A gummy smile can come from teeth, gums, lips, jaw structure, or a mix of all four. You will pick the right treatment faster when you first identify the real cause instead of chasing whatever sounds “popular” on social media.
Dentists often describe a gummy smile as excessive gingival display, meaning you show more gum than most people during a full smile. Definitions vary. Some sources use more than 2 mm, while others use more than 3 mm above the upper front teeth.
The key idea stays the same. You want a plan that matches the cause.
Here are the setups outlined by Dr. Sally Kashani
Part 1 Start with measurement instead of opinion
A smart consultation begins with numbers.
Your provider should measure how many millimeters of gum you show during a natural smile and during a big posed smile. They should also measure how much upper tooth shows at rest, because that number helps them avoid overcorrecting.
This step matters because a one millimeter change can look dramatic on a smile line. Measurements give you a baseline, and they let you compare options with reality instead of guesswork.
Part 2 Identify which of the four causes drives your gummy smile
Most cases fall into one dominant category, even when you have mixed causes.
Teeth driven gummy smile
Your upper front teeth may sit too low, or your bite may overclose and push the front teeth into an over erupted position. Orthodontics can often help because orthodontics can intrude teeth and adjust the bite relationship.
Gum driven gummy smile
Your gums may cover too much tooth structure, so your teeth look short even when they have normal length. Dentists often connect this to altered passive eruption, and they commonly treat it with crown lengthening or gum reshaping to expose more tooth.
Lip driven gummy smile
Your upper lip may lift too far when you smile. This often shows up as high lip mobility rather than “too much gum.” Treatments that target lip elevation, such as botulinum toxin for the elevator muscles or lip repositioning surgery, fit this category.
Jaw driven gummy smile
Your upper jaw may have extra vertical height, often described as vertical maxillary excess. Orthodontics can refine tooth position, but it cannot shrink jaw height in an adult. In severe skeletal cases, clinicians often discuss orthognathic surgery as the definitive option.
Part 3 Match the treatment to the cause
Once you know the category, treatment selection becomes much more logical.
If teeth position drives the gum show, orthodontic intrusion often makes sense. Clinicians commonly use fixed appliances, clear aligners, or temporary anchorage devices called TADs to intrude teeth and reduce gingival exposure.
If gum coverage drives the look, gum contouring or crown lengthening often creates the most visible improvement. These procedures reshape gum and sometimes bone levels so the full tooth crown shows properly.
If lip elevation drives the look, Botox can reduce muscle pull for a limited time, while lip repositioning aims for a longer-lasting mechanical limit on how far the lip lifts. Evidence supports Botox as effective but temporary, and the literature notes limits in long-term data.
If jaw structure drives the look, your orthodontist may still recommend orthodontics, but mainly as part of a combined plan. In severe skeletal patterns, surgical correction often offers the most predictable change.
Part 4 Decide how “permanent” you need the result to be
People often skip this question, and it matters.
Botox can help quickly, but it wears off. A review on botulinum toxin for gummy smile reports strong short-term reductions and then a gradual return toward baseline over follow-up.
Orthodontic movement can last, but you must commit to retention. Teeth drift when you ignore retainers, and even small relapse can bring gum show back.
Lip repositioning can reduce gingival display in selected cases, and systematic reviews describe it as useful for minor discrepancies, while also calling for stronger long-term studies.
Surgery that changes skeletal structure can deliver the most stable structural change, but it also carries the biggest commitment and recovery burden.
Part 5 Weigh tradeoffs that actually affect your daily life
People often focus on “before and after” photos and ignore lifestyle costs.
Orthodontics demands patience and compliance. Aligners require wear time. Braces require hygiene discipline. TADs add another layer, even though reviews describe them as effective for reducing excessive gingival display.
Gum procedures can heal quickly, but they can create sensitivity or require careful cleaning during healing. They also change tooth proportions, which can affect veneer or bonding plans later.
Lip procedures can feel tight during healing. They can also relapse in some patients, so you should discuss stability openly before you commit.
Jaw surgery can transform the smile, but it carries the most downtime and complexity. It also usually requires orthodontics before and after.
Part 6 Know when you need a combined plan
Many patients need two steps, not one.
You may need orthodontics to position teeth correctly first, then gum contouring to refine the gumline around the final tooth positions. This sequence often improves symmetry and helps your dentist avoid guessing where gums should land.
You may need orthodontics for tooth intrusion, plus Botox for lip hyperactivity, if both teeth and lip lift contribute.
You may need orthodontics plus surgery when the jaw drives the gummy smile, because orthodontics alone cannot correct the underlying skeletal height in adults.
Part 7 Ask consultation questions that force a real diagnosis
You want your provider to explain your gummy smile in a way that sounds like a diagnosis, not a sales pitch.
Ask them to tell you exactly how many millimeters of gum show at full smile, and what number they think counts as “ideal” for your face. Sources use different thresholds, so your provider should justify the target they choose.
Ask them to name the primary cause among teeth, gums, lip, or jaw. Then ask them to explain why the other causes play a smaller role in your case.
Ask what change they expect from the first treatment alone, and what additional change a second step could add if you want more improvement.
Ask what relapse looks like for that option, and what they do when relapse happens.
Part 8 A practical way to choose without overthinking
You do not need perfection on day one. You need the right first move.
When teeth or bite position drives the problem, start with an orthodontic evaluation. Orthodontics can set the foundation for everything else, and evidence supports intrusion mechanics, especially with TADs, for dental causes of gummy smile.
When gums hide tooth structure, start with a periodontal evaluation. Gum level correction can create the biggest aesthetic change when altered passive eruption drives the look.
When lip lift drives the problem, start with a lip mobility assessment. Temporary Botox can act as a “test drive,” while lip repositioning offers a more structural approach in selected cases.
When jaw structure drives the problem, start with an orthodontist who works with an oral and maxillofacial surgeon. You will get clearer answers faster, especially in moderate to severe skeletal cases.
Closing thoughts
You choose the right gummy smile treatment by matching the tool to the cause, then choosing the level of permanence and commitment that fits your life. A good clinician measures your gum display, identifies the dominant driver, and lays out a plan that makes mechanical sense.
When you follow that logic, you stop shopping for a “best” treatment and start choosing the right one for your anatomy.