Gummy Smile

[28657]

I'm wondering about correcting a gummy smile. I've done a little research on it but I can't find much information. I guess I have what is considered to be a "high lip line". It's not that bad - but I think it could look better. Is there a procedure where the dentist could trim my gums up to make my teeth look less short? I've read that most gum trimming procedures are followed by veneering, do I have to get veneers? Would I have to go to a dentist who specializes in cosmetic dentistry? And how much money are we talking about here?
Thanks!

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[DDSSlave]

There are several reasons for a gummy smile and each requires a different treatment plan. Ideally, we would be able to do a clinical exam or at least see a picture. Often there is simply excessive gums covering the crowns of teeth. Sometimes this can be treated with a gingivectomy where they cut away just the gums. Often the underlying bone must be recontoured as well. As long as the crowns of your teeth aren't anatomically short, one of these crown lengthening procedures may work. If your teeth are simply short you may have to add veneers. The only way to know for sure would be to probe your teeth. At the other end of the spectrum, if you have a high smile, the length of your teeth looks okay and you still show too much gingiva, you may need oral surgery (Lefort I) to correct the vertical maxillary excess. There are other causes that require other treatment... misalignment requiring ortho, etc. To help you any further, you would need to post a picture of your smile.

There is no such specialty as Cosmetic Dentistry. It's just an advertising gimmick that most dentists use. A good general dentist *should* be able to diagnose you correctly and explain your options. They may then do whatever procedure themselves or refer you to a periodontist, oral surgeon, or orthodontist depending on your specific treatment needs. A bad general dentist will just assume you need a gingivectomy without thinking and pull out their biolase laser.

I have no idea about money other than it depends on the treatment plan. Maybe less than a $1000 for simple crown lengthening, maybe several $1000s for veneers or oral surgery.

 

[KY2007]

I don't know how much crown lengthening is in private practice but it costs $184 at my school. This is for hard and soft tissue.

 

[28657]

To help you any further, you would need to post a picture of your smile.

Thanks so much for the information! Here's a couple of pictures.

 

[toofache32]

Make sure you look at the whole face and not just the mouth. If you have a gummy smile with normal crown length and periodontal conditions, you probably have vertical maxillary excess (VME). If this is the case, then this is an orthognathic problem treated with orthognathic surgery, usually a Lefort 1 with or without mandibular surgery.The upper jaw is shortened to hide more of your upper jaw (and therefore gums) under your upper lip. People with really bad cases also tend to have "long faces" and a weak chin. Do you have to try hard to close your lips all the way together? You also see this in chronic mouth breathers who may have stuffy noses or some other form of nasal airway obstruction.

Another cause is a short upper lip, in which case not much can be done. The upper lip length in females should be 20mm (+/- 2mm) from the bottom of the nose to the opening into the mouth. Another way to look at it is the distance from the lower lip opening down to the bottom of the chin should be twice the distance of the upper lip.

I googled VME and here's some interesting links:

http://www.db.uth.tmc.edu/faculty/dbutler/orthog03/sld001.htm

http://www.drhenrydds.com/casefive.html

http://www.hrcams.com/go/testimonial2.html

http://www.srt-psc.com/6case97.html

 

[tx oms]

It's equally important to look at your teeth/mouth/face with your lips in repose, meaning slightly open but not smiling. In other words, like a mouth-breather (Napoleon Dynamite). Most people don't walk around smiling all day, but you are likely to relax your lip and let your mouth hand open a little bit. The amount of tooth shown in this position would also be similar to talking. If you surgically impact the maxilla to create a "perfect" tooth/gum line in the smile position but ignore the repose position you may end up not showing any teeth in normal conversation or in repose. Basically, you'd look like a toothless old lady.

Edit: I like toofache's post. I think he, I, and most oral surgeons would agree that the best results come from looking at the entire face and facial skeleton.

 

[toofache32]

I edited my post to say a few more words about the upper lip length. But I could still be wrong. Happens all the time. Just ask my wife.

 

[DDSSlave]

It looks to me like you have vertical maxillary excess which means your maxilla is too long. To correct that would require oral surgery. The surgeon sections your maxilla and then shifts your jaw up. Just looking at the pics, I think crown lengthening would not be indicated. You have nice long teeth showing, aligned and positioned well, and overall a nice smile.

A good general dentist should be able to correctly diagnose you and (probably) refer you to an oral surgeon. An orthodontist should definitely be able to correctly refer you and treat you afterwards if necessary. If the dentist suggests crown lengthening and veneers, I would get a 2nd opinion to be sure.

 

[28657]

OK I'm not liking the sound of this...I thought it'd be a pretty easy corrective procedure.
I think I might have picked the worst pics I could find. I really really don't want to have to get maxillary surgery....sounds scary.
Maybe this new pic will change your opinion.
Whatever it is, I know I'll have to talk to a dentist in person, but it is nice getting to hear about something first.

 

[tx oms]

What's wrong with your smile in that pic? I'm not convinced I'd do anything. I thought in the first two that you might benefit from a gingival surgery, but now I'm not sure I'd even do that.

 

[toofache32]

What's wrong with your smile in that pic? I'm not convinced I'd do anything. I thought in the first two that you might benefit from a gingival surgery, but now I'm not sure I'd even do that.

I agree. We only have one picture to go by, but you look just fine to me. You also have to remember that the soft tissues of the face slowly sag with time and gravity, so it will be even less pronounced in the future. With this in mind, I would bet that many oral surgeons would be reluctant to operate on you because they if they fix such a mild deformity now, you might end up showing nothing but your bottom teeth 20-30 years from now.

Are you wearing a shirt?

 

[tactical dmd]

OK I'm not liking the sound of this...I thought it'd be a pretty easy corrective procedure.
I think I might have picked the worst pics I could find. I really really don't want to have to get maxillary surgery....sounds scary.
Maybe this new pic will change your opinion.
Whatever it is, I know I'll have to talk to a dentist in person, but it is nice getting to hear about something first.

amanda, you're hot...stop worrying about your gums.

And that is exactly what i would tell you if you were sitting in my chair.

 

[lunguv]

OK I'm not liking the sound of this...I thought it'd be a pretty easy corrective procedure.
I think I might have picked the worst pics I could find. I really really don't want to have to get maxillary surgery....sounds scary.
Maybe this new pic will change your opinion.
Whatever it is, I know I'll have to talk to a dentist in person, but it is nice getting to hear about something first.

Jeez u are insane . You look just fine! You are a pretty girl, I wouldnt worry about your gums too much!

 

[KY2007]

I think it's all in you head. Save yourself money and pain.

 

[28657]

Thanks for all your advice. I know it's not that big of a deal, and it's for cosmetic purposes only. If it were something simple to fix...like in and out of the dentist's chair in an hour for a couple hundred bucks, why not? But I would say hell no to getting my maxilla cut down...OUCH!