what to do with a gummy smileA gummy smile is a highly subjective diagnosis that shows tremendous variability over dental and non-dental populations. When patients identify gingival display as an area of concern, a restorative dentist has to be able to determine the etiology prior to investigating treatment options.

The gingival level is the gingiva to lip relationship. A study conducted by Dr. Vincent Kokich Jr., asked a group of lay people, orthodontists and general practitioners what they thought about acceptable gingiva levels for smiles. The results are somewhat surprising.

Lay people: Those who were not professionals viewed the threshold at 3mm; when the gums hit the 3 mm mark they rated the smile as less attractive.

Orthodontists: Orthodontists rated their threshold at 2 mm, the strictest requirement in the study group.

General practitioners: Surprisingly, the threshold for GPs was 4 mm, the most lenient of the study group. The important question is: When do we treat a gummy smile? When it bothers the patient. The ideal target is to get somewhere under 3 mm for patients who desire to change their smiles. Before treatment, it’s necessary to understand exactly what causes a gummy smile. There are at least seven different causes, and if you don’t diagnose the cause correctly, you’re going to pick the wrong treatment for your patients.

The Seven Causes

  1. Gummy smiles with dental patientsShort upper lip (if a patient has an extremely short upper lip it’s not going to cover gingiva and their upper teeth)
  2. Hypermobile lip (lip moves too much)
  3. Vertical maxillary excess VME (short ramus and overgrowth of maxilla)
  4. Anterior over-eruption (excess overbite)
  5. Wear and compensatory eruption
  6. Altered active eruption (the teeth don’t make it out of bone)
  7. Altered passive eruption (gingiva doesn’t recede as the person matures)

Three Traditional Methods for Treating a Gummy Smile

Orthodontics: Intrudes over erupted teeth and levels them to correct position so that it eliminates gingival display.

Periodontal surgery: Crown lengthening to move gingival levels apically, typically performed on short teeth.

Orthognathic surgery: Moves the maxilla in an apical direction impacting the maxilla.

For instances when these traditional methods of treatment won’t work, such as a patient has a hypermobile lip, there are a couple of non-traditional methods: 

Botox: Studies suggest Botox, when injected into the muscles of the upper lip can to be an effective method; however, the improvement is temporary and must be repeated every three to six months.

Lip repositioning surgery: Severs the muscles that elevate the lip so it can no longer rise as far in a smile. An irreversible solution diagnosis is the key to a successful outcome.

Steve Ratcliff, D.D.S., M.S., Spear Faculty and Contributing Author


Commenter's Profile Image Chloe Trapnell
February 26th, 2014
Hi there I suffer from a gummy smile and just wondering what things can be done for it? I hear of having Botox in my top lip to hold the lip down, thanks chloe
Commenter's Profile Image Steve Ratcliff
February 26th, 2014
Hi Chloe Without seeing you in person and understanding why you have a gummy smile, I can't comment. As the article mentions, diagnosis is the key to a successful outcome. Thanks for the question though.
Commenter's Profile Image Manjitsingh Bhalla
September 15th, 2014
“Oh I too have a gummy smile and I do extremely require the most efficient gum treatment to get my smile back, really a dynamic with properly aligned teeth & gums”. This quotient is largely experienced by tens of thousands people with gummy smile. Displayed article seems to be very helpful to such cases. Attribution may vary for real causes of protuberant gums (better to have it properly diagnosed by one’s dentist and seek suitable treatment). Treatment options shown are tremendously result-centric, yet delivering favorable outcomes case by case. One thing is going to be very sure that if there is something less invasive, pain-less treatment available for, then it is always better to have that done.
Commenter's Profile Image Gus
April 20th, 2015
I have a short upper lip and was wondering if there was any device to stretch the lip. My orthodontist said there was a device to stretch the lip, but that was around 5 years ago, is that still a method used? Thanks! Gus