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Gum disease

Gum disease is inflammation of your gums (gingivae) and damage to the bone that anchors teeth in your jaws.

There are three main types of gum disease: gingivitis, periodontitis and acute necrotising ulcerative gingivitis (ANUG).

Gum disease is very common – gingivitis, the early form affects more than half of adults worldwide. It can be treated by a dentist or hygienist and in the early stages the effects can be reversed.

Gingivitis

If you have gingivitis, your gums become irritated by plaque, which is a mixture of food, bacteria and bacterial waste products that can build up on your teeth. If you don’t clean plaque off your teeth regularly, it can get underneath you gum line, causing your gums to become red, swollen and they may bleed when you brush them.

This is the early stage of gum disease and if you remove the plaque, your gums will recover. But if you don’t clean the plaque off your teeth, the gingivitis may develop into a more serious type of gum disease called periodontitis.

Periodontitis

If you don’t get treatment for gingivitis, your gums may begin to pull away from your teeth, leaving small pockets. These pockets trap plaque that you can't reach with a toothbrush. Over time, the plaque will harden to become tartar (calculus). Plaque and tartar build-up can cause further irritation, which may gradually spread to the bone structures around your teeth. As time goes on, the pockets can get deeper and more difficult to clean, and your gum and bone may shrink. This is called periodontitis.

If your gums shrink, they can expose some of the roots of your teeth, making them sensitive. And if you have bone loss, your teeth may become loose. If you don’t get treatment for a number of years, your teeth may fall out, or need to be taken out by a dentist.

Periodontitis can’t be completely cured; however, if you receive the appropriate treatment and make sure you floss and brush your teeth well, the progress of the disease can be stopped.

Acute necrotising ulcerative gingivitis

ANUG, also known as 'trench mouth', is a severe type of gum disease that develops suddenly. It can be treated with good dental hygiene, including brushing your teeth twice a day, flossing your teeth three times a week, and taking antibiotics. For more information about treating ANUG, see our FAQs.

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Details

  • Symptoms Symptoms of gum disease

    You may not know that you have gum disease because often it's not painful and you might not get any symptoms. 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:

    • a bad taste in your mouth
    • a wobbly tooth or teeth
    • gum abscesses (pus that collects under your gum)

    The symptoms of ANUG include:

    • painful ulcers that develop suddenly and bleed easily
    • bad breath
    • a metallic taste in your mouth
    • difficulty in swallowing or talking
    • a receding of the V-shaped bits of gum between your teeth
    • feeling generally unwell – possibly with a fever

    If you have any of these symptoms, you should see your dentist straight away.

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  • Diagnosis Diagnosis of gum disease

    Gingivitis can usually be diagnosed just by your dentist looking at your teeth. But if your dentist thinks you have periodontitis, he or she may look at your mouth more thoroughly and check for gum disease using a periodontal probe. This is used to measure how far your gum has pulled away from your teeth and how much bone – if any - has been lost. Your dentist will do this by putting the probe beside each tooth and underneath your gum line to check how well your gums are attached to your teeth.

    You may also need to have X-rays to check the condition of your teeth and jaw bone.

  • Treatment Treatment of gum disease

    The type of treatment you have will depend on how severe your gum disease has become. Your dentist may refer you for treatment with a dental hygienist – a health professional who specialises in the prevention and treatment of dental conditions such as periodontal disease. If you have severe gum disease, your dentist may refer you for treatment with a periodontologist (a health professional who specialises in treating gum disease).

    Professional cleaning

    If you have gingivitis, your dentist or hygienist will clean your teeth thoroughly with a gritty toothpaste using an electric toothbrush and special instruments called scalers. This type of thorough cleaning is called scale and polish. Your hygienist may also recommend an antiseptic mouthwash that will help to prevent plaque forming, and will help you learn how to brush and floss your teeth properly.

    In addition to scale and polish, if gingivitis has developed into periodontitis or you have ANUG, you may need more extensive treatment to remove plaque and tartar from the periodontal pockets. This is called root planing. You may need to have several appointments.

