Gummy Smile Treatment: Causes and Every Option

A gummy smile is not one condition. It is a visual result that can come from the gum, the bone, the lip, the jaw or a combination. Two people with the same amount of gum showing can need completely different treatments — and one of them may not need surgery at all.

That is why the first appointment should be a diagnosis, not a quote.

What counts as a gummy smile

There is no universal threshold. Clinicians look at the amount of gum displayed at a full smile, the proportion of gum to tooth, the position of the upper lip, and how much the lip rises when smiling.

A smile that shows a few millimetres of gum can be perfectly normal. A smile that shows a wide band of gum, short-looking teeth or an uneven margin is what usually prompts a consultation. The number matters less than the cause and the patient’s concern.

The five common causes

1. Altered passive eruption

The gum and bone sit lower on the tooth than they should. The tooth is a normal length, but part of it is covered. This is a common cause of a gummy smile and short-looking teeth.

Treatment: crown lengthening, which removes gum and a small amount of bone. Gum-only contouring can relapse if the bone is not addressed.

2. Hypermobile upper lip

The lip rises higher than usual when smiling, exposing more gum. The gum and bone may be normal.

Treatment: lip repositioning surgery, botulinum toxin to reduce lip elevation, or acceptance. Contouring the gum will not stop a lip that keeps moving.

3. Vertical maxillary excess

The upper jaw is long, so the whole midface and smile show more gum. This is a skeletal issue.

Treatment: orthodontics, orthognathic surgery, or a combination. Gum contouring alone will not correct it.

4. Gingival overgrowth

Gum tissue enlarges from medications, braces, poor hygiene or systemic conditions. The gum covers more of the tooth than it should.

Treatment: treat the cause, improve hygiene, and remove excess tissue with gingivectomy or gingivoplasty. If a medication is responsible, the prescribing clinician should be involved before changing anything.

5. Tooth wear or small teeth

The teeth are short because of wear, erosion or development. The gum line may be normal, but the tooth-to-gum ratio looks wrong.

Treatment: restorative work (crowns or veneers) may be needed after the gum is positioned. Contouring alone can expose more root rather than more tooth.

Diagnosis: what a good consultation includes

• Extraoral and intraoral photographs at rest and at a full smile.
• Gum-to-tooth measurements on the central incisors.
• Lip mobility assessment — how far the upper lip rises.
• Probing depths and bleeding scores.
• Radiographs to assess bone levels and root anatomy.
• Bone sounding or a CBCT in selected cases.
• A discussion of the smile line, facial symmetry and expectations.

Cleveland Clinic describes checking bone levels around each tooth before contouring, because removing gum without addressing bone can lead to regrowth. The same logic applies to the whole smile.

Treatment options by cause

No single row is “the best.” The diagnosis picks the row.

The procedures in brief

Gum contouring (gingivectomy/gingivoplasty). Removes or reshapes soft tissue. Local anaesthesia, one to two hours for a full smile, about a week of surface healing. $200–$600 per tooth.

Crown lengthening. Removes gum and bone to expose more tooth. More swelling and a longer recovery than a gum trim. $1,000–$2,500 per tooth.

Lip repositioning. A surgical procedure that limits how far the upper lip rises. It is aimed at a hypermobile lip, not at excess gum. Often $1,500–$4,000.

Botulinum toxin. Relaxes the lip elevator muscles temporarily. It can be useful for a hypermobile lip, but it is not a substitute for contouring or crown lengthening. $200–$600 per visit, repeated every few months.

Orthodontics or orthognathic surgery. Addresses tooth position or jaw length. A multi-month or multi-year commitment, with a different fee scale.

What treatment costs

A full-smile gum contouring case commonly lands at $1,200–$3,500. Crown lengthening for the same teeth can be $3,000–$6,000 or more. Lip repositioning is often $1,500–$4,000. Botox is the cheapest per visit and the only one that wears off.

The gum contouring cost guide explains what changes each quote, including sedation, bone work and the number of teeth.

Risks and limits

• Relapse. Gum can regrow if bone was not reduced when needed.
• Asymmetry. Healing can differ from side to side.
• Exposed roots or sensitivity. Removing too much tissue can expose root surfaces.
• Infection or bleeding. Uncommon but possible.
• A result that does not match the mock-up. Teeth that are small, worn or rotated may need restorative or orthodontic work to finish the smile.

A good consent conversation names these before surgery, not after.

Questions to ask

1. What is causing my gummy smile — gum, bone, lip or jaw?
2. Which measurements support that diagnosis?
3. Will you remove bone, and why or why not?
4. What will my smile look like at eight to twelve weeks?
5. What is the plan if the gum regrows or the lip still rises?
6. Are there non-surgical options, and what do they cost over a year?

The bottom line

A gummy smile is a symptom, not a diagnosis. The treatment that works is the one aimed at the cause: contouring for excess gum, crown lengthening for low bone, lip repositioning or Botox for a hypermobile lip, orthodontics or surgery for a skeletal issue. Start with a clinician who measures before recommending.

For the procedure itself, read what gum contouring is. For local providers, use the periodontist directory.