A gummy smile, also known as excessive gingival display, is a smile that shows more gum tissue above the upper teeth than the person would like. If your smile reveals more gum than you want it to, that is as close as anyone gets to a way to define a gummy smile, because the point at which a smile looks gummy is a matter of proportion rather than a fixed measurement.
The important thing to understand before you read any further is that there are at least six separate causes, they are not variations of the same problem, and each one responds to a different treatment. A gum procedure fixes one of them. Performed on the wrong cause, it produces long teeth and the same gummy appearance you started with.
So the useful question is not how to fix a gummy smile in general. It is what is causing yours, and which treatment option follows from that. The right treatment depends entirely on the cause, and the treatment options for a gummy smile have very little in common with each other.
What Counts As A Gummy Smile
Most people show a small band of gum above their upper teeth when you smile fully, and that is normal. Around 2mm or less is generally regarded as ideal, and above roughly 3 to 4mm of gum display, the smile line starts to read as gummy to most observers. What matters is how much gum shows above the teeth during a full smile, not a posed one.
Those numbers describe averages, not a diagnosis. A smile that shows gum and is otherwise a balanced smile does not need treating because it exceeds a measurement, and smile aesthetics are not decided by a ruler.
Is A Gummy Smile Actually A Problem?
Not medically, in most cases. Excess gum display is a cosmetic characteristic, not a disease, and it has no bearing on your oral health. Plenty of people find it charming, and a number of well-known faces have one and are none the worse for it.
There are two exceptions worth naming. If your gums are enlarged because of gum disease or a medication reaction, that is a health issue and needs treating regardless of appearance. And if teeth have not erupted fully, that is worth understanding rather than ignoring.
Otherwise this is entirely elective. We say that plainly because the honest reason to do something about a gummy smile is that it bothers you, not that it is wrong.
The Common Causes Of A Gummy Smile
Altered passive eruption. The teeth are a normal size but the gum never finished migrating up them during development, so it still covers part of the crown of each tooth. The teeth look short and square, even though tooth length is normal underneath. This is the most common cause we treat, and the most common reason patients have excess gum tissue showing.
A hyperactive upper lip. The upper lip muscles lift further than average when you smile, exposing gum that would otherwise stay covered. At rest the smile looks entirely normal. This is a muscle behaviour, not a gum or tooth problem.
A short upper lip. Similar effect, different reason. The lip is simply shorter than average, so more gum shows even without excessive movement.
Vertical maxillary excess. The upper jaw has grown longer than average, carrying the teeth and gums lower in the face. This is skeletal, and no amount of gum surgery changes it.
Dentoalveolar extrusion. The upper front teeth, together with the bone holding them, have over-erupted. This often happens where tooth wear has shortened the teeth and the body compensates by pushing them further out, so each tooth sits lower than it should.
Gingival enlargement. The gum tissue itself has overgrown, sometimes described as gingival hyperplasia. It comes from gum disease, from a medication such as phenytoin, ciclosporin or nifedipine, or occasionally while wearing a brace, when cleaning around each tooth becomes difficult and the tissue responds with excessive gum tissue. This one is the exception to the cosmetic rule, since it usually reflects something happening in the tissue.
More than one can be present at once, which is common and is another reason the assessment matters more than the procedure. Two people with an identical gummy look can need completely different treatment approaches.
Matching The Treatment To The Cause
| Cause | What actually treats it |
| Altered passive eruption | Gingivectomy or crown lengthening, depending on where the bone sits |
| Gingival enlargement | Treat the cause first (gum disease or medication review), then reshape if needed |
| Hyperactive or short upper lip | Botox, repeated as needed. Lip repositioning surgery is an option, though it commonly relapses in gummy smile cases |
| Dentoalveolar extrusion | Orthodontic treatment, often using temporary anchorage devices to intrude the teeth |
| Vertical maxillary excess | Orthognathic surgery, which needs a surgeon with maxillofacial training |
Not all six are treated the same way, and some need expertise beyond periodontics. We would tell you that at the consultation rather than after treatment, and we would make sure the right people are involved in your plan. Effective treatment starts with working out which cause applies, because a gummy smile caused by a hyperactive lip and one caused by tissue are different problems wearing the same face.
Gum Contouring, Gingivectomy And Crown Lengthening
Where the cause is tissue covering a tooth of normal length, this is where the result is most predictable. It is also the situation most people picture when they ask what causes a gummy smile.
The distinction between the two procedures is about the bone, not the gum. If there is enough space between the bone and where the new gum line needs to sit, removing gum alone is enough. If the bone sits too high, it has to be reshaped as well, or the tissue simply grows back to re-establish the distance the body requires. Getting that judgment wrong is the most common reason a cosmetic gum procedure disappoints, and it is why the assessment involves measuring rather than looking.
We use a laser for the soft tissue work in most cases, which means less bleeding, usually no stitches, and a more comfortable recovery.
Botox And Lip Repositioning For A Gummy Smile
Where the cause is lip movement rather than gum or bone, we offer Botox for a gummy smile. Botulinum toxin injected into the hyperactive upper lip muscles weakens the lift slightly, so less gum shows when you smile. It may reduce a gummy smile noticeably within a couple of weeks, it takes a few minutes, and there is no surgery involved.
