Gingivitis is the least serious type of gum disease. If you have gingivitis, your gums have become irritated, most often by plaque. Plaque is a soft, sticky substance caused by bacteria that can build up on your teeth.
If you don’t clean plaque off your teeth regularly, it can get under your gums. This can irritate your gums. They may become red, swollen and bleed when you brush them.
If you remove the plaque and look after your teeth and gums well, it is very likely to get better. If you don’t get the plaque off properly, you may develop a more serious type of gum disease called periodontitis.
If you don’t get treatment for gingivitis, the inflammation may spread to the ligaments and bones that hold your teeth in place. This is called periodontitis. Your gums may begin to pull away from your teeth, leaving pockets. These pockets trap plaque that you can't then reach with a toothbrush.
Over time, the plaque will harden to become tartar (calculus). This can cause further irritation and infection. As time goes on, the pockets can get deeper and more difficult to clean, making the problem worse. Pus may collect under your gums if the infection is bad (known as abscesses).
Periodontitis can cause your gums to shrink back from your teeth (recession). If this happens, it can expose some of the roots of your teeth, making them sensitive. If you have bone loss, your teeth may become loose. If you don’t get treatment for a number of years, you may lose some teeth.
Periodontitis can’t be completely cured. But you will need to get treatment and make sure you floss and brush your teeth well in the future. This way, any further damage to your teeth and gums is likely to be slow or may stop.
Acute necrotising ulcerative gingivitis (ANUG)
ANUG, also known as 'trench mouth', is a severe type of gum disease that develops suddenly. It causes swelling, ulcers, bad breath (halitosis) and pain. For more information on ANUG, see our FAQs section.
You may not know you have gum disease because it's not always painful. This is one of the reasons why it's important that you attend regular check-ups with your dentist.
Usually the first signs of gingivitis are:
- bleeding gums when you brush your teeth
- red and swollen gums
If gingivitis has developed into periodontitis, you may have:
- bad breath (halitosis)
- a bad taste in your mouth
- gum recession and sensitivity
- a wobbly tooth or teeth
- gum abscesses (pus that collects under your gum)
The symptoms of acute necrotising ulcerative gingivitis (ANUG) include:
- very painful ulcers that bleed easily
- bad breath (halitosis)
- a metallic taste in your mouth
- difficulty swallowing or talking
- having a lot of saliva in your mouth
- feeling generally unwell – possibly with a fever
ANUG often occurs in the V-shaped bit of gum between your teeth. If you have any of these symptoms, you should see your dentist straight away.
Your dentist can usually diagnose gingivitis by looking at your teeth. If your dentist thinks you have periodontitis, he or she may look at your mouth more thoroughly. They will check for gum disease using a periodontal probe. This is a small, thin metal measuring tool. It measures how deep any gaps are between your teeth and gums.
You may also need to have X-rays to check the condition of your teeth and jaw bone.
The type of treatment you’ll have will depend on how severe your gum disease is. Your dentist may refer you for treatment with a dental hygienist. A hygienist specialises in the prevention and treatment of dental conditions such as gum disease. If you have severe gum disease, your dentist may refer you to a periodontologist. This is a health professional who specialises in treating periodontal disease.
If you have gingivitis, your dentist or hygienist will clean your teeth thoroughly above and below the gums. This can also be called a scale and polish. They will clean any plaque or tartar from your teeth using handheld or electric (ultrasonic) instruments. Your hygienist may also recommend a mouthwash that will help to prevent plaque forming. He or she will help you learn how to brush and floss your teeth properly.
If you have periodontitis or acute necrotising ulcerative gingivitis (ANUG), you may need extra treatment. This will remove plaque, tartar and damaged tooth covering. This is called root planing. You may need to have several appointments.
Your dentist or hygienist may inject a local anaesthetic into your gums beforehand if you need this. This will completely block the feeling from your gums. You’ll remain awake during the treatment.
Your dentist or hygienist will check the size of any pockets in your gums during the following months to make sure your treatment has worked.
If you’re having scaling, root planing or treatment for ANUG, your dentist or hygienist may prescribe you antibiotics.
You may need to have gum surgery if your gum disease is severe. Your dentist may refer you to a periodontologist for this. There are a number of types of surgery that can help remove bacteria and repair your gums and bone. If you need more information, ask your dentist.
Gum disease happens when plaque builds up around teeth that aren’t cleaned properly. Cleaning your teeth well might be harder if you:
- wear braces
- have implants
- have dentures
- have poorly fitting crowns or fillings
- have other irregularities in your teeth
Other factors that can make you more likely to get gum disease are:
- smoking cigarettes
- having diabetes
- getting older
- having a weakened immune system, for example if you have HIV/AIDS
- having Down’s syndrome
You can prevent gum disease by controlling the amount of plaque and tartar that builds up on your teeth.
