A gummy smile, known clinically as excessive gingival display, refers to a smile that reveals a noticeably large band of gum tissue above the upper teeth. Most dental professionals consider gingival display of roughly 3–4 mm or more beyond the gum line to be excessive, though how much bothers any individual person varies widely. The causes range from how your lip moves to how your jaw grew to how far your teeth actually erupted, and the treatments span everything from a few units of Botox to jaw surgery. Understanding what is driving your particular gummy smile is what determines which fix, if any, makes sense.
Why Some People Show More Gum Than Others
There is no single “gummy smile gene.” The condition has several distinct causes, and many people have more than one contributing factor at the same time. The main categories break down along anatomical lines.
- Hypermobile upper lip: When the muscles that lift your upper lip during a smile pull it higher than average, more gum gets exposed. Normal lip movement during a full smile is around 6–9 mm from rest to full smile. When the lip travels further than that, clinicians call it a hypermobile or hyperactive lip.1Seminars in Orthodontics. Gummy smiles: Etiologies, diagnoses & formulating a clinically effective treatment protocol
- Altered passive eruption: Your teeth may have erupted to their correct position in the jawbone, but the gum tissue never receded to reveal the full crown. The gum margin sits lower on the tooth than it should, making your teeth look short and your gums look tall. One cross-sectional study of gummy smile patients in Thailand found that over half had this condition, and most of those also had a hypermobile lip on top of it.2PubMed. Clinical and radiographic assessment of gummy smile patients with altered passive eruption: a cross-sectional study in a Thai population
- Vertical maxillary excess: The upper jaw itself grew too long vertically, pushing the gum and teeth further downward. This skeletal cause tends to produce the most dramatic gummy smiles and is often the hardest to treat without surgery.
- Short upper lip: Even with normal lip movement and normal jaw proportions, a lip that is physically short at rest will cover less gum tissue when it rises into a smile.
Because these causes frequently overlap, figuring out which ones apply to you is the first step in choosing a treatment. A person whose gummy smile comes mainly from a hyperactive lip faces a very different set of options than someone whose jaw is vertically overgrown. And someone with altered passive eruption may need gum surgery regardless of what else is going on.
When Medications Are the Culprit
Not all gummy smiles trace back to anatomy you were born with. Certain medications can cause the gums themselves to overgrow, a condition called drug-induced gingival overgrowth. The most common offenders are calcium channel blockers used for high blood pressure and immunosuppressant drugs taken after organ transplants. The overgrown tissue can cause discomfort, make it harder to chew and speak, and create the appearance of excessive gingival display even in someone who never had one before.3PubMed Central. Drug-induced gingival overgrowth in cardiovascular patients If you developed a gummy smile after starting a new medication, that connection is worth raising with your doctor or dentist before pursuing cosmetic treatment.
How Much Gum Is “Too Much”
The threshold is partly clinical and partly cultural. Dental professionals generally agree that showing more than about 3 mm of gum tissue above the upper front teeth during a full smile qualifies as a gummy smile. But the amount that actually bothers people, both the person smiling and the people looking at them, is not a fixed number.
A study comparing perceptions across three Middle Eastern populations found that women in all three groups and Syrian men tolerated up to about 2 mm of gum display without considering it unattractive, while Lebanese men disliked any visible gum tissue above the teeth at all.4International Arab Journal of Dentistry. Analysis of Changes in Gingiva-Occlusal Parameters as Perceived by Three Middle-East Populations That kind of variation shows up across cultures and between genders, which means the “problem” threshold is partly in the eye of the beholder.
The psychological impact, however, is real for people who are self-conscious about it. A study of young adults in southern Brazil found that those with excessive gingival display scored more than twice as high on a measure of negative oral-health-related quality of life compared to controls. The effects showed up as psychological discomfort, functional limitation, and social handicap.5PubMed. Impact of excessive gingival display on oral health-related quality of life in a Southern Brazilian young population Only about a fifth of people with excessive gingival display in that study reported being satisfied with their smile, compared to nearly four-fifths of controls.
