The doctor explained that my gums were longer than my teeth, so the dimensions werent right, said Miller-Pence, 52, a psychoanalyst living in San Luis Obispo, Calif.
Fifteen years ago, she had a gingivectomy, an operation to remove some of the extra gum tissue. A month later, she was grinning broadly. Now everyone comments on my smile, she said.
Gummy smiles occur for a variety of reasons, most commonly a short upper lip, excessive gum tissue or small teeth, all of which are genetic. According to Dr Stan Heifetz, a cosmetic dentist in New York and White Plains, ideal smiles show up only to about two millimetres of gum. Anything over three to four millimetres of gum showing starts to look gummy, he said.
Doctors who specialise in cosmetic procedures estimate that about 14 per cent of women and 7 per cent of men have excessive gingival exposure when smiling.
In the past, surgery was the main treatment option, but that is often costly and painful. Doctors sever the muscles that elevate the upper lip so it can no longer rise as high, or they do a crown lengthening procedure that cuts away gum tissue so the crown appears longer.
In extreme cases, they might perform orthognathic surgery, which repositions the upper jaw if it sticks out too much. But this can be complicated and can take up to two years to complete, Dr Heifetz said. Laser therapy is also sometimes used.
Now people are going another route: onabotulinumtoxinA, otherwise known as Botox.
For the last few years, dentists have been injecting Botox into the upper lip elevator muscles. It paralyses the muscles, inhibiting contraction of the upper lip when smiling to prevent the gummy smile.
In contrast to surgery, Botox is quick and easy, doctors who do the procedure say.
A March 2014 study in Aesthetic Surgery Journal found that off-label use of Botox was a safe and effective procedure for gummy smile, albeit one that lasts only three to four months for the average patient, confirming the findings of an earlier report in the American Journal of Orthodontics and Dentofacial Orthopedics.
The price is also more appealing than surgery: Botox costs around $350.
Miller-Pence said she paid about $15,000 for surgery and crowns, which was not covered by insurance.
Botox goes directly into the lip tissue, so theres almost no risk of digesting it, said Dr Peter Taub, a plastic and reconstructive surgeon at Mount Sinai Hospital in New York.
Stephanie McCarrell, a nurse anaesthetist in Tampa, Flroida, says she has received Botox three times for her gummy smile, which has always bothered her.
When I was a girl, the other kids made fun of me, said Ms McCarrell, 36. It really bothered me. I would smile without my teeth, just a closemouthed smile.
A few days after her injection, her upper lip had dropped and her gums were less visible, she said.
But Botox works only if the problem is in the lips, not the bone. And doctors have to be careful not to over-inject the muscles, or they could create an unnatural look.
* Botox (or onabotulinumtoxinA) is injected into the upper lip elevator muscles. It paralyses the muscles, inhibiting contraction of the upper lip when smiling to prevent the gummy smile.
* It goes directly into the lip tissue, so theres almost no risk of digesting it
* Doctors say the procedure is much easier than a surgery, or laser treatment
* Botox treatment costs around $350, as compared to a surgery which may cost around $15,000
* But, one set of injections lasts only three to four months for the average patient
- ABBY ELLIN