You can do this by:
- brushing and flossing your teeth properly
- visiting your dentist or hygienist regularly
- stopping smoking
To clean your teeth well, you should brush for about two minutes both first thing in the morning and last thing at night. You should also floss (or use inter-dental brushes) at least three times a week. Dental floss or inter-dental brushes can remove plaque and small bits of food from between your teeth and under your gum line. These are areas that a toothbrush can't reach.
You may prefer to use an electric toothbrush instead of a manual one. Some studies show that certain types of electric toothbrush may be better at removing plaque than manual toothbrushes. It’s important to use the correct technique to brush your teeth, so ask your dentist or hygienist for advice.
Some mouthwashes can help to reduce the amount of plaque bacteria when used with regular brushing and flossing. If you do use an antiseptic mouthwash or toothpaste, be aware that they can stain your teeth. Always read the information on the box or bottle. If you have any questions, ask your dentist or hygienist for advice.
Brushing and flossing can't remove every trace of plaque, because most people have irregularities in their teeth where plaque can build up and harden. This can only be removed by your dentist or hygienist, which is why it’s best you have regular check-ups. Regular dental checks are particularly important if you have diabetes or other risk factors for gum disease.
All my teeth have porcelain or gold crowns. Do I still need to floss them?
Yes, you should still use floss to clean between your crowns and under your gum line to prevent plaque from building up.
The gold and porcelain surfaces of your teeth are artificial and can’t decay. Plaque can still build up under your gums in the same way as it would if you didn’t have crowns. Depending on the fit of each crown, plaque may build up where it joins the tooth.
You may not be able to see the edges of your crowns (if they’re below your gum line). However, plaque under the gum line can still cause damage to your gums and teeth. Looking after your crowns carefully will also help them last longer.
Your dentist or hygienist can show you the correct way to brush, floss and use interdental brushes.
I'm pregnant and have gingivitis. Will it go away after I've had the baby or will I always have it now?
Gingivitis is quite common during pregnancy and usually gets better after you've had your baby.
If you're pregnant, you may be more likely to develop gingivitis, which is a type of gum disease. If you already have gingivitis, pregnancy can make it worse. This is likely to do with changes in your hormones.
Increases in hormones can make your gums more sensitive to bacteria. This makes them more likely to become inflamed (swollen), causing gingivitis. Because of this, it is especially important that you clean your teeth carefully during your pregnancy. This will help to reduce your chances of getting gingivitis during your pregnancy.
Brush and floss your teeth well. If you notice signs of gum disease, such as bleeding gums, make an appointment with your dentist.
After your baby is born, your gingivitis should start to improve if you look after your teeth and gums well.
I've suddenly developed very bad breath and painful ulcers on my gums. Is this gum disease?
It's possible that you may have a condition known as acute necrotising ulcerative gingivitis (ANUG). This is also known as 'trench mouth'. It’s a severe type of gum disease, but it can be treated.
The symptoms of ANUG include sudden, painful ulcers and bad breath. If you have ANUG, the ulcers tend to bleed easily and the V-shaped bits of gum between your teeth start to disappear.
Usually, gum disease develops gradually and is often painless, but ANUG is a sudden, severe gum infection caused by bacteria. You're more likely to get ANUG if you:
- don't brush and floss your teeth regularly
- are under stress
- have a weakened immune system, for example, because of another condition (such as HIV/AIDS)
ANUG is very painful – particularly when brushing your teeth or eating. If this happens, make an appointment to see your dentist as soon as possible. Your GP can prescribe pain relief while you wait for your appointment with the dentist. Try to keep brushing your teeth, even if you can only do so with a soft brush.
ANUG usually gets better with professional cleaning to remove the plaque and tartar from your teeth and gums. This involves your dentist cleaning your teeth very thoroughly with special instruments. This is called a scale and polish. Your dentist or hygienist may need to inject a local anaesthetic into your gums beforehand.
- Some dental and periodontal diseases. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed July 2014
- Gingivitis and periodontitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
- Gingivitis. BMJ Best Practice. www.bestpractice.bmj.com, published August 2014
- Gum disease. Crowns. British Dental Health Foundation. www.dentalhealth.org, accessed 20 April 2015
- Young practitioners guide to peridontology. British Society of Peridontology. www.bsperio.org.uk, November 2012
- Periodontitis. The Merck Manuals. www.merckmanuals.com, published July 2012
- Wu M, Chen S-W, Jiang S-Y. Relationship between gingival inflammation and pregnancy. Mediators Inflamm 2015; 623427. doi:10.1155/2015/623427
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Reviewed by Hemali Bedi, Bupa Health Content Team, May 2015.
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