Botox as a Temporary Fix
Botulinum toxin injections are the least invasive option and the most popular starting point for people who want to try something before committing to surgery. The idea is simple: weaken the muscles that pull your upper lip up too high, and the lip won’t rise as far when you smile. The main muscles targeted are the levator labii superioris alaeque nasi, the levator labii superioris, and the zygomaticus minor, all of which work together to elevate and retract the upper lip.6PubMed. Dose and injection site of botulinum toxin type A for gummy smile management: A systematic review and bibliometric analysis
The treatment works, but the results do not last. A meta-analysis found that botulinum toxin effectively reduces gummy smiles of up to about 4 mm, with peak results in the first couple of weeks. The effect starts fading after that, and by about 24 weeks the gum display tends to return close to where it started.7PubMed. Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression A follow-up study tracking patients over a year found that complete relapse occurred by the four-month mark, with patients returning fully to baseline by twelve months.8PubMed Central. A Standardized Technique for Gummy Smile Treatment Using Repeated Botulinum Toxins: A 1-year Follow-up Study
This temporary nature is both the main limitation and the main selling point. If you are unsure whether you want permanent changes to your smile, Botox lets you preview a reduced-gum look for a few months with virtually no downside risk. Doses are small, typically 3 to 5 units per side depending on the severity, and side effects in the studies have been minimal: no allergic reactions, no significant bruising or pain reported across multiple trials.9Journal of Oral Biology and Craniofacial Research. To evaluate the effect and longevity of Botulinum toxin type A (Botox®) in the management of gummy smile – A longitudinal study upto 4 years follow-up The catch is that you need repeat injections every few months to maintain the result, which adds up in cost and clinic visits over time.
Crown Lengthening for Short-Looking Teeth
When the gummy smile is caused by altered passive eruption, meaning the gum tissue covers too much of the tooth crown, the most direct fix is to surgically recontour the gum line. Crown lengthening involves repositioning the gum tissue further up the root, sometimes with removal of a small amount of underlying bone, to expose more of the natural tooth.10PubMed Central. Clinical Considerations for Crown Lengthening: A Comprehensive Review The result is teeth that look proportionally longer and a gum line that sits higher.
There are different surgical approaches. A randomized controlled trial comparing a one-stage technique (bone recontouring plus immediate flap repositioning) against a two-stage technique (bone recontouring first, then gingivectomy four months later if needed) found that both achieved highly accurate results in reaching the target crown length. The two-stage approach preserved more of the keratinized gum tissue and had a lower impact on quality of life during recovery. About a quarter of patients in the two-stage group did not even need the second procedure.11PubMed. One- versus two-stage crown lengthening surgical procedure for aesthetic restorative purposes: A randomized controlled trial
The psychological payoff can be substantial. A two-year study tracking patients after aesthetic crown lengthening found that self-esteem scores improved significantly within 30 days of surgery and continued improving out to two years. Oral-health-related quality of life scores dropped dramatically over the same period, falling from a median of 19 at 30 days to a median of 6 at two years, where lower scores mean fewer negative impacts.12PubMed Central. Effect of aesthetic crown lengthening on life quality and self-esteem: 2-year study
Lip Repositioning Surgery
For gummy smiles driven mainly by a hypermobile lip rather than by the gum tissue itself, lip repositioning surgery offers an alternative to repeated Botox. The procedure physically limits how high the upper lip can rise by removing a strip of tissue from the inside of the lip and suturing it in a lower position. It is considered minimally invasive compared to jaw surgery and is suited for patients with increased lip mobility or mild vertical maxillary excess.13PubMed Central. A Review of Current Techniques in Lip Reposition Surgery for Treating Excessive Gingival Display
The technique has evolved over the years, with modifications aimed at reducing relapse. A comparison of a modified surgical technique against the conventional approach found that the modified version had less relapse and better long-term cosmetic results.14PubMed. A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile Still, complications do occur. The most commonly reported issues across the literature include discomfort during recovery, scar tissue formation, and pain, so the procedure is not without tradeoffs.15European Journal of General Dentistry. The Lip Repositioning Surgery: A Review of the Technique’s Evolution
Orthognathic Surgery for Skeletal Causes
When the root cause is vertical maxillary excess, meaning the upper jaw bone itself is too long, the most definitive correction is orthognathic (jaw) surgery. This involves surgically repositioning the maxilla upward to reduce how far the teeth and gums sit below the base of the nose. One approach, the horseshoe osteotomy, allows surgeons to remove bone from the anterior nasal base area and push the front of the maxilla upward with a high degree of precision.16PubMed Central. Surgical procedures for correcting vertical maxillary excess: A review
Jaw surgery is the most involved option by far: it requires general anesthesia, hospital stay, weeks of recovery, and carries the standard risks of any major surgical procedure. For that reason, it is typically reserved for cases where the skeletal discrepancy is severe enough that less invasive approaches would not produce a satisfying result. In some cases, orthodontic treatment using temporary anchorage devices like miniscrews can partially substitute for jaw surgery by intruding the teeth and rotating the jaw without an operating room. One case report described treating a skeletal Class II patient with a gummy smile using miniscrews placed in multiple locations, successfully correcting the gummy smile and improving the facial profile.17PubMed Central. Gummy smile and facial profile correction using miniscrew anchorage Orthodontic approaches using skeletal anchorage are particularly suited to less severe cases where the patient wants to avoid surgery entirely.18PubMed Central. Effectiveness and Personalized Approaches in the Correction of Gummy Smile: A Systematic Review of Orthodontic and Surgical Treatments
Combining Treatments
Because most gummy smiles have more than one cause, combining treatments often makes more sense than relying on a single approach. A person with both altered passive eruption and a hyperactive lip might get crown lengthening to fix the gum-to-tooth ratio and then Botox to manage the lip, for instance.
