Too Much Gum When She Smiled, and Three Possible Reasons Why

Quick answer: A gummy smile has several distinct causes, and they need completely different treatments. Gum surgery fixes one of them. Applied to the wrong cause it achieves nothing, and the tooth ends up looking worse.

The call

She arrived having already researched the procedure she wanted, which was gum contouring, and having found a price for it.

Rochel, 26, from RBS Gimmel, showed roughly 5mm of gum above her upper front teeth when she smiled fully. She had disliked it since her teens.

The question worth asking before agreeing was why the gum was showing — and there are three quite different answers.

What we found

The three mechanisms, each with a different treatment:

Altered passive eruption. The gum has not finished migrating to its adult position, so it still covers part of the crown. The teeth look short and squat because a portion is hidden. Measured crown height is less than normal, around 8mm rather than the usual 10 to 11mm on a central incisor. This is treated by crown lengthening — removing excess gum, and a small amount of bone where needed — and it works well.

A hypermobile upper lip. The lip itself lifts further than average on smiling, exposing more gum. Tooth height is normal. Gum surgery here removes tissue that was never excessive, and the result is long-looking teeth with the same amount of gum visible. This is treated by lip repositioning surgery, or in some cases by botulinum toxin to reduce the pull of the lifting muscles.

Vertical maxillary excess. The upper jaw is longer than average, so the whole dental block sits lower in the face. Tooth height and lip movement are both normal. This is a skeletal problem, and the definitive treatment is orthognathic surgery — a substantial undertaking, and not something gum surgery approximates.

Combinations occur, which is why measuring rather than guessing matters.

Rochel's measurements: crown height on the upper central incisors was 8.2mm — short. Lip movement from rest to full smile was 7mm, within normal range. Facial proportions on the analysis were unremarkable.

That is altered passive eruption, and it is the one gum surgery genuinely solves. Probing confirmed a wider band of gum tissue than needed, with bone at a normal distance from the enamel junction — meaning the gum could be removed without also removing bone.

Had she had the hypermobile lip pattern, the procedure she had priced would have wasted her money and left her with elongated teeth.

What we did

Photographs, measurements and a digital mock-up showing the projected gum position and resulting tooth proportions. She approved the proposed outline before anything was done.

Crown lengthening on the upper six teeth, under local anaesthetic, about an hour. Excess gum removed to the planned outline, contoured to a natural scalloped shape with the peaks positioned slightly distal to the midline of each tooth, which is what looks natural — a straight cut across all six reads as artificial immediately.

No bone removal was needed, which meant faster healing and a lower risk of the gum creeping back.

Six weeks of healing before final assessment. Gum position settles over that period and judging it earlier gives a false picture.

The outcome

Gum display on full smile reduced from about 5mm to about 1mm. Crown height went to 10.4mm — the teeth are the same size, and more of them shows.

Stable at two years.

She had not needed veneers, orthodontics or anything on her lip. She had needed the right one of three procedures, chosen by measuring rather than by assuming.

What to do if this happens to you

1. Ask which of the three causes applies to you, and ask to see the measurements.
2. Ask for your crown height in millimetres. Short crowns point to gum; normal crowns point elsewhere.
3. Ask for a mock-up before agreeing to irreversible gum removal.
4. Be cautious if gum surgery is offered without measurement. It only fixes one of the three causes.
5. Ask about bone. If bone must be removed too, healing and planning are different.
6. Judge the result at six weeks, not at one.

Showing more gum than you would like? Ramat Beit Shemesh Urgent Dental Care measures before recommending surgery. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.