    Your dentist or hygienist may need to inject a local anaesthetic into your gums beforehand. This will completely block the feeling from your gums, and you will remain awake during the treatment. Your dentist or hygienist will monitor the size of the periodontal pockets during the following months to make sure the treatment has been successful and the periodontitis isn’t getting any worse.

    Medicines

    If you’re having scaling, root planing or treatment for ANUG, your dentist or hygienist may prescribe you antibiotics.

    Gum surgery

    You may need to have gum surgery if your gum disease is very severe and other methods such as deep cleaning and medicines haven’t worked. Your dentist may refer you to a periodontologist for this. There are a number of types of surgery that can help to build your gum tissue back up after it has shrunk from gum disease. If you need more information, ask your dentist.

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  • Causes Causes of gum disease

    Gum disease happens when plaque builds up around teeth that aren’t cleaned properly. This may be more likely to happen if you find it difficult to clean your teeth well, for example if you wear braces or dentures, or have irregularities in your teeth that you can't reach with a toothbrush.

    There are other factors that can make you more likely to get gum disease, for example if you smoke or have diabetes. You may also be more likely to get gingivitis during hormonal changes, such as during pregnancy or puberty.

  • Prevention Prevention of gum disease

    You can prevent gum disease by controlling the amount of plaque and tartar that builds up on your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth properly and stopping smoking will help to do this.

    Dental floss or inter-dental brushes can remove plaque and small bits of food from between your teeth and under your gum line – areas that a manual toothbrush can't reach. You may prefer to use an electric toothbrush. There is some evidence to suggest that certain types of electric toothbrush may be more efficient at removing plaque than manual toothbrushes. It’s important to use the correct technique, so ask your dentist or hygienist for advice.

    Some antiseptic mouthwashes reduce the amount of plaque bacteria when combined with regular brushing and flossing. However, there isn’t currently enough evidence to say whether mouthwash can help prevent gum disease. If you do use an antiseptic mouthwash, it's important that you don't use it for too long as it can stain your teeth. Always read the information on the mouthwash box or bottle and if you have any questions, ask your dentist or hygienist for advice.

    Even thorough brushing and flossing can't remove every trace of plaque as most people have irregularities in their teeth where plaque can build up out of reach and harden into tartar. This can only be removed by your dentist or hygienist during scaling.

  • FAQs FAQs

    I'm middle-aged and all my remaining teeth are porcelain or gold crowns. Do I still need to floss them?

    Answer

    Yes, you should still use floss to clean between your crowns and under your gum line to prevent plaque from building up.

    Explanation

    Although the visible surfaces of your teeth are made of porcelain or gold, plaque can still build up around the gum line in the same way as it would if you didn't have crowns. Depending on the fit of your crown, plaque may gather in, around and underneath, the gum line.

    The gold and porcelain surfaces of your teeth are artificial and can't decay. However, you still need to brush and floss your teeth carefully – just as you would with natural teeth. Although you may not be able to see the edges of your crowns (usually the edges are tucked under your gum line), if plaque is left to gather between your teeth, it will eventually cause decay on the root surfaces and underneath your crowns. If you have tooth decay, your crowns may become loose and may fall off. Tooth decay can also cause toothache.

    It's very important to clean all your remaining teeth carefully whether or not they have a crown. Your dentist or hygienist can show you the correct way to brush, floss and use interdental brushes.

    I'm pregnant and have developed gingivitis. Will it go away after I've had the baby or will I always have it now?

    Answer

    Gingivitis is quite common during pregnancy, but you can get rid of it.

    Explanation

    If you're pregnant, you may be more likely to develop gingivitis – the first stage of gum disease. If you already have gingivitis, pregnancy can make it worse. This is likely to do with changes in your hormones.

