Gummy Smile, Big Gums, and Small Teeth: Causes and Treatments

A gummy smile, also called ‘excessive gingival display', is when you smile and too much of your gumline is visible. There are various factors that can cause a gummy smile, including overactive upper lip muscles, jaw development problems, or bite problems.

A gummy smile is usually considered to be a cosmetic dentistry issue, not one that requires treatment to improve your oral health. But even so, it can be a source of self-consciousness for many and it's understandable if you'd like to know about your treatment options.

In this article, we'll address the following:

• How to identify a gummy smile
• What causes a gummy smile
• When fixing big gums is medically beneficial
• Treatment options for gingival smiles

We hope this information helps you decide on the best course of action for your gums and your smile.

What is a gummy smile?

A gummy smile is a smile that reveals an excessive amount of your gumline. It's also known as excessive gingival display. Gummy smiles aren't necessarily a bad thing. In most cases, they are a cosmetic issue and not a medical issue.

While there are some measurements as to whether or not you actually have excessive gingival display, it is estimated that around 10% of 20- to 30-year-olds think that they have gummy smiles.

How do I know if I have a gummy smile?

You may think that you have a gummy smile, and you may be right because it's quite common. According to a generally agreed-upon measurement, a normal smile shows 1 to 2 millimeters of the gums. A gummy smile is when 3 to 4 millimeters of your gumline is exposed.

But there's no need to take out your tape measure — if you like the way your smile looks, then there's most likely no medical reason to pursue treatment.

What causes a gummy smile?

There are many reasons why you may have excessive gingival display, including genetic reasons, medications, and poor oral hygiene. Let's have a look at some of the most common.

Lip discrepencies

If your upper lip is shorter than would be perfectly proportional, when you smile, you might expose more of the gumline than is typical. And add to that a lip with hypermobile muscles, meaning they tend to go up dramatically when you smile, then you're going to see even more of that gumline.

Too much gingival tissue

It may seem obvious, but if it looks like you have big gums, it may just be that you have too much gum tissue. If this is the case, your teeth are a normal length, and your lips may be proportional, but you were simply endowed with long gums.

Tooth growth differences

You might have a gummy smile because of the way your adult teeth grew in, which in some cases, might be due to genetics. Sometimes when teeth come in, gums will cover a greater part of the tooth surface than is typical.

This is known as altered passive eruption, and can also result in a gummy smile. It's also possible for your front teeth to erupt too much, requiring your gums to also grow longer in order to support them. This is called dentoalveolar extrusion.

Another tooth growth issue that could result in a smile with large gums is vertical maxillary excess. This condition happens when your upper jawbone is longer than it should be.

Medication

Some prescription meds can actually cause enlarged gums. This might happen with immunosuppressants (for transplant patients to prevent tissue rejection), phenytoin (epilepsy patients), and heart disease medications, including verapamil, diltiazem, and nifedipine.

If you experience this side effect with these medications, your gums will grow excessively around your teeth, resulting in a condition called gingival hyperplasia. This is an instance where a gummy smile will most likely require treatment, as gum overgrowth could lead to gum disease.

Gingival hyperplasia

This is the abnormal overgrowth of gum tissue around the teeth and has four potential causes:

• Inflammatory gingival enlargement: The inflammation is caused by plaque buildup on the teeth from food, bacteria, and poor hygiene practices.
• Medication-induced gingival enlargement: Certain drugs can cause gingival hyperplasia as side effect, including the ones we mentioned above.
• Hereditary gingival fibromatosis: Genetics may play a role in gingival hyperplasia but is very rare. The cause in this case would be related to the overproduction of collagen. Repeated surgical removals may be required because of the recurrent nature of this condition.
• Systemic causes of gingival enlargement: Some diseases can lead to gingival hyperplasia such as leukemia, HIV, diabetes, anemia, Crohn’s disease, lymphoma, and vitamin deficiencies. Pregnant women may also experience this.

Hyperactive muscles

The muscles in your upper lip can also control how much of your gum line is exposed. If your muscles are hyperactive, your upper lip will rise more than is normal and will show off more of your gumline. This can also give the appearance of a gummy smile.

Genetics

A lot of these factors that we are mentioning may be partially owed to genetics, and a gummy smile itself might be due to genetics as well. For many, a gummy smile caused by having a large jaw, a short upper lip or small teeth can be caused by genetics.

A gummy smile may also be due to gingival fibromatosis, which is a hereditary disease wherein the gum tissue slowly grows and can even expand to the point of causing issues with speech.

Poor hygiene

If you don't brush and floss your teeth regularly, dental plaque builds up on your teeth, and bacteria and plaque also make their home underneath your gums. The gum tissue then becomes inflamed, giving them a larger appearance.

People with braces are particularly susceptible to this type of gum enlargement via poor dental hygiene because it's more difficult to brush and floss with braces. This allows more bacteria to build up around the gums, resulting in greater inflammation, and thus larger-than-normal gums.

Poor hygiene can often become a vicious cycle because when your gums are enlarged due to inflammation, they are bound to be sensitive and painful. This can lead patients to floss and brush even less, in order to avoid the pain, in turn allowing more bacteria to build up. Thus the cycle continues.

