There are those who cover their mouths with their hands, those who smile without opening their lips, those who are careful not to laugh out loud in public. Often, it is not misaligned or protruding teeth, or the presence of an embarrassment that causes discomfort and embarrassment diastema but the so-called gum smile (o gummy smile).
The term itself doesn’t say much. To understand what it is all about, just take a dip into the past, when the unforgettable Alberto Sordi brings Guglielmo il Dentone to the big screen. One of the most famous and successful characters of him. In the movie The complexes a man enters a contest to become the new face of the news. Although he shows preparation that would make him win hands down, he sports an aesthetic defect that plays against him. A smile characterized by very pronounced teeth (hence his nickname) and extremely evident and marked upper gums.
When do we talk about the gingival smile?
The gingival smile is precisely “an excessive exposure of the gum of the upper arch while smiling”, clarifies the maxillofacial surgeon Tito Marianetti. «Generally when our face takes on joyful expressions, the mouth opens radiantly and the soft tissue above the teeth peeps out by 1-2 millimeters at most. In some people, however, the gum comes out a lot and sometimes reaches (or exceeds) the centimetrecausing shame and insecurity in those with this “horse” smile».
Behind this imperfection there could be some problems
Vertical hyperdevelopment of the maxilla
Although it is mostly considered a beauty flaw, the gum smile is a disorder that can also hide some underlying dentoskeletal malformations. «In most cases, in fact, this gum smile is caused by a vertical hyperdevelopment of the maxillaalso called long face syndrome, whereby the bone grows downwards and also drags the gum behind it, which extends to such an extent that it appears excessively when opening the mouth» explains the specialist.
Alteration of the maxillo-mandibular complex
This anomaly is due to an alteration of the maxillo-mandibular complex, which can arise as a result of some respiratory disorders present in early childhood. «If in the first years of life a child breathes badly through the nose, whatever the reason, the tissues and structures of that part of the body are subject to transformations, which can then have repercussions on future aesthetics: gradually the palate becomes ogival, the jaw grows too vertically, the chin becomes receding, the teeth often take on important dimensions and the gums protrude exaggeratedly», Marianetti goes into detail.
Hypertrophy of the soft tissue itself
In addition to an excess of bone, the origin of this problem can also be there soft tissue hypertrophy. In some cases the gum tends to cover the teeth more than normal simply because it has increased in volume due to gingivitis.
“This inflammatory process can depend on an accumulation of bacterial plaque, on the intake of certain drugs, such as antiepileptics, immunosuppressants or antihypertensives, or on hormonal variations, such as those that characterize pregnancy,” continues Marianetti. Finally, the gum smile can also be caused by theoveractivity of the levator muscle, located between the mouth and nosewhich lifts the upper lip excessively during a healthy laugh, exposing the soft, pinkish tissue underneath.
Gingival smile can create discomfort and states of shyness
If from a simple blemish that makes the gum smile less pleasant it becomes a cause of inner discomfort, to the point of causing states of shyness and reluctance, you can contact a specialist to remedy the problem. “Usually those who come to consult the maxillofacial surgeon, who is the reference figure in these cases, complain of a disharmony of the lower third of the face, i.e. the lower part of the face, characterized precisely by an over-exposure of the gums”, he says Marianetti.
Several ways to correct this blemish
The doctor, after a careful clinical analysis, can proceed with aaesthetic cephalometric investigation it’s a Three-dimensional CT, which evaluate skeletal, dental and tissue ratios and compare them to baseline measurements. This procedure allows the specialist to identify the critical issues present in that particular maxillo-mandibular complex, to know with certainty what exceeds the upper jaw and to develop the best treatment also on the basis of the cause that gave rise to the disorder.
Diode laser gingivoplasty
If the cause of the gum smile is an excessive growth of the soft tissue, caused by taking antiepileptic, immunosuppressant and antihypertensive drugs, and the disorder persists for a long time even after their suspension, the specialist may suggest a gingivoplasty.
«It is an operation that allows you to remodel the entire gingival parabola, through the use of a diodi laser which removes the excess parts and immediately seals the wound, immediately stopping the bleeding and greatly reducing healing times» explains the surgeon. This small outpatient surgery, performed under local anesthesia, allows you to shorten the gum, recreate the natural scallop and improve the smile line.
If, on the other hand, the horse smile is given by an atypical development of the upper jaw, the is indicated surgical correction. «Let’s assume that the bone is 5 millimeters more than normal, with the same amount of gingival overexposure; at this point the surgeon performs a Le Fort I osteotomy under general anesthesia, i.e. a horizontal incision that passes above the dental arch and below the nasal pyramid and allows the excess bone to be removed. The remaining jaw rests on the remaining bone and is stabilized with titanium plates and screws to be kept for life», warns Marianetti.
The stabilization takes place on the inside and is therefore invisible. However, by removing a “slice” of the maxilla, the mandible is no longer aligned with the upper part. This automatically causes a dental malocclusion. «When you opt for an orthognathic surgery of this type, you also work on the jaw, so that the opening and closing of the mouth are restored correctly».
Contrary to what one might think, this operation, which it lasts about three hours and requires a couple of nights’ stayis decidedly non-invasive. «Post-operative pain is minimal, the swelling disappears after a month and the person can resume their activities within a week», confirms Marianetti. “Obviously, since the maxilla and mandible have been immobilized for a long time and have undergone intensive correction, one must wait for the stabilization and healing of the bone before returning to normal nutrition. For the first 40 days, therefore, it is advisable to mainly follow a liquid diet ».
Botulinum toxin
In case the upper lip is pulled up by the levator septum muscle, botulinum toxin may help.
“By injecting five or ten units of this substance at the level of the muscle, the lip tends to go down», explains Marianetti. “Unfortunately, as in other cases in which the use of botulinum toxin is used, the final effect is that of an unnatural immobility which covers the excess gum tissue but gives rise to an equally unpleasant and artificial smile” concludes the surgeon .