Network television programs such as “Extreme Makeover” and “The Swan” have brought into the general public’s eye various dental-related problems that cosmetic dentists can address. The viewing audience is always so amazed at the changes even just the smile can make to the person’s overall appearance.

In talking with my friend and colleague Dr. Bill Dorfman, the cosmetic dentist for the ABC Television Show “Extreme Makeover”, we agree that one of the great outcomes of these television programs is the awareness raised of different possibilities in cosmetic dentistry and cosmetic surgery. Increased awareness means that people are empowered with updated information on what can be done, and therefore can ask better questions and make better informed decisions for themselves. Because of these programs I often am asked related questions about what is possible in cosmetic dentistry.

Your Smile Can Be Beautiful

I know it sounds like candy a child would buy at a crack seed store, but what I am referring to as the “gummy smile” is when a disproportionate amount of gums show when a person laughs or smiles when comparing gums and teeth. The result is a smile that seems to resemble one of a young child. And although many people want a youthful smile, having one of a 10-year-old is not what anyone has in mind. In the gummy smile, not only do the gums look too prominent, but also the teeth look too small, too square, or like baby teeth. In dental research and literature there is actually a mathematical ratio called “The Golden Proportion” which specifies what the proportion of gums to teeth should be (in consideration of the entire face) for optimal facial esthetics.

Generally the gummy smile is the result of genetics, which is to say you are predisposed to how much gums show when you smile. Normally, as permanent teeth emerge, gums are supposed to naturally pull back. For most people their gums will pull back to a level that looks normal, natural and esthetic. For others this normal gum process stops prematurely, leaving the tooth looking shorter than it should. Another situation that contributes to a gummy smile problem is when someone is born with an enlarged or long upper jaw. The excess bone creates a severe gummy appearance.

How Veneers Can Help Make Your Smile Beautiful

A gummy smile can be treated mainly in two ways. For less severe to moderate gum disproportion, the treatment is a gum-lift followed by porcelain veneers. A gum-lift is where excess gum tissue is artistically sculpted to a new more proportionate height. Gum tissue heals quickly, provided proper home care is done. Then porcelain veneers may be placed over to create a beautiful smile. Veneers serve to not only protect the newly exposed tooth surface, which may not have a complete enamel covering, but they can also change the shape, color and size of the tooth to match the patient’s face. Depending on the complexity and the amount of gum-sculpting needed to reduce the gumminess, slight bone removal may be recommended. A thorough examination and x-rays are required first to ensure a patient is a good candidate for a gum-lift.

For more severe disproportion, possible treatment may be the actual breaking and repositioning of the upper jaw. Healing time may be a minimum of six weeks, where the jaw is wired shut and nutrients are taken in liquid form. Due to the radical nature of this procedure, this remedy is not really appealing to most people. However, the gum-lift procedure has been successful in correcting many of these complex problems. This used to be the only way the gummy smile was addressed years ago. About 12 years ago a current patient of mine was told by a more conservative dentist that this jaw surgery was the only way to improve her gummy smile. She decided to not do it at the time as she thought the surgery was too invasive. Fortunately her waiting paid off, and she was pleased to have her smile corrected with the simpler gum-lift, teeth whitening and porcelain veneers just before her wedding.

There are situations when a person may have more than one dental-related problem occurring at the same time. For example, there was a patient that not only had a gummy smile and small-appearing teeth, but also had an asymmetrical muscle pull of the cheeks where more gums and teeth showed on one side when she smiled. The ideal remedy would have been to surgically address the cheek muscles for an even pull. However the patient was not interested in such a surgery. Still, a gum-lift and veneers helped significantly to balance the appearance of her lopsided smile.

Questions & Answers

(1) Q: Does a gum-lift affect the strength of a tooth?

A: No, it does not.

(2) Q: Does it hurt to have a gum-lift done?

A: First, it is performed under local anesthesia, so no pain is felt during the procedure. Within days the gums heal themselves, using a special home care regimen.

(3) Q: Do gums grow back?

A: In the vast majority of people, no, but there are rare occurrences where it does happen.

Finally, it is important to have a gum-lift done by a cosmetic dentist who routinely performs them. Because gum-sculpting is irreversible, it must be done correctly. As with anything in cosmetic dentistry, it’s important for the dentist to have an artistic eye when performing the gum-lift so the worst case scenario doesn’t happen where gums are sculpted crooked or too high. It’s best to ask a cosmetic dentist to show before and after photos of the actual dental procedures he or she has done.

Dentistry has come a long way in how the gummy smile can be treated. Patients are able to greatly benefit when a procedure can now be performed with a much simpler recovery than what was done in the past. And it’s rewarding for dental professionals also to provide more accessible opportunities that more people can take advantage of.