
Excessive gingival display, an almond gummy smile, is primarily of aesthetic concern. However, it can adversely affect an individual’s confidence, who may not wish to smile freely. As we have seen, there are many causes, but most importantly, the efficacious therapies are available today. You may have a balanced and harmonious smile with the help of minimally invasive non-surgical options, targeted minor surgical procedures, and orthodontic or orthognathic intervention. The journey of tackling a gummy smile is often different for different people. Seeking expert guidance will help you identify the exact cause so that the best treatment can be planned.
If you are ready to look into ways to improve your smile and boost your confidence, the next step is a consultation. We encourage you to call The Hawthorne Dentist at 310-775-2557 for a checkup to see how our expertise can get you the dazzling smile you desire.
