My Dentistry Blog
Posts for: June, 2018
Even with picture perfect teeth, you may still be unhappy with your appearance. The problem: too much of your upper gums show when you smile.
There’s no precise standard for a “gummy smile”—it’s often a matter of perception. As a rule of thumb, though, we consider a smile “gummy” if four or more millimeters of upper gum tissue show while smiling. In any event if you perceive you have a gummy smile, it can greatly affect your self-confidence and overall well-being.
The good news is we can often correct or at least minimize a gummy smile. The first step, though, is to find out why the gums are so prominent.
There are a few possible causes: the most obvious, of course, is that there’s more than normal gum tissue present. But the cause could be the front teeth didn’t fully erupt in childhood and so the gums appear more prominent. Other causes include the upper lip moving too far upward when smiling (hypermobile) or an elongated upper jaw that’s out of proportion with the face.
Finding the exact cause or combination of causes will determine what approach we take to minimize your gummy smile. If too much gum tissue or not enough of the teeth show, we can use a surgical procedure called crown lengthening to expose more of the crown (the visible part of a tooth), as well as remove excess gum tissues and reshape them and the underlying bone for a more proportional appearance.
A hypermobile upper lip can be treated with Botox, a cosmetic injection that temporarily paralyzes the lip muscles and restricts their movement. But for a permanent solution, we could consider a surgical procedure to limit upper lip movement.
Surgery may also be necessary for an abnormal jaw structure to reposition it in relation to the skull. If, on the other hand it’s the teeth’s position and not the jaw causing gum prominence, we may be able to correct it with orthodontics.
As you can see, there are several ways varying in complexity to correct a gummy smile. To know what will work best for you, you’ll need to undergo an orofacial examination to determine the underlying cause. It’s quite possible there’s a way to improve your smile and regain your self-confidence.
If you would like more information on improving a gummy smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gummy Smiles.”
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
If you have periodontal (gum) disease, you’ve no doubt experienced red and swollen gums. If, however, you notice an especially inflamed area next to a tooth, you may have developed a gum abscess.
An abscess is a pus-filled sac that develops as a result of chronic (long-standing) gum disease, an infection caused by bacterial plaque that’s built up on tooth surfaces from inadequate oral hygiene or from a foreign body (food debris) getting stuck below the gums. The abscess, which typically develops between the tooth and gums, may be accompanied by pain but not always (the affected tooth may also be tender to bite on). Abscesses may grow larger, precipitated by stress or by a general infection like a common cold, and then abate for a time.
As with other abscesses in the body, a gum abscess is treated by relieving the pressure (after numbing the area with local anesthesia) and allowing it to drain. This is often followed by cleaning any infected root surfaces of bacterial plaque and then irrigating the area with a saline and/or antibacterial solution. We may also prescribe antibiotics afterward and some form of pain control (usually a non-steroidal anti-inflammatory drug like ibuprofen) to help with discomfort.
Although the results of this procedure can be dramatic, it’s just the first step in treating the overall gum disease. After a few days of healing, we continue with a complete examination and recommend further treatment, usually starting with removing bacterial plaque and calculus (hardened plaque deposits), the underlying cause for the infection and inflammation, from all tooth and gum surfaces. This may take several sessions before we begin seeing the gum tissues return to a healthier state.
The key to preventing an abscess recurrence (or any symptom of gum disease) is to remove plaque everyday through proper brushing and flossing, and visiting us twice a year (or more if you’ve developed chronic gum disease) for cleanings and checkups. Doing so will raise your chances of avoiding an uncomfortable and often painful gum abscess in the future.
If you would like more information on gum abscesses, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal (Gum) Abscesses.”