Your teeth may be the “main attraction” of your smile—but your gums are no less important as its supporting cast. When your gums look healthy and are appropriately sized in relation to the teeth, they help frame the “stars” of your smile in an attractive way. But if they are not, your teeth may appear too small or too large—giving you a “gummy smile,” or making you look “long in the tooth.”
Cosmetic gum surgery can help correct these and other gum problems. Besides making your smile more attractive, it can also restore the health and function of your gums when they have suffered damage from dental disease.
There is considerable variation in what people see as a “normal” smile. However, gums that drape the teeth in an attractive rounded arch, and reveal about 10 mm of the visible crown, are usually perceived as creating a balanced ratio between tooth length and width. But if the gums have receded, the teeth can appear too long, and seem out of proportion to their width.
One of the most common causes of gum recession is periodontal (gum) disease. This generally results from bacterial plaque that is not removed from tooth surfaces, due to inadequate or inefficient oral hygiene. Gum disease triggers inflammation, the body’s defensive response to disease; this can cause tissue damage if it persists, and may ultimately lead to gum recession. Another common cause of gum recession is brushing too hard or too often, which can seriously damage gum tissue.
Besides creating a poor appearance, gum recession may lead to serious health consequences. If allowed to progress, recession eventually exposes the tooth’s dentin, a highly sensitive layer normally covered by enamel, cementum and gum tissue. Dentin is more susceptible to infection and decay than the hard enamel covering the tooth’s chewing surfaces. Gum recession may also cause detachment of the ligaments that hold the tooth in place in the jaw. If left untreated, these factors can eventually result in tooth loss.
A “gummy smile” has an appearance that is the opposite of gum recession: the teeth appear too small in relation to the rest of the mouth. One cause of a gummy smile is an overgrowth of gum tissue, which can be caused by a number of conditions. Certain genetic and developmental factors can also result in this situation. In some cases, the teeth have erupted abnormally, with only part of the crown (less than 10 mm) emerging from the gums. In other cases, excessive tooth wear has shortened the visible crown, causing the gums to appear too prominent. Alternately, the upper lip may be hyper mobile, meaning that it moves too far upwards while smiling, and shows an excessive amount of gum tissue.
Many gum problems can be addressed surgically to restore balance to your smile. But before surgery, it’s often necessary to bring existing gum disease under control. Bacterial plaque and calculus (hardened plaque deposits) both cause and sustain gum disease. To make infection stop and allow gums to heal, plaque and calculus must be removed from all tooth and gum surfaces; this is often accomplished with a procedure called scaling and root planing.
It’s possible for disease-free gums to experience some tissue re-growth—but sometimes, the damage from advanced disease is too great to overcome. In these cases, cosmetic surgery using gingival (gum) tissue grafting techniques can stimulate further tissue regeneration. Grafting takes living tissue from the patient, or processed tissue from another source, and places it where it’s needed in the mouth. Several different types of gum grafts are currently in use.
In a “free grafting” procedure, the surgeon removes a thin layer of the patient’s skin from a donor site—typically the palate (roof of the mouth)—and then carefully sutures it to the recipient site, with stitches smaller in diameter than a human hair. A variation known as connective tissue grafting is used if the recession has exposed the tooth roots significantly. Here, the surgeon separates tissue from the donor site but covers it with an adjacent flap of tissue that still is attached, keeping it connected to a nurturing blood supply.
Crown lengthening is another surgical procedure that is used for cases of excess tissue or abnormal tooth eruption. Using this technique, the dentist can reshape excess tissues and the underlying bone so that more of the tooth’s crown becomes visible.
Cosmetic gum surgery is often performed solely to enhance the appearance of the gums. It may also play a role in a comprehensive smile makeover, in combination with other treatments. These may include orthodontics or dental veneers to improve the shape or alignment of the teeth; injections or lip stabilization surgery to restrict the movement of the upper lip; and orthognathic (jaw) surgery to correct an abnormal jaw position.
Whether it’s used by itself or as part of a larger makeover plan, cosmetic gum surgery can have a dramatic effect on your life. Repairing and restoring your gums can help you regain better oral health and a more attractive smile.