Gingival Aesthetic (Gum Aesthetic)

WHAT A BALANCED GUM LINE LOOKS LIKE
There is no single correct gum line, and faces differ. But dentistry does work to some general reference points.
In most smiles the gum sits at a similar height on the two central front teeth, slightly lower on the teeth either side of them, and back up at the canines. The small triangle of gum that fills the space between two teeth — the papilla — is present and pointed rather than blunted or missing. And when you smile broadly, the amount of gum on display is modest.
When one of these is noticeably out of step, the eye picks it up even if the person looking cannot say what is wrong.

A GUMMY SMILE
A gummy smile is the term for an excessive amount of gum showing when you smile.
It is common, it is not a disease, and whether it matters at all is entirely a matter of personal preference. What makes it worth understanding is that it has several quite different causes, and the right treatment depends on which one applies.
The gum covers too much of the tooth. The teeth have fully erupted but the gum has not receded to its final position, so the teeth look short when they are in fact a normal length. This is the most straightforward situation to treat.
The upper lip lifts unusually high when smiling, exposing more gum than most people would. Here the gum and teeth are normal and the movement of the lip is the cause.
The upper jaw is long, so the whole upper set of teeth and gums sits lower in the face. This is a skeletal cause, and significant cases are addressed through orthodontics or jaw surgery rather than gum treatment.
The teeth have worn down over the years, so proportionally more gum shows above them.
An examination, photographs and sometimes a scan are what distinguish these, and the distinction matters — treating the gum when the cause is skeletal will not produce the result the patient wanted.

GUM CONTOURING AND CROWN LENGTHENING
Gum contouring reshapes the gum line, removing a small amount of excess gum tissue to lengthen the appearance of the teeth or to even out an irregular line. It can be done with a scalpel, with electrosurgery or with a laser, and it is usually carried out under local anaesthetic.
Crown lengthening goes a step further. Where simply removing gum would not be stable — because the bone underneath also sits too high — a small amount of bone is reshaped as well, so that the new gum line holds its position rather than growing back.
The difference between the two is decided by measuring how much tooth, gum and bone there is, not by preference. A gum line lowered without addressing the bone beneath it will often rebound.
Crown lengthening is also carried out for reasons that have nothing to do with appearance — for example to expose enough of a broken tooth for a crown to be fitted to it.

RECEDED GUMS
The opposite problem is gum recession, where the gum has pulled back and the tooth, or part of its root, is more exposed than it should be.
The common causes are gum disease, brushing too hard or with too stiff a brush, grinding and clenching, the position of the tooth in the arch, and in some people a naturally thin gum type.
Recession is not only cosmetic. The exposed root surface is softer than enamel, more prone to decay, and often sensitive to cold.
Where treatment is appropriate, a gum graft can cover the exposed root. Tissue is taken from elsewhere in the mouth — most often the palate — or a donor or synthetic material is used, and it is positioned over the recession and allowed to heal. There are also tunnel techniques that achieve the same result through smaller openings.
Before any of this, the cause has to be identified and stopped. Grafting over a habit that is still happening is temporary by definition.

 

MISSING PAPILLAE AND BLACK TRIANGLES
The small triangle of gum between two teeth can be lost — through gum disease, after orthodontic movement, or where the shape of the teeth leaves too wide a space at the gum. What remains is a dark gap, often called a black triangle.
These are among the harder things in dentistry to correct, because gum tissue does not reliably grow back into a space once it has been lost. Depending on the case, the approach may be to reshape the teeth so they meet lower down, to add composite or ceramic to close the space, or in some situations to attempt a graft.
An honest assessment of what is realistically achievable is particularly important here.

 

UNEVEN GUM LEVELS
Sometimes only one tooth is out of step. The gum sits noticeably higher or lower on a single tooth, which the eye reads as an asymmetry in the smile.
Correcting it may be a matter of a small amount of reshaping, or it may need orthodontic movement of the tooth itself to bring the gum with it. Which one applies depends on why the level is different in the first place.

 

PIGMENTATION
Gums vary in colour between individuals, and darker pigmentation in the gums is normal and harmless. Some people choose to have it lightened; many do not, and there is no health reason to.
Where it is treated, the pigmented surface layer is removed, usually with a laser. Pigmentation can return over time.

 

WHAT TO EXPECT AFTERWARDS
Most gum aesthetic procedures are carried out under local anaesthetic and take under an hour.
Soreness for a few days is usual, managed with ordinary painkillers. Where a graft has been taken from the palate, that donor site is often the more uncomfortable of the two areas for the first week.
Gum tissue takes several weeks to settle into its final position and appearance. Where the result is being combined with crowns or veneers, the gums are usually allowed to settle before the final restorations are made, so that the margins sit correctly against the finished gum line.
Aftercare generally involves avoiding brushing the treated area for a short period, using a prescribed mouthwash instead, eating soft food, and not smoking.

 

QUESTIONS PATIENTS ASK
Is it painful? The procedure is done under anaesthetic. Afterwards most people describe soreness rather than pain, for a few days.

 

Will the gum grow back? Where the bone has been correctly managed at the time, a contoured gum line generally stays where it has been placed. Where the bone level was the real cause and was not addressed, the gum is more likely to rebound.

 

Is laser better than a scalpel? Both are used routinely and both work. A laser can reduce bleeding during the procedure, which is why it is often preferred for soft-tissue reshaping. The result depends far more on the diagnosis and the planning than on the instrument.

 

Can it be done at the same time as veneers or crowns? The gum work is generally done first and allowed to settle, so that the restorations can be made to fit the final gum line.

 

Is a gummy smile a health problem? No. It is a matter of appearance and personal preference, and there is nothing wrong with leaving it alone.

 

How long do the results last? Contouring done with the bone level correctly assessed is generally stable. Grafting for recession is stable where the original cause — brushing technique, grinding, gum disease — has been addressed.

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