There are many elements that make up an ideal smile; bright, healthy-looking teeth immediately come to mind. But the gum tissue that surrounds and supports those teeth also plays a big role in how appealing your smile will look.
There are various cosmetic issues involving gum (gingival) tissue. For example, your smile may look “gummy” — meaning you seem to display too much gum tissue when you smile, or your teeth appear too short. Sometimes it’s the opposite problem — your teeth appear too long because your gum tissue has receded (pulled back), exposing tooth-root surfaces that were covered at one time. Or, you may have an uneven gum line, meaning gum tissue covers some of your teeth more than others. All of these cosmetic gum problems can be successfully treated with cosmetic procedures performed in the dental office.
Receding Gums. Sometimes your gums can shrink down (recede), exposing a portion of your tooth roots. This causes a cosmetic problem because of root surfaces, which have no enamel covering, tend to appear more yellow than the crowns of your teeth. Also, exposed roots can be more sensitive to cold or touch, and can be at greater risk of decay. There are various gum grafting procedures that can cover exposed roots, all of which involve moving gingival (gum) tissue from one site in the mouth to another. For example, roots can be covered with tissue from the roof of your mouth, which is of the same type; or adjacent (nearby) tissue can be moved over to cover an exposed root. Sometimes laboratory-processed tissue from another donor can even be used. All of these options can be discussed with you in more detail.
Uneven Gum Line. If you have an uneven gum line where some teeth are covered by more tissue than others, it is often possible to recontour (reshape) the tissue for a very pleasing effect. This can be done conventionally with a surgical scalpel or with newer dental laser technology. The advantage of a laser is that it seals the tissue as it sculpts it, making the procedure more comfortable and requiring a shorter healing time.
Excess Tissue. A gummy smile can be caused by excessive gum tissue covering more enamel surface of a tooth’s crown (upper portion) than normal. Some people feel self-conscious about smiling because they believe their gums are too prominent. Though we each have our own definition of what makes a smile beautiful — including how much gum is too much — a smile will usually be perceived as “gummy” when 4 millimeters (just over an eighth of an inch) of gum tissue shows. If your smile looks gummy to you, it’s important to figure out exactly what’s causing this. Only then can the appropriate cosmetic dental or periodontal (gum) procedures be recommended to give you a more pleasing appearance of the gums and teeth. In some cases, a procedure known as “crown lengthening” can be performed, in which gum tissue (and sometimes a small amount of bone tissue) is removed to expose more tooth surface, while in other cases, a gum recontouring procedure may be more effective.
Periodontal procedures are available to stop further dental problems and gum recession, and to improve the aesthetics of your gum line. For example, an exposed tooth root resulting from gum recession may not be causing you pain or sensitivity, but is causing one or more of your teeth to look longer than the others.
Many people inherit the problem of excessive or uneven gums. An aesthetic surgical procedure called a gum lift can be used to correct this problem.
Causes of Excess Gum Tissue – Gummy smiles may be caused by one or more factors relating to the gums themselves, the teeth, or even the lip or jaw. Each of these areas will require a different approach to solving the problem. Let’s look at some of the ways a gummy smile can be corrected:
Gums. If your teeth appear too short in relation to your gums, it could be that they are being covered up by too much gum tissue. This problem can be solved with a periodontal plastic surgery technique called “crown lengthening,” which involves removing and reshaping the excess tissue to expose the full length of teeth.
Teeth. There are natural variations in the tooth eruption process that can result in shorter than normal teeth and gumminess of the smile. If that’s the case, your teeth can be made to appear longer by capping (crowning) them or covering them with thin porcelain veneers. It’s also possible that your teeth have become worn down over time, especially if you have a grinding habit. When this happens, it can cause what is known as a compensatory eruption. To compensate for the wear and maintain a functional bite, the teeth actually begin to move (or erupt) very slowly outward from the gum. This makes the smile appear gummier because the gums, which are attached to the teeth, move with them as they erupt. In some cases, orthodontic treatment can be used to move the affected teeth back up into the correct position. Afterward, the worn-down teeth would usually be restored with porcelain crowns or veneers.
Lip. On average, the upper lip moves 6 to 8 millimeters from its normal resting position to a full smile. If the lip is hypermobile, meaning it rises much farther up, more gum tissue will be revealed. Here the action of the muscles that control the lip will need to be modified so they don’t raise it quite so high. Treatment can range from Botox shots that temporarily paralyze the muscles (for about six months), to surgery that permanently restricts how high the lip can move, referred to as a lip stabilization procedure.
Jaw. Sometimes the upper jaw (maxilla) is too long for the face, a condition referred to as Vertical Maxillary Excess. If this is the case, the jaw would need to be repositioned with orthognathic surgery (“ortho” – straighten; “gnathos” – jaw). Of all the treatment listed here, this one is the most complex — but it can achieve dramatic results.
As you can see, there is no one-size-fits-all approach to correcting a gummy smile. However, there are various techniques that can achieve dramatic improvements.
All cosmetic gum surgery can be performed at the dental office — and it usually requires only a local anesthetic (numbing shot). In fact, for laser surgery, you may need only a topical anesthetic applied in gel form. If you would like a deeper level of relaxation, you can have oral or possibly even an IV sedative; but if this is required, you will need a ride home. Laser surgery leaves no open wounds and causes minimal, if any, discomfort, though the anatomy of the area may preclude laser use. An examination is required to determine whether conventional or laser treatment is in your best interests.
Grafts may take longer to heal, particularly if the tissue is taken from the roof of your mouth. If that’s the case, you will have two sites that need to heal: the donor site from which the tissue was taken, and the recipient site where the tissue was attached. Both of these sites will require stitches, usually of the dissolving type. You will need to eat a softer diet and avoid chewing on that side of your mouth for a few days. Though full healing may take a few weeks, you will be able to resume your normal activities the very next day. Whichever kind of cosmetic gum surgery you may need, the procedures are routine and predictable — and they can do wonders for your smile!