Tooth eruption

Tooth eruption is when your teeth push their way out of your gums and become visible. Sometimes a tooth doesn't erupt properly, which is called altered passive eruption (APE). With APE, the tooth that didn't erupt properly is partially covered by the gums, and when more than one tooth has this happen, it can appear that the person has a gummy smile.

Treatments for gummy smiles

Thankfully for those looking for a solution, there is a wide range of treatments that may work to fix a gummy smile. Let's have a look now.

Veneers

Getting a veneer is a cosmetic solution that can fix a gummy smile as long as there are no underlying issues that need to be addressed. For example, if your gums are inflamed because of periodontal disease, then covering them up with veneers is not a viable option. Veneers can help with a gummy smile because they will make your teeth appear longer, and more proportionate to your gums.

Orthodontics

Braces and other orthodontic treatments can help get rid of a gummy smile if the appearance of excess gums is caused by having a misaligned bite, or other jaw problem.

Once your smile is aligned, the gums will be less noticeable and appear less when you smile. In this case, braces would be taking care of two problems at once — misaligned teeth and an imperfect gumline.

The video below shows how orthodontists diagnose and plan treatment for gummy smiles.

Root planing

If you haven't been up on your dental hygiene, your gums may become detached from the roots of your teeth and form unsightly and painful pockets. They may also become inflamed and larger from an overgrowth of bad bacteria and a buildup of plaque.

If this happens, root planing could help. This is a procedure that is usually performed as part of a deep cleaning treatment, wherein your dentist scales away the plaque from your teeth and then smoothes your roots down so your gums can reattach.

Crown lengthening

Crown lengthening is a process where the extra gum tissue that a person has is removed so that a greater part of the tooth crown is exposed. This process may consist of two parts: the gingivectomy (removal of the gum), and osseous surgery (removal of extra bone and jawbone shaping).

Gum contouring

Gum contouring is typically done with lasers. During this procedure, your gums are shaped to meet with a more attractive aesthetic. This is an invasive procedure, typically only done for cosmetic reasons. We have an entire article dedicated to gum contouring that you can check out here.

Lip repositioning or botox

If you have a hyperactive lip, causing your upper lip to raise up higher than normal when you smile, thus exposing more of your gum line, you might want to consider a lip repositioning procedure. During this procedure your upper lip is moved downward with surgery to hide more of your gums.

Botox can also be used as a treatment for a gummy smile. In this case, Botox is injected between your nose and your upper lip and freezes your lip muscles in such a way that your lips don't reveal as much of your gumline when you smile.

Orthognathic surgery

During orthognathic surgery, the upper jaw will be repositioned in correspondence to the amount that you want to reduce the appearance of your gummy smile. In essence, orthognathic surgery balances the length of your jaws. It is a long process and may require braces beforehand.

Temporary anchorage devices (TADs)

TADs are like branches, in that they move your teeth into a position that reduces your gummy smile. However, they are more invasive than braces, because small screws are implanted into your jawbone. Even so, this option is less invasive than orthognathic surgery.

Cost of treatment for gingival smile

The cost of fixing your gummy smile will vary greatly depending on which treatment you get. If scaling and root planing as part of a deep cleaning procedure is all you need, it won't cost more than $350, but if you need a more extensive procedure like surgery, it could cost into the thousands.

The cost will also depend on whether or not your treatment is for medical reasons or purely cosmetic reasons, in which case it won't be covered by your insurance.

Have a look at the table below for a summary of some of the treatment options and their costs:

Is a gummy smile bad?

A gummy smile isn't necessarily bad, as long as you have healthy gums. Whether or not your smile is aesthetically pleasing is entirely up to you. That being said, a gummy smile may need to be fixed. This is when there is an underlying issue, such as jaw misalignment or gum disease, that is causing your gums to expand.

Conclusion

A gummy smile is when more of your gumline is exposed than is normal when you smile. It can be caused by any number of factors, ranging from genetic conditions to certain medications, to a poor dental hygiene routine.

In most cases, a gummy smile is a cosmetic issue, and you only need to think about treating it if you are unhappy with how your smile looks. However, when enlarged gums are caused by gum disease or another underlying medical issue, you will need to seek treatment.

Treatment for gummy smiles includes orthodontics, laser surgery, deep cleaning, lip repositioning, and more. Talk to your dentist if you are concerned about the size of your gums and would like to find a solution.

FAQs

Is a gummy smile unattractive?

If you have healthy gums, but a gummy smile, it's only unattractive if you think it is. Slightly gummy smiles may not even be noticeable; however, you may want to treat more severe cases. Sometimes a gummy smile is a result of underlying problems, like gum disease, in which case it's important to seek treatment.

How do you fix a gummy smile?

You can fix a gummy smile with anything from improving your oral hygiene routine to intervention with laser surgery. It all depends on how gummy your smile is and why you have large gums.

Is a gummy smile normal?

Most gummy smiles are a natural occurrence and are only cosmetic issues. If you are happy with how your smile looks, then there's no need to worry if your gums are slightly larger. Sometimes, however, a gummy smile is the result of gum disease, jaw alignment problems, or problems like gingival fibromatosis. If this is the case, then you will need to seek treatment.