Too Much or Too Little Gums: Gummy and Toothy Smiles

A person’s smile is one of the first things people remember. We notice how large, straight, crooked, white, or yellow their teeth are or whether or not they have braces. We also notice those things they might prefer we didn’t see as well. Characteristics like too much gum show or a “gummy smile” and things like too much teeth show or a “toothy smile”. When those things interfere with your everyday quality of life for one reason or another, you may want to take a look at what you can do to correct those concerns and boost your self-confidence.

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Overview

You may be wondering what exactly it means to have a gummy or a toothy smile, and whether or not you could be classified in either category. At the most basic level, a gummy smile refers to an excessive revelation of the gum line associated with smiling. Essentially, it denotes someone whose smile is comprised of more gum than teeth rather than an even balance of the two. A toothy smile, on the other hand, shows more teeth than gum, which also distorts the gum-to-teeth ratio, also creating an imbalance in a person’s smile. Read further in the article to gain a greater understanding of these conditions, as well as the methods in place for correcting those concerns, should you determine correction is the right step for you.

Terminology/Definitions

Many of the terms and definitions surrounding a gummy smile or a toothy smile sound complicated and undecipherable when in reality, they are scientific or medical explanations that can be easily understood. Use the list below to assist you in decoding any unfamiliar or tricky words and verbiage:

Anteroposterior Teeth – the teeth that make up the front to back curve of the jawline, also known as the Anteroposterior Curve

Crown Lengthening – used to even the gum line and reveal a natural, balanced smile

Gingivitis – a gum disease that causes irritation, inflammation, and redness of the gums

Gingival Exposure/Gingival Display – visible gums; the portion of the gums you can see when you look at yourself or another person

Hematological Conditions – illnesses or disorders that involve blood or blood-forming organs (ex: anemia, sickle cell disease, leukemia, complications resulting from chemotherapy or transfusions, etc.)

Hyperplastic Effects – increase in tissue leading to extreme enlargement

Periodontal Disease – a gum disease; infection of the tissues that hold your teeth in place; leads to sore, bleeding gums, tooth loss, and difficulty chewing

Signs, Symptoms, and Pathophysiology

According to an article published by StatPearls, “facial attractiveness and a well-balanced smile are particularly important for self-esteem and social integration,” meaning that the feature(s) that negatively alter your facial aesthetics can coincide with your level of confidence as well as your ability to assimilate comfortably with the people around you. In other words, the way you look is connected to the way you feel, and the way you feel directly corresponds to your quality of life. Therefore, it is important to feel and look your best self, whatever that means for you.

The basics for a gummy smile and a toothy smile are outlined below to give you the best understanding of what each concern means and to better understand the concepts, but also enable you to speak about them more comfortably as you assess treatments that would react favorably with your needs.

Gummy Smile

As you might correctly assume, a gummy smile is indicative of what characterizes the condition itself. It means that a large, abnormal portion of your gums are exposed when you smile. This excessive gum tissue is usually part of the upper jaw/upper lip area. There are many reasons a gummy smile can happen including genetics, poor oral hygiene, the use of drugs that cause hyperplastic effects, hormonal imbalances, hematological conditions, and sometimes even the way you age.

Genetically transferred gummy smiles mean that you “too much gum” is an inherited trait. Gummy smiles that are a result of poor oral hygiene happen when there is a lack of proper dental care – correct and frequent brushing and flossing at home as well as annual dental visits (or bi-annual visits depending on whether or not your insurance covers it). The lack of proper care leads to bacterial growth and a buildup of tartar which causes gingival (gum) growth.

Hyperplastic effects refer to instances when a drug causes excessive growth of gum tissues. Although there are several drugs that this could correlate with, a study done by the West Side VA Medical Center in Chicago found that patients taking phenytoin (Dilantin, Parke-Davis), Nifedipine and Diltiazem developed symptoms of hyperplastic tissue, the tissue that swells due to the intake of the drugs. If you are taking these or other calcium channel blockers, you may be able to attribute your gummy smile to their hyperplastic effects. See your provider know for sure.

A study done by the Department of Obstetrics and Gynecology at the University of Vermont College of Medicine found that there is a correlation between pregnancy, hormone imbalances, and hyperplastic effects. Hormonal imbalances could be something as simple as pregnancy or puberty. Essentially, pregnancy can cause a change in cell division that leads to arterial growth. This growth can manifest itself in the uterus, in the gums, or not at all, and works similarly to the way changes occur during puberty.

