Gum disease

Gum disease, also known as gingivitis, is where the gums become swollen, sore or infected.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you have this condition you see a dentist within a month.

How is it diagnosed?

Your dentist can diagnose gingival disease by examining your mouth.

What is the treatment?

The best way to treat gum disease is good oral hygiene. This involves:

  • regular teeth brushing, twice a day with fluoride toothpaste
  • regular mouthwash
  • avoid smoking
  • visit your dentist regularly.

You can use non-prescription painkillers for pain relief.

When to worry?

If you develop and of the following symptoms, please see a doctor with 48 hours:

  • mouth ulcer or sore that has been present for more than 2 weeks.
  • unexplained, persistent lumps in the mouth that don’t go away
  • white or red patches on the lining of the mouth or tongue.

Introduction

Gum disease, also known as gingivitis and periodontal disease, is where the gums become swollen, sore or infected.

Gum disease is very common, affecting 15-20% of the world's population.

It is estimated that half the adult population has some degree of gum disease and most people experience it at least once. It is much less common in children.

If you have gum disease, your gums may bleed when you brush your teeth and you may have bad breath.

In severe cases of gum disease, a condition called periodontitis can develop. It affects the tissues that support teeth and hold them in place.

If periodontitis is not treated, the bone in your jaw can decay and small spaces can open up between the gum and teeth. Your teeth can become loose and may eventually fall out.

Read more about the symptoms of gum disease.

What causes gum disease?

Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky substance that contains bacteria.

Some bacteria in plaque is harmless, but some is very harmful for the health of your gums. If you do not remove plaque from your teeth by brushing them, it will build up and irritate your gums, leading to inflammation and soreness.

Read more about the causes of gum disease.

When to see your dentist

You should make an appointment to see your dentist if your gums are painful, inflamed or if they bleed when you brush your teeth.

You can find a dentist near you by using the post code search facility.

Preventing and treating gum disease

Mild cases of gum disease can usually be treated or 'reversed' by maintaining a good level of oral hygiene. This includes brushing your teeth using an effective technique at least twice a day and flossing daily.

If necessary, your dentist will be able to give your teeth a thorough clean and remove any hardened plaque (tartar). They will also be able to show you how to clean your teeth effectively to help prevent plaque building up in the future.

If you have severe gum disease, you will need to have further non-surgical treatment and, in some cases, surgical treatment. This will usually be carried out by a specialist in periodontics.

Read more about treating gum disease and how to keep your teeth clean. Also, read more about preventing gum disease.

Complications of gum disease

If you have untreated gum disease that develops into periodontitis, it can lead to further complications such as:

  • gum abscesses (painful collections of pus)
  • damage to the periodontal ligament (the tissue that connects the tooth to the socket)
  • damage to the alveolar bone (the bone in the jaw that contains the sockets of the teeth)
  • receding gums
  • loose teeth
  • loss of teeth

Read more about the complications of gum disease.

Symptoms

Try checking your symptoms with our AI-powered symptom checker.

Healthy gums should be pink, firm and keep your teeth securely in place. Your gums should not bleed when you touch or brush them.

Gum disease, or gingivitis, is not always painful and you may be unaware you have it. This is why it is important to have regular dental check-ups.

The initial symptoms of gum disease are:

  • red and swollen gums
  • bleeding gums after brushing or flossing your teeth

If gum disease develops into periodontitis (where the tissues that support teeth are affected), you may also have the following symptoms:

  • a bad taste in your mouth
  • loose teeth that can make eating difficult
  • gum abscesses (collections of pus that develop under your gums or teeth)

Acute necrotising ulcerative gingivitis

Acute necrotising ulcerative gingivitis (ANUG) is a rare condition. The symptoms are usually more severe than those of gum disease and periodontitis.

The symptoms of ANUG can develop quickly and include:

  • bleeding, painful gums
  • painful ulcers
  • receding gums in between your teeth
  • bad breath (halitosis)
  • a metallic taste in your mouth
  • excess saliva in your mouth
  • difficulty swallowing or talking

You may also feel generally unwell and have a high temperature (fever) of 38C (100.4F) or more.

You should visit your dentist immediately if you have any of the above symptoms.

Diagnosis

You should see your dentist if you have painful, swollen or bleeding gums.

Your dentist will be able to confirm whether you have gum disease and provide necessary treatment.

Periodontitis

Periodontitis is a form of gum disease that develops if gingivitis is not treated. It affects the tissues that support teeth and hold them in place, and can lead to teeth loosening or falling out.

If you have periodontitis, you will need a thorough dental examination. Your dentist may use a periodontal probe to examine your mouth. This is a medical instrument shaped like a thin silver stick with a bend in one end.

