Uneven Teeth and Gums: Causes and Treatment Options

Uneven teeth and an uneven gumline can often be corrected, but the right option depends on what caused the unevenness in the first place. Teeth that look uneven may be worn down by grinding, chipped, crowded or out of line, or restored with old dental work that no longer matches. A gumline that looks uneven may have extra gum tissue over some teeth, gums that have receded from others, or inflammation from gum disease. Treating the cause first, then evening out the appearance, gives a result that looks better and lasts longer.

This guide from the Timonium office of Dr. Steven W. Haywood, DDS explains the common reasons teeth and gums look uneven, the treatment options for each, and how to keep your smile even once it has been corrected.

What makes teeth look uneven

Grinding and clenching

Grinding and clenching place excessive force on your teeth, wearing the enamel away and introducing small cracks. Over time, some teeth can become shorter or flatter than others, and the edges of the front teeth can look chipped or jagged. Many people grind at night without knowing it.

Chips and fractures

Biting hard objects, using your teeth as tools or a fall can chip a corner off a tooth. Even a small chip on a front tooth can make a smile look uneven.

Crowding, gaps and bite problems

When teeth are crowded, turned or tipped, some sit higher or lower than their neighbors. A bite that doesn’t meet evenly can also wear certain teeth faster. With a correct bite, pressure is distributed evenly when you bite down, which reduces the potential for excessive wear and breakage as you age.

Old dental work

Older fillings, crowns or bonding can wear, stain or chip, leaving a tooth a different shape or shade from those around it.

What makes a gumline uneven

Extra gum tissue over some teeth

Your smile line is shaped by your facial muscles, the size and shape of your lips and teeth, and your gum tissue. When a lot of gum tissue shows, or covers more of some teeth than others, the upper teeth can look short or uneven. Often the cause is excessive gum tissue rather than short teeth.

Gum recession

Receding gums make some teeth look longer than others. Gum disease is a common cause, and brushing too hard can contribute. Read smart brushing beats aggressive brushing.

Swollen or inflamed gums

Gums that are puffy, red or bleeding can look irregular along the edges of the teeth. Bleeding or receding gums, bad breath and deep pockets in the gums can be signs of infection. Read danger zone: 5 warning signs of gum disease.

Uneven gums treatment options

Treat gum disease first

If inflammation or infection is part of the picture, it comes first. The practice offers non-surgical periodontal care, including scaling and root planing, which removes harmful bacteria from beneath the gums, and periodontal maintenance. Oral DNA testing identifies which periodontal pathogens are present so treatment can be more accurate. Gum infection that is caught early and treated as a serious infection can be managed and controlled. See gum disease treatment.

Treatment for an uneven gumline caused by extra tissue

When the gums are healthy but cover too much of certain teeth, a gum lift sculpts the gum line to expose more of the teeth and create balanced proportions. It can be done with a dental laser or radiosurgery. When only a small movement or a little reshaping is needed, radio-surgical technology is used in almost all cases, and the Picasso laser allows soft tissue procedures with greater precision and comfort.

For a major gum lift or minor recontouring, the Haywood surgical smile makeover combines gum surgery with same-day customized veneers, which helps guide tissue healing and shows the cosmetic result right away. See gum lift and read gum contouring in cosmetic dentistry.

When recession is the cause

A gum lift moves gum tissue upward, so it is not the answer for gums that have already pulled back. The first step with recession is finding and controlling the cause, such as gum disease, hard brushing or grinding. Dr. Haywood can then explain the options for your particular case.

Options for evening out the teeth

Dental bonding

Bonding applies tooth-colored composite resin to repair chips and fractures, make a smile look more even, close gaps and change the shape of teeth. It can be completed in a single visit, typically requires no anesthesia, and is one of the most affordable cosmetic procedures. See dental bonding.

Porcelain veneers

Veneers are thin, translucent shells bonded to the front of the teeth. They can improve gaps, chips, stains and crooked teeth, and make a smile look more even. A veneer can be as thin as a contact lens and doesn’t require grinding down the entire tooth. See dental veneers.

Crowns

When a tooth is extensively damaged or cracked, a porcelain crown restores its shape and protects what remains. When a more conservative repair will work, that is recommended first.

Straightening

If teeth are uneven because of their position, moving them may be the best fix. Dr. Haywood is an Elite Invisalign Provider, and metal braces are offered for more complex cases. Instant orthodontics uses veneers, bonding, crowns and tooth and gum reshaping to transform crooked, gapped or uneven teeth in as little as one or two visits. See Invisalign, and for a comparison of moving versus reshaping, read crooked or gapped teeth: your options.

Matching the fix to the cause

• Worn teeth from grinding: control the grinding, then rebuild worn edges with bonding, veneers or crowns.
• A chipped tooth: bonding for a small chip, a crown or veneer for larger damage.
• Crowded or turned teeth: Invisalign or braces, sometimes combined with cosmetic work.
• Too much gum showing: a gum lift, sometimes with veneers.
• Red, swollen or bleeding gums: gum disease treatment before any cosmetic change.
• Receding gums: find and control the cause first.

See the result before you start

Cosmetic imaging is part of every cosmetic evaluation. Digital photos of your smile are changed on the imaging computer, so you and Dr. Haywood can plan the improvements you’d like to see together. See cosmetic imaging.

Keeping your smile even

• Protect against grinding. Comfortable, clear bite guards custom-made for you help control tooth wear, and bite protection is suggested for all cosmetic work.
• Don’t use your teeth as tools. Opening packages or bottles and biting hard objects can chip teeth and dental work.
• Brush gently with a soft brush to protect your gums.
• Keep up with cleanings. A professional cleaning every six months is recommended, and cleaning appointments at the practice last a full 60 minutes. See general dentistry in Timonium.

Paying for treatment

Every case is different, so your fee is discussed after an assessment. The practice is out of network with all dental insurance providers. You pay at the time of your visit, and the office files the claim on your behalf so your plan can reimburse you for whatever it covers. Health savings and flex plans are welcome, and financing is available through CareCredit, with no-interest options for up to 12 months, and Cherry, with plans from 3 to 24 months. See financing options.

Frequently asked questions

Can an uneven gumline be fixed without surgery?

It depends on the cause. If the gums are swollen from infection, non-surgical gum disease treatment is the first step. If extra gum tissue is the cause, a gum lift reshapes it, and small changes are usually made with radio-surgical technology or a laser.

Why are my front teeth different lengths?

Common reasons include wear from grinding, a chipped edge, teeth that sit at different heights because of crowding, or a gumline that covers more of one tooth than another. An exam shows which one applies to you.

Can bonding even out my teeth?

Often, yes. Bonding can repair chips, change the shape of teeth and make a smile look more even in a single visit. Porcelain veneers resist stains better and last longer.

Should I fix my gums or my teeth first?

Healthy gums come first. Once any gum problems are under control, the gumline and the teeth can be planned together so they look balanced.

Plan an even smile in Timonium

If your teeth or gums look uneven, a consultation can find the cause and show you the options. Request an appointment or call (410) 453-9399. The office of Dr. Steven W. Haywood, DDS is at 108 W Timonium Rd, Ste 200, Timonium, MD 21093, serving Timonium, Lutherville, Cockeysville, Towson, Hunt Valley and Baltimore. New patients are always welcome.