Reducing gums depends on why they look or feel too large. Swollen gums from inflammation can often shrink back to normal with better oral care or a professional cleaning. Gums that have physically overgrown due to medication need a different approach, sometimes including surgery. And if your gums are healthy but simply show too much when you smile, cosmetic procedures can reshape or reposition the tissue. Here’s what works for each situation.
Why Gums Become Enlarged
Gum tissue can grow beyond its normal size for several distinct reasons, and identifying yours determines which treatment actually helps.
The most common cause is inflammation from gum disease. When plaque and tartar build up along the gumline, the body responds with swelling. Early-stage gum disease (gingivitis) makes gums puffy, red, and prone to bleeding. If it progresses to periodontitis, the tissue can become significantly swollen and start pulling away from the teeth, forming deep pockets that trap more bacteria.
Certain medications are another major culprit. Three drug classes are responsible for most medication-related gum overgrowth: anti-seizure drugs (phenytoin being the worst offender), immunosuppressants used after organ transplants, and calcium channel blockers prescribed for high blood pressure. About 53% of kidney transplant patients taking cyclosporine develop noticeable gum overgrowth. The tissue doesn’t just swell temporarily; it physically grows and won’t shrink on its own.
Hormonal changes during pregnancy or puberty can also cause temporary gum enlargement, as can chronic mouth breathing, which dries out and irritates gum tissue.
Reducing Swollen Gums at Home
If your gums are puffy and inflamed rather than physically overgrown, you can often bring them back to normal size without any professional procedure. Daily brushing and flossing is the foundation. Plaque is the trigger for most gum inflammation, and removing it consistently gives your body a chance to heal.
A warm saltwater rinse can soothe sore gums and help reduce swelling. Just dissolve a pinch of salt in warm water and swish gently. Applying an ice pack to the outside of your cheek for 20 minutes on, 20 minutes off during flare-ups also helps with acute swelling. These measures won’t fix advanced gum disease, but for mild gingivitis, consistent home care over two to three weeks often produces visible improvement.
Professional Deep Cleaning
When gum pockets have deepened and tartar has hardened below the gumline, home care alone won’t reach the problem. A deep cleaning, called scaling and root planing, goes further than a standard dental cleaning. Your dentist removes all plaque and tartar above and below the gumline, cleaning all the way to the bottom of each pocket. Then the tooth roots are smoothed so the gum tissue can reattach snugly against the teeth.
After the procedure, your dentist will schedule a follow-up to measure pocket depth and check how much the gums have tightened. For many people with moderate gum disease, this is enough to significantly reduce gum size without surgery. The gums shrink as inflammation resolves, sometimes over several weeks.
Surgical Gum Reduction
When gum tissue has physically overgrown or when cosmetic reshaping is the goal, surgery becomes the most direct option. Two procedures cover most situations.
Gingivectomy
A gingivectomy removes excess gum tissue. It’s the standard treatment for gum overgrowth caused by medications, and it’s also used when gum disease has created thick, fibrous tissue that won’t respond to cleaning alone. In a traditional gingivectomy, a surgeon cuts away the excess tissue with a scalpel and may remove a small amount of underlying bone, then closes the area with stitches.
Gingivoplasty
A gingivoplasty reshapes healthy gum tissue for cosmetic reasons. If your gums are disease-free but uneven or cover too much of your teeth, this procedure sculpts them into a more balanced contour. It’s often performed alongside a gingivectomy to refine the final appearance after excess tissue has been removed.
Laser Gum Contouring
Laser treatment has largely replaced the scalpel for cosmetic gum reshaping and offers a noticeably easier recovery. The laser removes tissue precisely while simultaneously sealing blood vessels as it works, so there’s very little bleeding and no stitches needed. This translates to less swelling, less discomfort, and a lower risk of infection compared to traditional surgery.
Most people can return to normal activities the day after the procedure, though the first 48 hours require gentle care. Applying a cold pack to your cheek in 20-minute cycles during the first 24 to 36 hours helps manage any swelling. Your gums do the heavy lifting of healing during the first week, and you’ll want to stick to soft foods and gentle brushing during that time. Full healing continues over the following weeks, but the functional recovery is fast.
Risks of Gum Reduction Surgery
All gum reduction procedures, whether scalpel or laser, share a few potential complications. Infection is possible any time tissue is cut, though proper aftercare reduces this risk substantially. Tooth sensitivity is common because removing gum tissue exposes parts of the tooth that were previously covered. Hot and cold foods may bother you for a while, but sensitivity typically fades as your mouth adjusts.
The most frustrating risk is tissue relapse. Gum tissue can gradually creep back toward its original position over time, especially with medication-related overgrowth where the triggering drug is still being taken. Some people need a second procedure months or years later.
Non-Surgical Options for a Gummy Smile
If your gums are healthy and normal-sized but you show too much of them when you smile, the issue may be with your lip movement or tooth position rather than the gums themselves. Several treatments can reduce gum visibility without touching the gum tissue at all.
Botulinum Toxin Injections
Injections near the nose can relax the muscles that pull your upper lip too high when you smile. The dose is calibrated to how much gum is showing: roughly one unit of neurotoxin per millimeter of visible gum tissue. For a smile that shows gum on both sides, additional injection points near the nasolabial fold balance the effect. Results last several months before needing a touch-up, making this a low-commitment option to test whether reduced gum visibility gives you the look you want.
Lip Repositioning Surgery
For a more permanent solution, lip repositioning limits how far your upper lip can retract. The procedure removes small strips of tissue inside the lip, creating a shallower vestibule that physically restricts the elevator muscles. In clinical studies, patients with 5 to 6 mm of gum showing saw their display drop to about 3 mm at six months. One study of 13 patients reported gum visibility dropping from an average of 5.8 mm to just 1.3 mm. The range considered attractive is 1 to 3 mm, so most patients land well within that window.
Orthodontic Treatment
When teeth have erupted too far downward, pushing the gumline with them, orthodontics can push them back up. This works best when the cause of the gummy smile is dental rather than skeletal. Temporary anchorage devices (small screws placed in the jawbone) give braces or aligners a fixed point to push against, allowing precise intrusion of the front teeth. Studies show this approach can move upper incisors upward by about 2 to 3 mm, which is often enough to bring the gumline out of view. The jaw can also rotate slightly in response to this tooth movement, compounding the cosmetic improvement without any surgery on the gums themselves.
What Gum Reduction Costs
Costs vary widely depending on the procedure, how many teeth are involved, and whether the work is cosmetic or medically necessary. As a baseline reference, Medicaid reimbursement rates in Connecticut set a gingivectomy covering four or more teeth at about $261 and a smaller procedure covering one to three teeth at about $68. Private-pay costs are typically higher, and laser procedures often carry a premium over traditional scalpel work. Cosmetic procedures like gingivoplasty for a gummy smile are rarely covered by insurance, so expect to pay out of pocket for those. Your dentist or periodontist can provide a specific estimate after evaluating how much tissue needs to be addressed.