# Gummy smile

> Citation bundle for Gummy smile on The Treatment Registry.
> URL: https://thetreatmentregistry.com/conditions/gummy-smile
> Bundle URL: https://thetreatmentregistry.com/api/citations/conditions/gummy-smile

## Description

Excessive gingival display on smiling, typically defined as more than 3 mm of gum visible. Causes include short upper lip, vertical maxillary excess, altered passive eruption, and hyperactive upper lip elevator muscles. Treatment depends on the underlying cause and ranges from botulinum toxin through to orthognathic surgery in severe cases.

## Treatment ladder

### conservative

- **Lip-positioning exercises** — Limited evidence base. Reasonable trial in mild cases before any procedural option.

### procedural

- **Botulinum toxin to lip elevators** — Injection of botulinum toxin into the muscles that elevate the upper lip. Effect lasts 3-6 months. The standard first-line procedural option in cases where the cause is muscular hyperactivity.
- **Gingival crown lengthening** — Gum-tissue recontouring (sometimes with bone removal) to expose more of the tooth crown. Permanent and effective where the cause is altered passive eruption.
- **Lip-repositioning surgery** — Limited mucosal resection to restrict upper-lip elevation. Reversible over time but more predictable than botulinum toxin in suitable cases.

### surgical

- **Orthognathic jaw surgery** — Maxillary impaction to address vertical maxillary excess. Major surgery; reserved for severe cases where the cause is skeletal and the patient's facial proportions are otherwise affected.

## Related procedures

- https://thetreatmentregistry.com/procedures/jaw-surgery

## Sources

- [WHO Surgical Safety Checklist](https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery) — World Health Organization (accessed 2026-05-09)