Gummy smile: what it is, causes and treatment options

A gummy smile is when, as you smile, a band of gum above the upper teeth shows more than you would like. It can have different causes, such as excess gum tissue, a lip that rises too much, overgrowth of the upper jawbone or short teeth, so there is no single treatment. The right path depends on which of these causes is present, and often there is more than one.

A gummy smile is not a disease. It is a feature of the smile, and many people are perfectly comfortable with it. When it bothers you, though, it is worth understanding where it comes from before thinking about a procedure, because treating the wrong cause tends to give little result, or a result that does not last.

In this article, Dr. Cléo Salustiano (CRO-SP 170844) explains what counts as a gummy smile, the most common causes, the treatment options that exist and how a gum health assessment defines what makes sense in each case.

This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the gum health page to learn how the treatment is done here and book your assessment.

What causes a gummy smile?

A gummy smile has four main groups of causes: excess gum tissue over the teeth, an upper lip that rises more than usual, vertical overgrowth of the upper jawbone, and short teeth, whether from wear or from position. There is no single number that defines it, but a gummy smile is generally described when more than 3 to 4 millimeters of gum show in a full smile. More than the measurement, what matters is how much it bothers the person and how it relates to the rest of the face.

Excess gum tissue happens when the gum did not fully recede after the teeth erupted, so it covers part of the crown. The teeth look short and square even though they are normal in size underneath. Gums can also be enlarged by inflammation or by certain medications. In the first case, gingivoplasty is usually the option considered; in the second, the first step is treating the inflammation.

When the cause is the lip, the teeth and gums are in normal proportion, but the upper lip is short or rises more than average when smiling. When the cause is the bone, the upper jaw grew more vertically, and the whole row of teeth sits lower relative to the lip. Short teeth can come from wear over the years, from grinding or erosion, or from teeth that moved down further than normal. In each scenario, treatment is quite different.

That is why the assessment looks at the whole picture. The dentist observes the smile at rest and in motion, measures tooth and lip length, checks how much gum sits above the bone on each tooth and, when needed, requests X-rays, a CT scan or an orthodontic assessment. In clinical practice, it is common to find more than one cause at once, for example some excess gum combined with a lip that rises quite a lot.

A simple observation can help you understand your own case, but it does not replace an exam. If the teeth look short and square even with the lip at rest, the gum may be involved. If the teeth are in normal proportion and the gum only shows a lot in a full smile, the lip may play a bigger role. And if the lower third of the face looks longer overall, the bone may be contributing. These are only clues: confirming them depends on measurements and, sometimes, imaging.

What are the treatment options for a gummy smile?

Gummy smile treatment depends on the cause: gingivoplasty when there is excess gum, surgery with bone recontouring when bone covers part of the tooth, orthodontics when tooth position contributes, jaw surgery for marked bone overgrowth and, for a lip that rises too much, lip-focused options. In some cases, the answer is restoring worn teeth. None of these options suits everyone.

Gingivoplasty reshapes the gum line and shows more of the tooth. It is indicated when the gums are healthy and there is enough space down to the bone. When the gum sits very close to the bone, or bone covers part of the crown, crown lengthening with bone recontouring is indicated, because removing gum alone would let it grow back. When the teeth are worn down, the solution may involve restoring the teeth, sometimes combined with gum adjustment.

For a lip that rises more than usual, one of the existing options is botulinum toxin applied to the muscles that lift the lip, which reduces how high it rises during a smile. The effect is temporary, lasts a few months and must be repeated to be maintained, and whether it is indicated depends on an individual assessment. There are also surgical lip repositioning techniques, used in selected cases. These alternatives have their own indications, limits and side effects, and should be discussed with a qualified professional.

When the cause is tooth position or bone growth, orthodontics comes in and, in more marked cases, jaw surgery, performed by an oral and maxillofacial surgeon together with the orthodontist. Orthodontics can, for example, move the front teeth upward, changing the relationship between tooth, gum and lip. These treatments take longer, but they address the origin of the problem when it lies in the bone structure or tooth position.

The order of steps also matters. If the gums are inflamed, they are treated first. If the plan includes veneers, the gum line is usually set before the cosmetic work. None of this is a reason to give up: they are steps along the way, organized into a treatment plan presented after the assessment.

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