Thursday, September 1, 2005
Dear Dr. Mady: I have been unhappy with my smile for most of my life and now I am fourty years old and wish to do something about it. When I smile, I show more gums than teeth, the gum heights are also uneven and it looks terrible to point where I don’t like to smile. My dentist said that I can have jaw surgery or a more simple a procedure called a gingivectomy to help improve my gummy smile. What exactly is involved with these procedures and which one would be best for me? - Dawn in Orillia
Dear Dawn: An uneven, gummy smile is not usually attractive but an experienced cosmetic dentist or periodontist (gum specialist) can treat the gingiva to make a vast improvement in your smile and self esteem.
As your teeth erupted during childhood, they were naturally covered by gums. With age these gums automatically receded to show the crowns of your teeth when you smile. This does not occur in all individuals and then the gums hide the smile. A gingivectomy is a form of minor gum surgery that can give you more of a smile that you desire.
The gingivectomy is best described as the surgical removal of a certain amount of pink gum tissue. It can be performed using anesthesia and a scalpel, an electrosurgical knife or machine, a dental rotary instrument and most recently by laser. It is usually quick and relatively painless. The most common method is using a scalpel to make a small incision around the involved teeth and then immediately removing the tissue using a dental instrument. A periodontal, putty-like dressing is then placed over those teeth to assist in healing. Your dentist or periodontist will later remove the dressing and check the healing. Total healing usually takes a few weeks.
Sometimes excess gum tissue growth is the culprit. There are other things that can cause this tissue growth. They include but are not limited to certain medications (especially heart and anti-seizure meds), and certain medical conditions. This may not be the situation in your case, but if it is, the results of gum surgery and the maintenance of the results could be modified.
Also, a gummy smile can be from having naturally short crowns on your teeth, or ones that have been worn down from bruxism (grinding) of your teeth. This makes the ratio of gum to clinical crown size change in a negative direction. Sometimes people are just born with a short upper lip and an injection of botox (to partially paralyze the nerve) can help to stop the upper lip from raising high when smiling and revealing the gummy smile. However, this could decrease the effectiveness of your smile.
If you have a long upper jaw (maxilla), the bone heights above your teeth in the front can be excessive. In a case like this, a procedure called crown lengthening can be performed where not only gingival is removed, but some of the bone around the necks of the teeth also, for an improved appearance. If the height of the bone is moderate to severe, then the patient may require orthognathic surgery by an oral surgeon. This is a more complicated surgery performed under general anesthesia, where a complete section of bone is removed from your upper jaw and the jaw is repositioned and wired in a new, more appealing position. After healing, the results can be phenomenal.
If perfection is sought in a severe case of a gummy smile, several clinicians may be involved including a cosmetic dentist, an oral surgeon, a periodontist and even an orthodontist. The type of treatment and cost will be determined after you have had a complete and comprehensive oral examination and a study of your smile and personal expectations. A gorgeous smile is created by the union of several different elements. Everything, not just the teeth should be beautifully arranged for maximum esthetics!
If you want more information about cosmetic dental procedures, periodontics, oral surgery or orthodontics, go to www.drmady.com and click “articles” and then type a search topic in the search box on the left and simply select “go”. There is an abundance of interesting and educational information in all of these articles. You can also e-mail Dr. Mady any questions at firstname.lastname@example.org
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5