Gummy Smile

• Clinical Definition: The excessive gingival display on the upper teeth when a patient smiles which exceeds 2mm.

• Indications: Vertical maxillary excess; high lip mobility; altered passive eruption.

• Level of Urgency: Elected procedure if related to aesthetics. If related to an active inflammatory process, then urgent treatment may be required.

• Treatment Options: Gum contouring using laser technology; Botulinum toxin therapy; Orthognathic surgical procedures.

• Visual Changes: Shorter-than-average teeth; excessive amounts of pink gum covering the majority of the front portion of your mouth or an imbalance in the proportions of the face.

• Sensory Differences: Gum tissue can feel thicker than usual or have a fibrous texture, covering more of the tooth's enamel than is typical.

• Sensory Experience: Lip fatigue/strain and/or tension in the lips when you try to close over your top teeth normally as you are resting.

• Bleeding gums, persistent foul breath or "halitosis" or pockets (pockets where bacteria live) forming in the gums due to Gingivitis and/or Periodontitis.

• Chronic TMJ pain or chronic lip tension that may indicate extreme misalignment of your jaw bone structure.

• Swollen and sore papillae that will not reduce even after using regular methods to clean your mouth.

• Altered Passive Eruption: When teeth do not come out of gum tissue at time of development they are entrapped by gums.

• Maxillary Vertical Excess: The upper jawbone is too large resulting in a dropped mid-face and lower gum line.

• Overdevelopment of the Levator Labii Superioris Muscle: This muscle pulls up the upper lip excessively as the smile develops.

• Genetics: Jaw size and shape, along with upper lip movement, can be inherited.

• Relapse after Orthodontic Treatment: Without some form of retention after an orthodontist removes your braces there is a possibility that the teeth will move or erupt differently than when you were wearing them.

• Medications: Certain medications such as calcium channel blockers or cyclosporine for example have been known to cause gingival hyperplasia (excessive growth of the gum) in long term users.

• Mirror Examination: Smile normally in front of a mirror. This will help you assess exactly how much (in mm) your gum is relative to the amount of your teeth.

• Lip Mobility Test: Carefully draw your upper lip downward to find out how much of your gum shows when smiling; if there is significant reduction, it could indicate that muscles are involved.

• Tissue Check: Rub your gums gently with your fingers. Your gums should be firm and light pink. If your gums appear bright red, swollen or bleed easily, then these symptoms could mean an infection.

• Clinical Examination: Visually examine how long your crown is in relation to your gum and also the way that your gum lines curve as well as where your smile lines fall.

• Periodontal Probing: Use a periodontal probe to measure the depth of the space between the base of each tooth and its surrounding gum tissue to assess whether or not the gum tissue is healthy enough for your dentist to make decisions about adjusting bone levels around the roots of your teeth.

• Radiography & Digital Mapping: Panoramic x-ray technology along with digital smile design computer software can assist your dentist in visualizing where the roots of your teeth are located and thus the shape of the bone on which they sit.

• A mild level of gum display is a 2 to 4 mm amount of gum visible when smiling. Minor soft tissue reshaping can usually manage this level of gum display.

• A moderate level of gum display is a 4 to 6 mm amount of gum visible when smiling. Crown lengthening may be required to manage this level of gum display as well as other treatments such as targeted botulinum toxin injections.

• A severe level of gum display is a greater than 6 mm amount of gum visible when smiling. A combination treatment plan (periodontic/ orthodontic) and/or surgical jaw repositioning are often necessary to treat this level of gum display.

• Gingivectomy/Laser Contouring: The gingivectomy/laser contouring procedure is a precise method of removing excess gum tissue by utilizing diode lasers which helps to reveal the patient's natural tooth crowns.

• Botulinum Toxin Injections: Botulinum toxin is injected into the upper lip muscles that elevate your lips when you smile to temporarily relax them. This reduces excessive upward pull on the gums and reduces the visibility of the gums while smiling.

• Crown Lengthening and Orthodontics: Crown lengthening is an oral surgery procedure in which the surgeon will remove some of the gum tissue from around the teeth and reshape the supporting bone structure so that there is sufficient room for restorations (crowns). When needed, the surgeon may also refer patients to see a specialist in orthodontics.

• The cost of botulinum toxin treatments vary by the clinic and location. Generally ranges between ₹8,000-₹18,000 per treatment session.

• The laser gum contouring procedure can cost anywhere from ₹10,000 to ₹35,000 based upon how many anterior (front-facing) teeth are being treated.

• Advanced surgical interventions (crown lengthening or orthognathic), which may be required to address significant soft tissue deficiencies due to a severe skeletal discrepancy, may also require an advanced maxillofacial surgeon and can be very costly. Average costs: ₹45,000 - ₹150,000+.

• Periodontists: Periodontists are critical as they will provide the precision required for gum recontouring, crown lengthening and manage hard tissues.

• Orthodontists: Orthodontists should be consulted if your teeth need to be aligned or you want to intrude some of your teeth to correct your vertical dimension.

• Maxillofacial Surgeons: Maxillofacial surgeons will need to be consulted if your problem is so severe that it requires the jaw to be surgically moved.

The Standard Consultation is an appointment that has been scheduled at the patient's own convenience to evaluate their cosmetic needs.
Gum Contouring (a periodontal intervention) should be performed urgently if it creates a condition where gums will trap active plaque and/or create an area of inflammation due to being too large.

1. Are there ways to fix a "gummy" smile without surgery?

Yes. Non-surgical options exist for people who have mild to moderately severe gummy smiles resulting from either hyperactive lip movement or excessive gingival tissue. Botulinum toxin injections or laser reshaping of the gum line can help reduce the amount of gum showing when smiling.

2. Is gum reshaping with lasers painful?

Using local anesthesia ensures that patients experience little to no pain while undergoing a laser gum reshaping procedure. Healing time is also very short after this type of procedure.

3. Will my insurance cover gummy smile correction in Kerala?

Because most types of gum contouring (periodontal interventions) are considered cosmetic; standard health insurance policies usually do NOT cover these types of procedures.

• Gingival Hyperplasia: Inflammation/Plaque Build-up/Medication can cause gums to become enlarged beyond normal size.

• Malocclusion: Incorrect alignment of your teeth; may increase functional biting pressures and compromise your overall smile esthetics.

• Porcelain Veneers: Placed after Gum Contouring to help create a better proportion/shape/shade harmony with other teeth.

• Professional Dental Scaling & Root Planing: Important for maintaining healthy periodontal tissue as part of long term care after changes are made to the gum architecture.

The ability to effectively manage visible excess gingiva for extended periods of time is contingent upon a correct initial assessment of the underlying etiologic reason (dental, bony, muscular). As such, a multi-disciplinary team composed of both Periodontists and Cosmetic Dentists will provide you with aesthetically pleasing, predictable results that protect the future oral health and function of your treated area.