2.Uneven Gums

Uneven Gums = Uneven Bone

If you read the section above on Black Triangles, then you know that gums normally follow bone. When gums are “uneven”, it’s typically a sign that the supporting bone is also uneven.

What! How Did I Get Uneven Bone?

Bone becomes uneven when teeth come in at different levels, either under or over erupting, as well as when the jaw bone develops unevenly. The infection of gum disease also makes bone uneven because it destroys the bone around the teeth.

Are Uneven Gums a Problem?

They don’t really seem like a big problem other than the fact that they don’t look great. However, uneven gums can be a sign of an imbalanced bite. Furthermore, an imbalanced bite eventually causes multiple broken teeth and toothaches. Also, if the gums are uneven because of an infection, it is a sign of advanced periodontal disease and bone loss that means you have a high risk of immediate tooth loss and health complications.

How Do I Fix Uneven Gums?

First of all, find out what’s making them uneven. This means a thorough bite analysis, bone evaluation and gingival exam. Therefore, a successful long term fix means correctly fixing the root problem and it could mean adjusting how your teeth come together, treating a periodontal infection, or leveling out teeth and bone.

In the pictures below, you can see how a patient’s crooked teeth and uneven gums were transformed into a beautiful smile with the help of braces and a gum sculpting surgery. The “Before” pictures shows her uneven gums when she had just gotten braces. The “After” picture shows her teeth after the gum sculpting surgery. Even though she wasn’t through with her braces yet, you can already see the difference in her smile!

You Be the Dentist

These pictures are from one of our patients who lost a tooth and was unhappy with how her teeth and gums looked. Take a look at the before picture and see if you can spot the problems.

1. Look at the gumline.
   • Do you see how it’s uneven?
   • Did you spot that the teeth are yellow at the gumline?
   • Why do you think they’re yellow?
2. Look at the upper teeth.
   • The first thing you probably noticed is the missing tooth.
   • Can you find the tooth with the white vertical fracture line
   • What causes fracture lines AND tooth loss?

What’s going on here?

There are several dental issues in play, but the major condition that causes uneven gums and yellowed teeth (ie gingival recession) as well as fracture lines and tooth loss is an imbalanced bite.

Having an imbalanced bite means that the teeth don’t fit together evenly, which causes some teeth to get hit harder than others. The constant extra banging weakens these teeth.

Because an imbalanced bite causes gum recession, it can lead to gum disease which really complicates things. This patient’s condition is made worse by the old porcelain crowns on her lower teeth that are harder than her real teeth and exaggerate the effects of the bite imbalance.

By correctly diagnosing the issues, we were able to fix the uneven gumline, replace the missing tooth and balance the bite without major reconstructive dentistry. That’s a win, win, win!

4. Gummy Smile

I Show More Gums than Teeth! (Technical definition of a gummy smile calls for more than 2 mm of gum tissue showing during smiling)

Recently I met a lady who complained “It’s like I have pink teeth! My smile is ugly and I HATE it!” We frequently meet patients who are embarrassed because their smiles are dominated by pink gums instead of beautiful white teeth.

Why So Gummy?

Like a lot of dental issues, gummy smiles can be caused by several things that are easier or more complicated to fix.
What’s causing your gummy smile? Here are three questions to help you figure that out.

Gums Be Gone! Fixing a Gummy Smile

Fixing a gummy smile depends on what’s causing it. Logical, right?

Well, some folks with gummy smiles are scared to death because they’ve been told that all gummy smiles require jaw surgery. While it’s true that jaw problems require jaw solutions, which may include surgery, you’ve already read that there are four different causes for a gummy smile.

When you have a hyperactive upper lip, the solution can be as simple as Botox injections to keep the hyperactive lip muscle from pulling your lip so high.

If your smile is gummy due to over-erupted teeth, then moving the teeth back with orthodontics and re-contouring the gums can give you back a beautiful smile that is also healthier than the one you started with.

Finally, if your gums never moved into the appropriate position, then “Esthetic Crown Lengthening”, a surgery to re-contour the gum tissue will not only fix your gummy smile, but it will also transform previously “short” teeth to their full, natural length.

Gum Recession

Recession: The Case of the Disappearing Gums

Recession is the opposite of a gummy smile. In fact, people with recession are losing gum tissue. Furthermore, it’s usually uncomfortable. Recession areas can cause zinging sensitivity when anything sweet, hot or cold touches those yellow recession spots at the gumline.

Recession is not only uncomfortable, but it also looks funny. No surprisingly, people notice the yellow recession spots on their teeth next to the gums. In some cases, they can even feel recession spots with their fingernail like a funny notch in their tooth. As recession gets worse, teeth look too long and black triangles appear next to the visible yellow tooth roots. Eventually, recession lets teeth loosen to the point of falling out. If teeth falling out sounds extreme, remember that one of the gum’s jobs is to protect the bone which holds teeth in place.

Why Do Gums Say Goodbye?

Gum tissue has a stressful job. It is the security guard of the tooth roots and bone and its task is to keep the bad bugs out of the body. Bacteria are always in the mouth. They are constantly multiplying and constantly pressing in and under the gums. These bacteria survive off leftovers from the food we eat, especially protein molecules. When bacteria succeed in securing a position under the gums, the immune system gets called in like a SWAT team. Unfortunately, in the process of fighting and killing bacteria, inflammation sets in, bone suffers and starts to dissolve and it takes the gums with it.

As if being on the front lines of the battle between healthy bone and bacteria wasn’t enough, we often abuse our gums accidentally. Brushing too hard with a scrubbing motion or with hard toothbrush bristles causes recession. Additionally, not getting regular cleanings leads to recession as do poor or irregular home care habits. In fact, gums get stressed by clenching, grinding and any other habits or devices that routinely create extra force. Finally, smoking or chewing tobacco products are not “just” risk factors for oral cancer. In fact, they also damage gum tissue and contribute to recession.

I Want My Gums Back!

Recession is treatable and every treatment starts by dealing with the bacteria that are causing the problem. In fact, this may be as simple as gum therapy and a deep cleaning. In some cases, it also requires additional treatments like laser therapy, gum surgery, antibiotics or bone grafts.

If recession is mild, then simply cleaning the bacteria and changing the way you brush can be enough to help the gums re-establish themselves as security guards. However, more severe recession requires both treating the infection and rebuilding the tissue that was lost.

Not surprisingly, it is always simpler and cheaper to treat recession while it is mild. If teeth are already loose, that automatically means greater expense and fewer options. Thankfully, there are options even for loose teeth. In these cases, however, the solutions are usually more complicated than a deep cleaning.