Research supports this layered strategy. One study comparing lip repositioning alone versus lip repositioning combined with botulinum toxin found that the combination group showed significantly greater improvement at three months, although by twelve months the surgical results had stabilized and the difference between the two groups was no longer statistically significant.19Journal of Oral Biology and Craniofacial Research. Comparison of lip repositioning and lip repositioning with botulinum toxin application in gummy smile treatment The Botox appears to provide a short-term boost during the healing period, even if the long-term outcome depends on the surgery. Another study described a “combo technique” combining crown lengthening, lip repositioning, and Botox as a single integrated treatment plan, reporting stable aesthetic results with high patient satisfaction and less Botox needed compared to injections alone.20PubMed. The Combo Strategy: Triple Approach for Gummy Smile-18-Month Case Series
The logic behind combining approaches is straightforward: if the gummy smile has two or three contributing causes, treating only one leaves the others in play. A gingivectomy that beautifully reshapes the gum line will still leave you with a gummy smile if the real driver was a hyperactive lip all along.21PubMed. The effect of a combination of clinical crown lengthening surgery and botulinum toxin A injection in gummy smile treatment
Laser Gingivectomy
Laser-assisted gum contouring has become a popular alternative to traditional scalpel-based crown lengthening, especially for cases caused by altered passive eruption. Diode lasers and high-power lasers can both remove excess gum tissue to expose more tooth structure, and they offer some practical advantages during the procedure itself. A study comparing high-power laser gingivectomy against conventional gingivectomy found that the laser group had no intraoperative bleeding at all, while the conventional group bled as expected during surgery. On the other hand, the conventional technique led to better tissue healing at the two-week mark, and there was no significant difference in postoperative pain between the two methods.22PubMed. Gingivectomy with high-power laser for correction of the gummy smile resulting from altered passive eruption-a case series
A separate trial comparing diode laser gingivectomy to Botox injections head-to-head found the laser approach produced superior and longer-lasting results, while patients tended to prefer the Botox for its minimal invasiveness.23PubMed Central. Gummy Smile Management Using Diode Laser Gingivectomy Versus Botulinum Toxin Injection – A Prospective Study That tradeoff encapsulates a recurring theme in gummy smile treatment: the more lasting the result, the more involved the procedure.
Digital Planning and Predictability
One of the meaningful shifts in gummy smile treatment over the past decade has been the adoption of digital smile design tools. Before any tissue is cut or any injection is given, clinicians can now photograph your face, load the images into software, and plan exactly how much gum tissue to remove from each individual tooth. The enlarged digital view makes it easier to analyze how your teeth, gums, lips, and overall facial proportions relate to each other, and to design a target outcome before the procedure begins.24Indian Journal of Dental Research. Digital Smile Design for Gummy Smile Correction
Digital workflows can also be used to create 3D-printed surgical guides that tell the surgeon or periodontist exactly where to make incisions, reducing guesswork during the actual procedure and cutting down on the need for revisions afterward.25PubMed Central. Digital Smile Makeover: A Multidisciplinary Team Approach For patients, the practical benefit is straightforward: you get a preview of the expected result before agreeing to anything, and the surgeon works from a precise plan rather than eyeballing it in real time.
How Aging Changes the Picture
Here is something that surprises most people: gummy smiles tend to improve on their own with age. A study analyzing dynamic smile changes across different age groups found that the amount of upper-tooth display during smiling decreased by about 1.5 to 2 mm as people got older, with the most noticeable reduction occurring after the 30-to-39 age bracket. No one in the 50-and-over age group displayed a “high” smile (the type that shows the most gum), and no one in the teenage group displayed a “low” smile.26PubMed. Dynamic smile analysis: changes with age
The reasons are a combination of soft tissue changes and muscle behavior. As you age, the upper lip tends to lengthen, the muscles that lift it lose some of their range of motion, and the skin around the mouth loses elasticity. All of these work together to cover more of the upper teeth and gums during a smile. For someone in their twenties who is bothered by a mild gummy smile, this natural progression is worth knowing about. A 2 mm reduction over the next couple of decades could be the difference between a gummy smile and a smile you are happy with, which might change whether an irreversible surgical procedure makes sense right now.
This also has implications for orthodontic and surgical planning in younger patients. Treating a gummy smile aggressively in a teenager, before the facial soft tissues have finished maturing, risks overcorrection that could leave the patient showing too little tooth and gum in middle age. Clinicians treating adolescents and young adults need to factor in this natural trajectory, not just what the smile looks like today.