If Your Smile is a Picture, Then Your Lips and Gums are the Frame.
Just like a broken frame can make a great picture look silly, having gum problems can distract from a nice smile. This happens whether we have too much or too little gum tissue and when gums have an unusual shape.
A Health-o-Meter You Can See
How our gums look tells us a lot about how healthy our mouths are! When things don’t look right, our mouth is usually trying to warn us about a deeper health problems. Fixing gum issues makes our smiles healthier and can impact our overall health in amazing ways! For healthy gums, I recommend Oral-B and Sonicare Electric Toothbrushes.
1. Black Triangles between Teeth
I have black triangles between my teeth.
Black triangles, if large enough, can really distract from a nice smile. The dark area can look like a cavity or food stuck between your teeth. What is it really? In reality, these dark triangular areas are basically shadows formed by empty space that “should” be filled with gum tissue.
How Do Black Triangles Form?
Black triangles appear when the gums between the teeth don’t extend as far up the tooth as they should.
Why wouldn’t gums extend as far as they should? Great question.
- In the first place, the teeth may have grown into the mouth at a funny angle leaving a larger space than normal that hasn’t completely filled with gums.
- Additionally, black triangles are caused by poorly shaped restorations (i.e. filling or crown) that leave too much space at the gumline.
- Finally, the third reason black triangles occur is the most serious: bone loss and gum recession. Gums tend to follow bone. Therefore, if you are losing bone, the gums will start creeping back up the tooth and will create black triangles as they recede. Significantly, the reason this is the most serious of the three possible causes is that bone loss is a sign of serious gum infection.
Fixing Black Triangles?
Getting rid of black triangles can be as easy as straightening a crooked tooth or replacing a poorly shaped filling or crown. If the black triangles are being caused by recession, successfully fixing them will mean treating the underlying infection & getting the gums, bone and tooth roots back into a healthy condition.
Black Triangle Bonus Features
The great news about treating black triangles caused by recession is that it not only improves how your smile looks, it also improves your overall health in dramatic ways. In our patients with diabetes, we are hearing amazing stories about how they are regaining control of their blood sugar more easily after taking care of their gum infections. The human body is amazingly complex and yet amazingly simple. Eliminating infection and disease in any one part of the body improves the health of the whole body!
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.
- 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?
- 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.
If your lips hide most of the teeth during relaxed lip position, then you have normal length teeth. However, if when you smile, you show 2-4 mm of gum tissue, you may have Hyperactive Upper Lip. That just means your lip is “traveling” too much during smiling. Therefore, you may want to consider periodic botox treatment.
When you smile, look at your teeth size, your lip thickness and how much gums are showing and answer this: Do your teeth look like they’re a normal size? Does your lip seem to be a normal thickness (ie. Are you lips somewhere between Kim Kardashian thick and Karlie Kloss thin)? Now look at how much gums show. If you have regular size teeth and a normal lip thickness, but see lots of gums when you smile, then you may have either hyper-erupted upper teeth or vertical maxillary excess, which is a fancy way of saying that either your teeth came too far down or your jaw grew too long.
Hyper-Erupted Upper Teeth:
If you read about the other conditions described above on this page, then you know that gums are supposed to follow teeth and bone. If the teeth over-erupt and the gums keep coming down with the teeth, you’ll end up with a very long, gummy smile. You most likely have 2 solutions to choose from: either Corrective Gum surgery and tooth rebuilding OR “moving” the tooth back into the bone via braces or Invisalign.
Vertical Maxillary Excess:
In this case, the cause of a gummy smile is an extra long upper jaw or maxilla. If the upper jaw grows too long, called vertical maxillary excess, the extra bone creates a gummy smile. Your solution is oral surgery to relocate the entire segment at a higher level.
When you smile, do your upper teeth seem short but they are not worn out at the edges? If your teeth seem short and you’re seeing lots of gum tissue, you may have Altered Passive Eruption, aka “lazy gums.”
- Sometimes, the gums only do half of their job when adult teeth come in. As teeth move down into the mouth, the bottom part of the gums is supposed to shape itself up against the top white part of the tooth. When they don’t shape up like they’re supposed to, it’s called altered passive eruption and it results in a gummy smile with very short teeth. Therefore, your solution is Corrective Gum Reduction Surgery.
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.
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.
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