Hematological conditions refer to illnesses or disorders involving blood or blood-forming organs. Examples of hematological conditions include, but are not limited to anemia, sickle cell disease, leukemia, and complications resulting from chemotherapy or transfusions.

Having hyperactive upper lip muscles can be another issue leading to a gummy smile because they cause the top lip to curl up and expose the excess gum tissue above the teeth. Sometimes this can be treated through the use of a neuromodulator, such as Botox®, although your doctor will need to check the severity of your hyperactive muscles before determining whether or not this is the best option for your gummy smile.

Whatever the cause of too much gum, this imbalance of the gum/teeth ratio is the most obvious when you smile. Because smiling is such a natural part of a healthy, full life, it may be a great benefit to your self-esteem and your overall social interactions to address your gummy smile.

Toothy Smile

Although this term might remind you of the typical trademark toothy smile, or “toothy grin”, associated with childhood, the reality is that too much tooth and not enough gum is no longer cute outside of your elementary school days. A massive toothy smile (meaning mostly teeth and little gum exposure) can be a very bad thing for your health and appearance as you mature. At first glance, that might sound contradictory to everything you’ve been taught. We all remember grown-ups in our lives telling us to “show our teeth” for pictures and to give a big, beautiful smile. These and similar statements are telling of just how important our smile is to our overall aesthetic. A big toothy smile is viewed as a more cheerful, genuine smile than a tight-lipped smile, however, that doesn’t necessarily refer to a lot of visible teeth. It refers to displaying the right amount of the tooth-to-gum ratio when smiling. Having too much tooth show can cause issues with self-esteem, speech, and even your health.

As more research is done that allows us to learn more about this condition, the downside to a toothy smile becomes more problematic than aesthetics alone. When there is too little gum protecting the top of your teeth, they can become loose, and problems with pain, swelling, and bleeding can begin to occur. This can be hereditary, but there are also times when medical conditions such as gingivitis and periodontal diseases can attribute to the lack of gums or gum recession. If left untreated, the lack of gums protecting your teeth can be problematic to your health, and also to your facial appearance.

The National Institute of Dental and Craniofacial Research reported that gum diseases are often a result of poor brushing and flossing habits. If you do not have established, proper dental habits in place, incorporating them into your daily routine would be incredibly beneficial to your overall health. See the list of oral health tips on the Centers for Disease Control and Prevention website if you need further direction for a dental hygiene routine.

If your toothy smile is the result of a disease, it will likely be either gingivitis or periodontal disease. Both of these diseases cause gum recession which is the basis of a toothy smile. In other words, if you have gum recession, expect to have a toothy smile. The U.S. National Library of Medicine defines gingivitis as “a condition of the gums characterized by inflammation and bleeding.” Sometimes gingivitis develops due to another medical issue, such as diabetes, but in almost every case, gingivitis occurs in the absence of proper dental hygiene as it is a result of a plaque build-up. Plaque forms when bacteria and mucus mix, and you must consistently brush and floss to avoid a build-up. Once the plaque builds up, it hardens to form tartar, which can only be removed by a dentist or a dental hygienist. When left untreated, your gums will begin to show signs of gingivitis, including bleeding, redness, and swelling. As this happens, and the gum line recedes, your smile line will appear different and you may even notice frequent bad breath in addition to the pain associated with the disease.

Another disease leading to a toothy smile is periodontal disease. Periodontal disease, also known simply as gum disease, begins in the same way as gingivitis with unaddressed plaque build-up resulting in hardened tartar on the teeth, but the National Institute of Dental and Craniofacial Research has found that smoking is the number one risk factor in developing gum disease. Furthermore, smoking inhibits the success of intervention methods for correcting gum disease and will only exacerbate issues leading to tooth loss and decay. If you want to see an improvement in your condition, you will need to address your smoking habits. Aside from smoking, the National Institute of Dental and Craniofacial Research cites genetics, diabetes, hormonal changes, medications that lessen the flow of saliva and illnesses such as AIDS as being risk factors for developing periodontal disease. Medications that lessen the flow of saliva include antihistamines such as diphenhydramine (Benadryl®) and pseudoephedrine (Sudafed®).

