You’re at the end of your orthodontic treatment and you’re noticing that your smile doesn’t look the same in photographs. Your teeth are beautifully straight, but what’s the deal with that gummy smile? It didn’t seem to be there before braces.
Gummy smile is naturally occurring in many patients, but it can be worsened and even caused by braces during certain types of orthodontic movements – particularly retraction and extrusion. But just as they can cause gummy smile, braces can also correct it.
So, before you avoid belly laughing for your entire life, let’s explore this further and answer a few questions – did you have a gummy smile before, did you just now notice it, or could gingivitis be the culprit? Read on if you want to learn more.
What is gummy smile?
Gummy smile, medically known as “excessive gingival display“, is when you smile and there’s a disproportionate amount of gum showing.
Patients are often self-conscious about this and have developed a “social smile” that helps them hide their perceived imperfection – much like a selfie posture. It’s only during true, genuine laughs, that this gummy smile reveals itself in all its glory.
So it’s safe to say that capturing the true extent of a gummy smile in a photograph at the orthodontist’s office is sometimes a difficult task. However, it’s still something we need to measure because we need to compare progress and see if we can reduce the gum display.
What causes a natural gummy smile?
A gummy smile is not a medical condition that needs to be treated, necessarily – it’s just an individual trait. We’ve all seen people with gummy smiles and there’s no harm in having one.
But when excessive maxilla growth starts to interfere with eating, speaking, and stands in the way of a normal bite, it’s time to intervene.
Here’s what we notice in patients with naturally-occurring gummy smiles:
- Excessive downward growth or downward tilting of the maxilla. Gummy smile isn’t limited to gums. Those gums sit on bone, and in this case, the entire bone is displaced downward inside the face. Some patients will have long faces and some will not be able to close their lips properly. When it’s severe, this type of anomaly can only be corrected through maxillofacial surgery.
- Short upper lip. A short upper lip is just what the name suggests – short. If the teeth and jaws are otherwise healthy and normal, you can’t do much but make your peace with it.
- Active upper lip. Hyperactivity in the lip muscle can cause it to contract and reveal too much of the gums. This is also an individual trait, so if it bothers you, you have the option of botox injections to help the lip stay lower during a smile.
How can braces cause or worsen gummy smile?
Let’s assume you had a moderate gum display before getting braces, but now your gummy smile seems much more obvious. What actually happened?
Well, it could be a number of things, and we’ll explore them below.
1. Crowding correction
If you had canines placed high up in the gums, or other misaligned teeth placed more vertically, their correction might confuse you. You may see gum exposure when, before, you barely had any gum showing at all.
2. Teeth retraction mechanics
During an extraction case, the upper front teeth are retracted towards the back with the use of powerchains, closing coils or archwire loops, and rubber bands. These forces can lead the occlusion plane downward and lead to more gingival display if no extra measures are taken to avoid this.
Correcting dental protrusion through extractions can lead to a certain degree of gum exposure, and the patient needs to be informed about this.
3. Open bite dentoalveolar correction
Patients with an open bite who refuse maxillofacial surgery can have their bite corrected through the use of up-and-down elastics and/or extractions. Since it’s only a dental correction, and the underlying, skeletal cause isn’t addressed, there’s a risk for the gummy smile to increase. But this is to be expected, and patients are often informed about this.
4. Gums growing over braces
Gingivitis associated with wearing braces is common, and will not completely go away until the braces are removed. It often takes months for the swelling to go down and the gums to recover. The teeth will appear smaller in size and the gums will look puffy and enlarged, giving the impression of a gummy smile. The solution is as simple as cutting the excess gum off – a procedure performed by an oral surgeon or periodontist.
Is there a way to fix gummy smile?
It’s important that you express your expectations before and during orthodontic treatment. If you see more gingival display developing, talk to your orthodontist before taking your braces off. Gummy smile isn’t an issue unless it bothers the patient, so we don’t always aim to correct it.
Here are the three main ways we can reduce your gummy smile inside the dental office:
1. TAD-supported intrusion
TADs (Temporary Anchorage Devices) are a wonderful new invention in orthodontics. These miniscrews act like anchors inside the bone, and we can achieve many new movements that may have been difficult or impossible before. Intrusion means driving a tooth into the bone – in our case, lifting the upper teeth toward the lip. We can lift the front teeth only or the front and back teeth (but that requires a lot more TADs). We can lift symmetrically (right and left), or asymmetrically if the bite plane is tilted.
After TAD-supported intrusion, gum surgery may be necessary to elongate teeth as they may appear a little shorter.
2. Maxillofacial surgery
Addressing the skeletal cause of gummy smile is the best way to go but this solution is often rejected by patients, especially in mild cases. Maxillofacial surgery is a serious intervention that’s expensive and requires time off from any activities. It’s also coupled with a lengthy orthodontic treatment with braces or aligners.
3. Gummy smile surgery
This type of surgery is performed on the gums alone, and it’s not as scary as it sounds. The periodontist or surgeon will remove as much unattached gingiva as possible in a process called “crown lengthening.” When everything heals, you’ll not only show less gum, but your teeth will also appear larger and more defined. Gummy smile surgery is performed for aesthetic reasons.
Something to consider before requesting gummy smile correction: A certain degree of gum display is normal, and maintains a youthful appearance. As a person ages, their upper lip tends to drop as a result of gravity, covering parts of the teeth. So if you don’t like your gummy smile in your twenties, you’ll be grateful for it in your forties and fifties.
A gummy smile can be charming or it can seriously hinder your self-confidence – it all depends on how you look at it. As orthodontists, we have tools that can reduce gum display, but uncontrolled forces can also lead to undesirable results. Talk to your doctor often about what’s bothering you – nothing is permanent until the braces come off!