Gummy Smiles at Pacific Park Family Dental
Hello, my name is Dr. Roman Zakhariya from Pacific Park Family Dental. Today, let's talk about gummy smiles.
What is a gummy smile?
Typically, a gummy smile is when a person smiles and we can see their gums right above their teeth more than 1 to 2 millimeters. Some gummy smiles are okay and they're charming. However, if the gum is too overgrown or too much, it can look like a person has short teeth. This illusion of horse teeth is what some people call it. Sometimes people come to me and say, "I don't like how my teeth are so short. I look like a horse when I smile." This is typically what people perceive as a gummy smile. In the most severe cases, it looks like people have very tiny teeth and a lot of pink gum right above their smile until it meets their lip.
What are some corrections that are possible?
Is this a thing that's even possible to correct? Let's talk about that. In a gummy smile situation, it is possible to correct the whole thing, sometimes just by reducing the gum. Imagine this: you have a short tooth, you have this much gum, and then your lip. This gum can be corrected by a surgery called gingivoplasty. We measure enamel length from the incisal edge all the way to where the top of the tooth transitions into the root structure. If any of that is covered by the gum, we simply anesthetize a person or numb you and then cut off the gum, exposing the extra length of the tooth and getting rid of the gummy smile. In those circumstances, that's pretty much the treatment you need. Imagine if this is your tooth and the gum is covering it like this. All we have to do is sort of raise this gum so you can actually see the entire surface of the enamel, thereby reducing the gum so you have a nice smile.
Sometimes, if a person has worn-down teeth, a different approach is needed. When a tooth comes in, it has a certain amount of enamel, and over time a person may chew away through the enamel. We might need to give a tooth a longer appearance. If they have a lot of gum and a very hyperactive lip that shoots way up when smiling, we may consider not restoring the tooth to its initial state but instead lifting the gum with surgery and restoring with a crown to give that nice enamel length appearance.
What is Botox and why is it used to treat gummy smiles?
In recent years, we have been using Botox to treat gummy smiles. What is Botox and why does it function to treat the gummy smile? Let's say that when a lip is at rest, you're seeing just a few millimeters of those front teeth peeking out from underneath the lip. That's perfect. That's exactly what we want. Imagine you tell a joke to that person and you see this lip go from here all the way up there. This is called a hyperactive lip. This is when muscles contract so much that they reveal not only teeth but also gums, and it looks like you are showing way too much anatomy underneath that lip when it contracts. What do we do about that? The simple solution is to administer Botox. You don't have to cut gums or experience crowns. When injecting Botox, we're essentially halting the signal from the nerve to the muscle. When we smile or do anything to initiate a muscle contraction, a nerve fires and then the muscle contracts in response. A nerve sends a signal, the muscle contracts, and that's how you have a smile. With Botox, it's a toxin that poisons the nerve just a little bit. When you do have a signal, it's not so strong, and that contraction is much weaker, leading to less retraction by the lip.
Why does that work? It's because now your lip doesn't shoot all the way up; it just smiles naturally. Some people do have hyperactive lips, which can cause a gummy smile. Once Botox is injected, it will last for a few months. However, it's not a permanent solution. It's something that you will have to maintain because your body is good at getting rid of toxins, and over time it will get rid of this botulinum toxin in your lip, making it hyperactive again. Usually, you have to upkeep Botox every few months or so.
Does Botox help reduce wrinkles?
People use Botox to avoid wrinkles or creases in the skin. Botox doesn't necessarily help reduce creases that are already present; it just protects you from getting more new ones. Why does it do that? Anytime you smile or frown, or if some people have this crease right here, when we get this area worked up with Botox, the muscles stop working, and that crease no longer forms over time. Imagine having a piece of paper that you're folding and unfolding multiple times. Over time, that crease is going to be super apparent within the paper. What you do is don't fold the paper. This is exactly what we're trying to do with Botox: not having your muscles make a crease in your skin. It takes some time to form a crease, and we just don't want that crease to form. We sort of numb the muscles so they don't create that crease in the future. That's how Botox will prevent you from getting wrinkles in areas like this or like this.
Can a normal smile become gummy with age?
If you have a normal smile, should you worry that it can become gummy with age? The only way your smile can become gummy is if you miss your dental appointments for cleanings. Let me explain. As your smile lives on, if you stop going to the dentist altogether, sometimes the way the gums react to plaque and calculus is to grow out of control. You can see kind of swollen, puffy, rounded gums when they start growing, which can create a gummy smile. It also creates an uncomfortable look to the gums, a red look. The gums will start bleeding quite a bit, and you may have bad breath. Yes, these things can contribute to gummy smiles. However, it's a very small percentage of cases of gummy smiles that I have seen. Typically, if you didn't have a gummy smile to begin with, chances are really high that you will never develop one. If you do develop a gummy smile due to missing your hygiene appointments, it's pretty simple to reinstitute those hygiene appointments and your gum will bounce right back.
How do you diagnose and treat gummy smiles?
Let's summarize. We have two types of gummy smiles. One is due to a very active lip that, when you smile, peels back the muscles and the lips, revealing everything candidly. The other type is where the teeth are short and the gums are long. In both cases, the treatments are vastly different. How do you know which treatment you need? The answer is simple: analysis. Let's look and see what you have, and from there, we can carry out the right diagnosis, which will drive the treatment. Having the right diagnosis is very critical because it will lead to the right treatment and actually fix the issue. This is how I help people with gummy smiles. We take photos in different smile positions, we take photos of retracted views, and we take measurements of how long the enamel part is to see what we have to work with. From there, we understand if it may be a hyperactive lip issue or a lot of gum and a very short tooth issue, and we design the treatment plans accordingly.
At Pacific Park Family Dental, you come first. Whether you need dental care or simply have questions, call us at (360) 803-3546 or email [email protected] to schedule your visit. Our team is here to help you every step of the way.