Keep in mind that gingivitis is gum inflammation that is often a precursor to periodontal disease. Not all cases of gingivitis lead to periodontal disease, especially not those that are caught and treated early. When the inflamed gums are left untreated, the gums will begin to bleed and be increasingly painful, sometimes even resulting in tooth loss. Once this happens, the gums are no longer inflamed (gingivitis), but diseased (periodontal disease). In addition to the above reasons, hyperactive lip muscles can also contribute to a toothy smile. This is similar to the way hyperactive muscles can cause a gummy smile, however, in this case, excess teeth are exposed rather than excess gum line.

Now that you have an understanding of both a gummy smile and a toothy smile, you may be interested in the methods and treatments available for correcting those concerns. The following section will provide you with information as you consider the next step in addressing your gummy or toothy smile.

How to Fix a Gummy Smile: Treatment and Correction

There are three proven treatment options available for correcting your gummy smile. Those include gummy smile surgery, Botox® injections, and lip injections.

Gummy Smile Surgery A gummy smile surgery, formally known as a gingivectomy, is an outpatient surgical procedure that addresses the appearance and functionality of the tooth/gum balance. Sometimes the smile shows an unattractive amount of gum tissue, while other times it reveals abnormally small teeth. Either way, the goal of a gummy smile surgery is to reposition the gum line on the teeth to improve the appearance of your smile. This often requires a combination of cutting, reshaping and laser removal of excess gum tissue. Sometimes the underlying jaw bone requires reshaping, as well, to bring complete balance to your face. The cost of a gummy smile surgery is determined on a patient-to-patient basis and averages between $3,000 and $8,000.

Neuromodulators to Treat a Gummy Smile Neuromodulators are another viable cosmetic method for correcting a gummy smile, however, the results are temporary and will disappear once they have been absorbed by the body. Neuromodulators include Botox® (Botulinum toxin type A), Dysport® and Xeomin®. Neuromodulators improve the look of a gummy smile by ensuring less lifting and movement of the lips when smiling. Less movement of the lips equals less gum show. Patients should note that these neuromodulators are powerful paralyzing agents and should only be administered by well-experienced practitioners. Consult your plastic surgeon or a qualified practitioner if you believe neuromodulators are the right option for your needs.

Lip Injections to Treat a Gummy Smile Lip injections offer another alternative to fixing your gummy smile. The versatility of the procedure makes it a convenient option if it fits within your needs. Cosmetic surgeons can use dermal fillers, collagen, and fat injected into the lips to change their size and shape. For example, this procedure can lengthen or fill out a short upper lip aiding in gummy smile correction by balancing out the lips with one another. Lip implants, orthodontic treatments, and other surgical smile makeover procedures can be used as well to enhance the overall results. By augmenting or reshaping the lips, it helps to balance gingival tissue display with the number of teeth visible.

How to Fix a Toothy Smile: Treatment and Correction

Gum Graft Surgery Typically, the way to fix the look of a toothy smile is by receiving a gum graft surgery. This is the most common and most effective method available. The leading causes of the toothy smile condition, gingivitis and periodontal (gum) disease, both cause the gum line to recede. Once this happens, pain, swelling, bleeding, and tooth loss often follow, especially if the conditions are not quickly caught and treated. Gum graft surgery helps to repair the wounded gum tissue and salvage what is left of your gums to prevent further infections. This is done through a process that involves collecting connective tissue and using it to cover areas of the gum line that have been exposed due to damage or infection. This connective tissue usually comes from the roof of your mouth, but that is dependent upon the condition of the mouth itself.

Neuromodulators to Correct a Toothy Smile Like with a gummy smile, neuromodulators can be used to temporarily treat a toothy smile, as well. Neuromodulators include Botox® (Botulinum toxin type A), Dysport® and Xeomin®, and work to correct a toothy smile by inhibiting the lifting and moving of your lips when smiling. Because neuromodulators are powerful and can cause paralyzation, it is recommended that only well-experienced practitioners administer your injections. Consult your plastic surgeon or a qualified practitioner if you believe neuromodulators are the right option for your needs.

Conclusion

If you are suffering from either a gummy or a toothy smile, reach out to your oral surgeon, provider, or plastic surgeon and ask for their advice about how to best proceed in correcting the issues that plague you. They are trained to be able to see the larger picture and to plan treatment according to your desired outcome, whether that be through the use of cosmetic dentistry or reconstructive plastic surgery. Keep in mind that full correction of your smile may not be possible, depending on the severity of the damage or the amount of gum or tooth showing. Be realistic in your expectations and communicate clearly with your doctor to achieve your best results.

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