The periodontal probe will be inserted beside your tooth, underneath the gum line. If you have healthy teeth, your gums should be attached to your teeth and the probe should not be able to slide very far below your gum line. You may have periodontitis if the probe is able to slide deeper under the gum line than normal.

In some cases, a number of X-rays may be needed to check the condition of your teeth and jaw bone.

Acute necrotising ulcerative gingivitis

You will also need to see a dentist if you have the symptoms of acute necrotising ulcerative gingivitis (ANUG).

The dentist will be able to diagnose the condition from your symptoms. It is very important that you see a dentist as soon as possible because ANUG can cause serious complications.

Read more about the complications of gum disease.

Treatment

The best way to treat all gum disease, including periodontitis and acute necrotising ulcerative gingivitis, is to practise good oral hygiene.

Gum disease and periodontitis

Good oral hygiene involves:

  • brushing your teeth for 2-3 minutes twice a day (in the morning and at night)
  • using an electric toothbrush if possible (unless you have ANUG, see below)
  • using toothpaste that contains fluoride if your water supply is low in fluoride (fluoride is a natural mineral that helps protect against tooth decay)
  • flossing your teeth regularly (preferably daily)
  • not smoking
  • regularly visiting your dentist (at least once every 1-2 years but more frequently if necessary)

See the [teeth cleaning guide] for more information and advice about good oral hygiene.

Mouthwash

Antiseptic mouthwashes that contain chlorhexidine or hexetidine are available over-the-counter from pharmacies. There is some debate about whether using mouthwash is necessary for people with healthy gums.

Your dentist may recommend using mouthwash if it helps control the build-up of plaque (the soft, sticky substance that forms when bacteria collect on the surface of your teeth). Your dentist will be able to advise you about which type of mouthwash is most suitable and how to use it.

Chlorhexidine mouthwash is not suitable for women who are pregnant or breastfeeding. It can also stain your teeth brown if you use it regularly. Rinse your mouth thoroughly in between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash from working.

Acute necrotising ulcerative gingivitis

Acute necrotising ulcerative gingivitis (ANUG) should always be treated by a dentist. However, if you see your doctor before visiting a dentist, they may provide you with some treatment while you wait to see your dentist. Possible treatments are described below.

Antibiotics

On their own, antibiotics are not effective at treating periodontitis, and they may only be recommended in severe cases of gum disease.

Metronidazole or amoxicillin are the most common antibiotics that are prescribed for ANUG. You will usually have to take these antibiotics for three days.

Amoxicillin is not suitable for people allergic to penicillin. It can also cause the contraceptive pill to fail, so women who are taking the contraceptive pill should use an additional form of contraception while taking amoxicillin and for seven days afterwards.

Metronidazole can react with alcohol, causing you to feel very unwell. Therefore, it is a good idea not to drink alcohol while you are taking metronidazole and for 48 hours afterwards.

Metronidazole and amoxicillin may also cause the following side effects:

Painkillers

Paracetamol and ibuprofen are the most commonly prescribed painkillers. They are also available over the counter from pharmacies. They may help reduce pain and discomfort caused by ulcers.

However, paracetamol and ibuprofen are not suitable for everyone so read the manufacturer’s instructions before taking them. Children under 16 years of age should not be given aspirin.

Mouthwash

Mouthwash that contains chlorhexidine or hydrogen peroxide may be prescribed to treat ANUG. Some chlorhexidine mouthwashes are also available over the counter, though they may not be as effective as a hydrogen peroxide mouthwash.

You should always read the instructions before using mouthwash. Some types may need to be diluted in water before they are taken. They are usually used 2-3 times a day.

See the advice above regarding the use of chlorhexidine mouthwash during pregnancy and breastfeeding.

Good oral hygiene

As with gum disease and periodontitis, you should continue to practise good oral hygiene (as described above) if you have ANUG.

However, because ANUG can cause painful ulcers, brush your teeth with a very soft toothbrush and avoid using an electric brush.

Dental treatments

The following dental treatments may be recommended to treat gum disease, periodontitis and ANUG:

  • scale and polish
  • root planing (debridement)
  • antibiotics (see above)
  • surgery

These are described in more detail below.

Scale and polish

To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. This is a ‘professional clean’ usually carried out at your dental surgery by a dental hygienist.

The dental hygienist will scrape away plaque and tartar from your teeth using a special instrument, then polish your teeth to remove marks or stains. If a lot of plaque or tartar has built up you may need to have more than one scale and polish.

The price of a scale and polish can vary depending on what needs to be carried out, so ask your dental hygienist how much it will cost beforehand.