The limitation is duration. A Botox injection lasts roughly three to four months, after which the effect fades and the treatment has to be repeated. Over years that adds up in both cost and appointments.
For a lasting version of the same correction, lip repositioning surgery limits how far the lip can rise by adjusting the tissue inside the upper lip. It is a small procedure, and we have performed it — more often in the past than we do now.
We generally prefer Botox for this cause, and the reason is relapse. Where a gummy smile is what you are treating, lip repositioning tends not to hold. The lip usually creeps back up over time. Not always to where it started, but far enough that the result fades and you are weighing a second procedure.
That is worth stating plainly, because most pages you will read present lip repositioning as the permanent answer and Botox as the temporary compromise. Repeating an injection sounds like the larger commitment right up until you compare it against a surgical result that may not last either. Which of the two suits you depends on how much movement your lip has, how much gum shows, and whether you would rather keep an appointment every few months or accept the chance of relapse.
Do Children Outgrow A Gummy Smile?
Often, yes, and this is the reason not to rush.
Passive eruption continues through the teenage years, and gum that covers part of the teeth at fourteen may have receded to a normal position by nineteen without anyone doing anything. Treating too early risks correcting something that would have resolved, and risks a result that no longer suits the face once growth finishes.
We generally wait until the late teens at the earliest, and later where the jaw is involved, since jaw growth has to be complete before any skeletal treatment is planned.
What The Assessment Involves
Working out which cause you have is mostly measuring and watching.
We look at how much gum shows during a full smile rather than a posed one, measure each tooth to see whether it is genuinely short or only partly covered, assess how far your upper lip travels between rest and a full smile, and check the relationship between your upper teeth and your face. X-rays show where the bone sits relative to the teeth, which determines whether gum removal alone would hold.
It takes one appointment, and it is the part that determines whether you get a good outcome. From it we can determine the best treatment option for your case and build a treatment plan around it, including where gum contouring would sit alongside a wider smile makeover with veneers or crowns.
What Affects The Cost
Gummy smile treatment cost depends entirely on which procedure your case needs, and the range across the options is wide.
- Which procedure is indicated, from injections at the low end to jaw surgery at the high end
- How many teeth are involved
- Whether bone is being reshaped or only gum tissue
- Whether treatment is combined with veneers or crowns afterwards
- For Botox, the ongoing cost of repeating it
Cosmetic treatment for gum display is not usually covered by insurance. Where the gum enlargement is caused by disease or medication, the periodontal treatment often is, and we will check your plan.
We’ll give you an exact cost as part of your treatment plan at your consultation.
Frequently Asked Questions
Can A Gummy Smile Be Fixed Without Surgery?
Sometimes. Botox works for a hyperactive lip without any surgery, and orthodontic treatment can address over-erupted teeth. Where gum tissue is covering the teeth, a procedure is needed, though laser gum contouring is minor and done in one visit.
Is A Gummy Smile Attractive?
Plenty of people think so, and it is a common feature of faces widely considered attractive. There is no clinical answer here. Treating it is worth considering if it bothers you and not otherwise.
Does Fixing A Gummy Smile Improve Oral Health?
Usually not, because in most cases nothing is wrong. The exception is gum enlargement from disease or medication, where treatment does improve gum health.
How Long Does Treatment Take?
A gum procedure is one visit, with the tissue settling over a few weeks. Botox takes minutes and shows its effect within about two weeks. Orthodontic approaches take months, and jaw surgery is a longer process still.
Will The Results Last?
Gum and bone reshaping is permanent where the right procedure was chosen. Botox lasts three to four months and is repeated. Lip repositioning commonly relapses where a gummy smile is the reason for doing it, which is why we usually prefer Botox for this cause. Orthodontic and skeletal corrections are permanent.
Can Veneers Fix A Gummy Smile?
Not on their own, since veneers change the teeth and not the gum line. They are often placed after gum contouring, once the proportions are right, which is how gum work and restorations combine to improve your smile.
What Is The Appropriate Treatment For A Gummy Smile Caused By The Jaw?
Orthognathic surgery, which needs a surgeon with maxillofacial training. Where the jaw is the cause, we will tell you at the consultation, make sure you get to the right person, and stay involved with any gum work that forms part of the plan.
Do I See A Periodontist, An Orthodontist, Or A Surgeon?
Start with an assessment that identifies the cause. Gum and bone are a periodontist’s work, tooth position is orthodontic, and jaw proportions need an oral surgeon with maxillofacial training. Any dental professional who tells you the answer before measuring is guessing.
Schedule A Consultation
If your smile shows more gum than you would like, the useful first step is finding out why, not booking a procedure. There is no single way to fix gummy smiles, because the appearance of a gummy smile can come from tissue, teeth, lip or jaw. We will measure your teeth, your gum position and your lip movement, tell you which of the causes applies to you, tell you what it would take for your smile to look the way you want it to, and be straight about what your case actually needs and who should be involved in treating it.
Call our office at (347) 493-2439 or schedule your consultation online.
