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.
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.
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.
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.
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:
If gingivitis has developed into periodontitis, you may have:
The symptoms of ANUG include:
If you have any of these symptoms, you should see your dentist straight away.
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.
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.
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).
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.
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 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.
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.
Produced by Natalie Heaton, Bupa Health Information Team, May 2013.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
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