Root planing

In some cases of gum disease or periodontitis, root planing (debridement) may be required. This is a deep clean under the gums that gets rid of bacteria from the roots of your teeth.

Before having the treatment, you may need to have an anaesthetic (painkilling medication) to numb the area. You may experience some pain and discomfort for up to 48 hours after having root planing.

Further treatment

If you have severe gum disease, periodontitis or ANUG, you may need further treatment, such as periodontal surgery. In some cases, it is necessary to remove the affected tooth. Your dentist will be able to tell you about the procedure needed and how it is carried out. If necessary, they will also be able to refer you to a specilaist.

If you are having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether this is necessary.

Prevention

The best way to protect gums from gum disease, periodontitis and acute necrotising ulcerative gingivitis is to always practise good oral hygiene

This means brushing teeth at least twice a day and flossing at least three times a week.

Read more about how to maintain good oral hygiene.

Visiting the dentist

If you have never had gum disease and have good oral health, you may only need to visit your dentist every 1-2 years for a check-up.

It is important you attend dental appointments so any problems with teeth and gums can be detected and treated early.

If you have had problems with gum disease or periodontitis in the past, you may need to visit your dentist more frequently. At each appointment your dentist will advise when you need your next appointment.

If you have an increased risk of developing gum problems - for example, if you smoke or have diabetes (a condition caused by too much glucose in the blood), you may be advised to visit your dentist more often so your teeth and gums can be closely monitored.

Causes

Gum disease (gingivitis) can be caused by a number of factors. However, poor oral hygiene is the most common cause.

Poor oral hygiene, such as not brushing your teeth properly or regularly, can cause plaque to build up on your teeth. Plaque is a sticky substance that contains bacteria.

Plaque

After eating and drinking sugary food and drink, the bacteria in your mouth break the carbohydrates down into acid.

The acid combines with bacteria, saliva in your mouth and any small particles of food remaining after brushing to produce a sticky film called plaque.

Plaque is usually easy to remove by brushing and flossing your teeth. Brush your teeth at least twice a day (once in the morning and once at night) and floss at least three times a week.

If plaque is not removed it can harden and form a substance called tartar. Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist.

Poor oral hygiene

Poor oral hygiene can cause plaque and tartar to build up on your teeth. Bacteria in plaque will irritate your gums, making them inflamed and sore. This is gum disease.

If gum disease is not treated and plaque and tartar continue to build up you may develop periodontitis. This can lead to your teeth becoming loose and eventually falling out.

Who is at risk?

You are more at risk of developing gum disease and periodontitis if you:

  • smoke
  • have diabetes - a long-term condition caused by too much glucose in the blood
  • have a weakened immune system - for example, due to conditions such as HIV and AIDS, or certain treatments such as chemotherapy (powerful cancer-killing medication)

Acute necrotising ulcerative gingivitis

As with other types of gum disease, poor oral hygiene is the main cause of acute necrotising ulcerative gingivitis (ANUG). Other risk factors include:

  • smoking
  • having a weakened immune system
  • malnutrition - a condition caused by not eating enough of the right food groups to get all of the nutrients needed for good health
  • stress

Complications

If you develop gingivitis and do not have the plaque or tartar (hardened plaque) removed from your teeth, the condition may get worse and lead to periodontitis.

If you do not treat periodontitis (where the tissue that supports teeth is affected), you may develop further complications including:

  • recurrent gum abscesses (painful collections of pus)
  • increasing damage to the periodontal ligament (the tissue that connects the tooth to the socket)
  • increasing damage to the alveolar bone (the bone in the jaw that contains the sockets of the teeth)
  • receding gums
  • loose teeth
  • loss of teeth

Acute necrotising ulcerative gingivitis

If you have acute necrotising ulcerative gingivitis (ANUG) and it is not treated, it can cause more severe complications.

The infection can spread to all areas of your gums and the alveolar bone surrounding your teeth. This can lead to:

  • the gums between your teeth being completely destroyed
  • large ulcers (open sores) leaving permanent holes in your gums
  • loose and unstable teeth

If ANUG is not properly treated the first time you have it, you are more likely to have recurring cases in future. This can leave you with:

  • bad breath(halitosis)
  • bleeding gums
  • receding gums

Gangrene

In very rare cases, ANUG can lead to a condition called gangrene. Gangrene occurs when tissue starts to die and waste away. The type of gangrene that can occur as a result of ANUG is called noma.

Noma affects lips and cheeks. If you develop it, you may need to have the dead tissue removed. Noma usually only affects people who:

  • have a very weak immune system - for example, those with conditions such as HIV and AIDS
  • are malnourished - do not eat enough of the right food groups to get the nutrients they need for good health
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