    As well as pregnancy hormones, there may be other causes of gingivitis. If brushing, flossing and the taste of toothpaste make you feel sick, you may not be caring for your teeth as thoroughly as usual. If you have been craving and eating sugary snacks, this can cause plaque to build up, leading to gingivitis. Make an appointment with your dentist if you’re having problems with your gums.

    Some dental treatments, such as fillings, aren’t recommended when you’re pregnant. However, most routine dental treatments are safe when you’re pregnant, though your dentist may suggest you have any procedures that aren’t urgent after your first trimester. If you are unsure about what treatments may be involved, discuss your concerns with your dentist.

    After your baby is born, your gingivitis should start to improve if you brush and floss your teeth effectively. You may find it difficult to make time for yourself during the first few weeks after your baby is born, but try to get back into the habit of twice-daily brushing and regular flossing as soon as possible. If you can, make an appointment with your dentist as you may need to have your teeth cleaned professionally, such as a scale and polish, either by your dentist or hygienist.

    I've suddenly developed very bad breath and painful ulcers on my gums. Is this gum disease?

    Answer

    It's possible that you have a condition known as acute necrotising ulcerative gingivitis (ANUG), also known as 'trench mouth'. This is a severe type of gum disease, but it can be treated.

    Explanation

    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.

    Gum disease develops gradually and is often painless, but ANUG is a sudden and severe gum infection. It's caused by harmful mouth bacteria. You're more likely to get ANUG if you smoke, don't brush and floss your teeth regularly, are under stress, or have reduced immunity because of another condition.

    ANUG is very painful – particularly when eating or brushing your teeth. If this happens and it’s too painful to brush your teeth, make an appointment to see your dentist as soon as possible. The main treatment for ANUG is professional cleaning to remove the plaque and tartar build up on the affected areas of your teeth and gums. This involves your dentist cleaning your teeth very thoroughly with special instruments. This is called root planing. You may need to have several appointments. Your dentist or hygienist may need to inject a local anaesthetic into your gums beforehand.

    In addition, you may be advised to use a mouthwash. It’s important that you practise good dental hygiene using a soft toothbrush if you find it painful. You will also need to floss your teeth three times a week. If you have very severe ANUG, you may be prescribed antibiotics to help clear up the infection.

  • Resources Resources

    Further information

    Sources

    • Gingivitis and periodontitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Gingivitis. BMJ Best Practice. www.bestpractice.bmj.com, published 27 September 2012
    • Periodontal (gum) disease: causes, symptoms and treatments. National Institute of Dental and Craniofacial Research. www.nidcr.nih.gov, published August 2012
    • Gum disease. British Dental Health Foundation. www.dentalhealth.org, accessed 19 March 2013
    • Gum disease. British Dental Association. www.bdasmile.org, accessed 5 April 2013
    • Peridontal disease. Centers for Disease Control and Prevention. www.cdc.gov, published 15 December 2011
    • Gingivitis treatment and management. eMedicine. www.emedicine.medscape.com, published 8 May 2012
    • Treating periodontal disease: scaling and root planing. American Dental Association. www.ada.org, published February 2003
    • Chambrone L, Sukekava F, Araújo MG, et al. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database of Systematic Reviews 2009, Issue 2. doi:10.1002/14651858.CD007161.pub2
    • Robinson P, Deacon SA, Deery C, et al. Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews 2009, Issue 2. doi:10.1002/14651858.CD002281.pub2
    • Eberhard J, Jepsen S, Jervøe-Storm PM, et al. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1. doi:10.1002/14651858.CD004622
    • Crowns. British Dental Health Foundation. www.dentalhealth.org, accessed 9 April 2013
    • Dental decay. British Dental Health Foundation. www.dentalhealth.org, accessed 10 April 2013
    • Visiting the hygienist. British Dental Health Foundation. www.dentalhealth.org, accessed 9 April 2013
    • Teeth and pregnancy. Better Health Channel. www.betterhealth.vic.gov.au, published June 2012
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    Produced by Natalie Heaton, Bupa Health Information Team, May 2013.

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