What Causes a Gummy Smile

Team Crown Lengthening, Gum Disease

The gummy smile is when the gums enlarge and can be caused by three main reasons (1) bacteria causing inflammation, (2) medication, and (3) systemic disease. Most of the treatment involves either gum cleanings or surgical intervention in the form of crown lengthening.


How does bacteria cause a gummy smile?


One reason by people develop gummy smiles is inflammation and bleeding of the gums caused by bacteria. Gum disease (gingivitis and periodontitis) can result in gum tissue swelling, overgrowing, and starting to bleed. Braces and other orthodontic appliances can trap food and if proper oral hygiene is not done, can result in gum overgrowth (Figure 1). The first step is to start performing good oral hygiene and get dental cleanings. In many instances, surgical removal of excess gingival tissue may be needed which can be accomplished quickly and efficiently with a dental laser (figure 2).


Gummy smile caused by a combination of poor oral hygiene and orthodontics increasing bacterial accumulation leading to gum overgrowth

Picture of a gummy smile correction after removal of excess gum tissue with a dental laser


What medications cause a gummy smile?


The following classes of drugs have been associated with gum overgrowth and a gummy smile.

  • Antiseizure (phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone)
  • Blood pressure (calcium channel blockers such as nifedipine, amlodipine, and verapamil)
  • Immunosuppressant (cyclosporine)
  • Amphetamines (cocaine, Ritalin, methamphetamine)

Treatment may not be needed, and this condition may resolve by itself if the drug causing the problem is discontinued or another drug is substituted. Bacteria caused by poor oral hygiene can make drug induced gummy smiles worse so frequent dental cleanings may be needed.  If these methods do not work surgical treatment may be necessary.


What conditions or diseases cause a gummy smile?


  • Hormonal changes associated with pregnancy or puberty
  • Diseases requiring hormone replacement therapy
  • Vitamin deficiencies (mostly vitamin C and vitamin Bs)
  • Benign neoplasms
  • Leukemias, malignant neoplasms/carcinomas, as well as many forms of granulomatous diseases

Treatment of gingival enlargement


Correction of the gummy smile is dependent on the reason for the gum overgrowth. If the gummy smile is caused by medication, stopping the drug and proper home care will usually resolve the problem. When caused by a disease, treatment of the disease usually will result in resolution. Hormonal fluctuations caused by pregnancy and puberty are often unavoidable, and gum overgrowth can often be minimized with excellent home care and dental cleaning visits. When these noninvasive modalities do not result in resolution of the gummy smile surgical treatment can remove the excess gum tissue.


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