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Gum disease


Expert reviewer, Steve Preddy, Dentist and Bupa UK Head of Clinical Services
Next review due October 2020

Gum disease is a common condition that affects the tissues around your teeth. It causes swelling and redness of your gums, and sometimes pain. If it gets worse, it can damage the bone and ligaments that hold your teeth in place.

An image showing periodontitis

What is gum disease?

Gum disease is a very common condition. In the UK, up to nine in every 10 people have some gum disease, even if it’s only a small amount. You need to look after your teeth and gums to prevent gum disease, or if you already have gum disease, to stop it getting worse.

Gingivitis (inflammation of the gums) affects the tissues that surround your teeth. It’s caused by a build-up of bacteria. If you have any signs of gum disease, you should speak to your dentist. Gingivitis can usually be treated by a dentist or hygienist, and through simple improvements that you can make to your oral hygiene.

If gingivitis isn’t treated, it can lead to another type of gum disease called periodontitis, which can affect the bones and ligaments that support your teeth as well. Periodontitis can usually be treated by a dentist and through improvements in your oral hygiene. But around one in every two adults in the UK has some periodontitis that’s hard to treat.

Types of gum disease

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

Gingivitis

Gingivitis is the least serious type of gum disease. It’s usually caused by a build-up of plaque. Plaque is a soft, sticky substance caused by bacteria that can stick to your teeth.

If you don’t clean plaque off your teeth by brushing and flossing regularly, it can lead to inflammation, and your gums may become red and swollen. Your gums may bleed when you brush them but aren’t usually painful.

If you remove the plaque and look after your teeth and gums well, your gingivitis is likely to get better. But if you don’t get the plaque off properly, you may develop a more serious type of gum disease called periodontitis.

Periodontitis

If your gingivitis isn’t treated, 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 may not be able to reach with a toothbrush.

Over time, the plaque hardens to become tartar (calculus). This may irritate your gums even more. The pockets may then get deeper and even more difficult to clean, making the problem worse. Sometimes you may develop an infection in your gums. Pus may collect under your gums, causing an abscess.

Untreated periodontitis can cause your gums to shrink back from your teeth (called recession). This may then expose some of the roots of your teeth, making them sensitive. If you have any bone loss, your teeth may feel loose. If your periodontitis isn’t treated for a number of years, you may even lose some teeth.

Acute necrotising ulcerative gingivitis (ANUG)

ANUG is a serious type of gum disease that develops suddenly. This bacterial infection is also known as trench mouth. It causes swelling, ulcers, bad breath (halitosis) and pain. ANUG must be treated by a dentist as soon as possible.

For more information, see our FAQ on painful ulcers.

Symptoms of gum disease

Gum disease isn’t always painful, so you may not realise you have it. This is one of the reasons why it's important to visit your dentist for regular check-ups.

Usually the first signs of gingivitis are:

  • bleeding gums when you brush your teeth or eat something hard like an apple
  • red and swollen gums

If your gingivitis has developed into periodontitis, you may also have:

  • bad breath (halitosis)
  • a bad taste in your mouth
  • gum recession and sensitive teeth
  • 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 high temperature (fever)

ANUG often affects the V-shaped bit of gum between your teeth.

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

Diagnosis of gum disease

Your dentist can usually diagnose gingivitis by looking at your teeth. They may ask if you’ve had gum problems in the past, you smoke or have any long-term medical conditions such as diabetes. They may want to rule out other possible causes of your symptoms, such as an infection, skin problem or allergy.

If your dentist thinks you have periodontitis, they may look at your mouth more thoroughly. They’ll check for gum disease using a periodontal probe, which measures how deep any gaps are between your teeth and gums. They may check how easily your gums bleed and how much plaque and tartar you have on your teeth.

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

Treatment of gum disease

The type of treatment you’ll have will depend on how serious your gum disease is. The aim of the treatment is to control any existing gum disease and prevent further problems. Your dentist will also try to deal with any tooth or bone loss so that you can clean your teeth more easily.

If you have gingivitis or mild periodontitis, your dentist may refer you for treatment with a dental hygienist. A hygienist helps to prevent and treat dental conditions such as gum disease. Your dentist or hygienist will explain what’s causing your gum disease and how you can prevent it.

If you have more serious periodontitis, your dentist may refer you to a periodontist. This is a healthcare professional who specialises in treating periodontal diseases.

Self-help for gum disease

You may be able to treat mild gum disease (gingivitis) with a daily brushing and flossing routine. Your dentist or hygienist will show you how to do this properly to make sure you’re removing all of the plaque on your teeth. Using a hand mirror, they may show you the plaque on your teeth so that you can recognise it. This will help you check that you’re removing it when you brush.

Plaque builds up on your teeth as soon as you’ve brushed them, so it’s important to clean your teeth regularly. Rinsing your teeth won’t remove the plaque. You’ll need to brush it off with a toothbrush, ideally one with a small head and even nylon bristles. Toothbrushes get worn down easily, so aim to replace yours every month or so. You should also use interdental brushes or dental floss to clean between your teeth. Your hygienist can show you how to use dental floss.

If you smoke, speak to your GP or pharmacist about giving up. Smoking makes you more likely to develop gum disease and can make it harder to treat gum disease.

Eating fewer sugary foods can help to stop your gum disease getting worse.

Professional cleaning for gum disease

If you have gingivitis, your dentist or hygienist will clean your teeth thoroughly above and below your gums. This may be called a scale and polish. They will remove 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. They will show you 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. Your dentist or hygienist may use a local anaesthetic to make the root planing more comfortable. This will completely block the feeling from your gums.

Your dentist or hygienist will arrange regular check-ups with you. They will keep an eye on the size of any pockets in your gums and how easily your gums bleed to make sure these get better over time.

Medicines for gum disease

Using a mouthwash won’t remove plaque that’s already built up on your teeth and won’t stop gingivitis or periodontitis getting worse. But if you find it difficult to clean your teeth yourself, your dentist or hygienist may recommend you use an antiseptic mouthwash as well. This may be because your hands aren’t very mobile due to arthritis or you’ve had mouth surgery.

Antibiotics aren’t usually prescribed for gingivitis or mild periodontitis. But if you have a very serious infection, your dentist may recommend a course of antibiotics.

Surgery for gum disease

If your gum disease is bad, and other treatments haven’t worked, you may need to have gum surgery. Your dentist may refer you to a periodontist.

There are several types of surgery for more serious periodontitis. These may help to remove bacteria and repair your gums and bone. They may also improve how your teeth look and reduce any sensitivity. If you need more information, ask your dentist.

Causes of gum disease

You may get gum disease if plaque builds up around teeth that aren’t cleaned properly. You may find it harder to clean your teeth well if you:

  • wear braces
  • have implants
  • have dentures
  • have poorly fitting crowns or fillings
  • have other irregularities in your teeth

Other things that can make you more likely to get gum disease are:

  • smoking cigarettes
  • having diabetes
  • getting older
  • stress
  • having a weak immune system
  • having Down’s syndrome
  • pregnancy
  • taking medicines that can make your mouth dry, such as antidepressants and antihistamines
  • eating an unhealthy diet
  • not getting enough vitamin C

Prevention of gum disease

You may be able to prevent gum disease by controlling the amount of plaque and tartar that builds up on your teeth.

Toothbrush trivia

You can do this by:

  • brushing and flossing your teeth properly
  • visiting your dentist or hygienist regularly
  • stopping smoking

Click on the image to open a full-size PDF of Toothbrush Trivia.

To clean your teeth well, you should brush for about two minutes twice a day – first thing in the morning and last thing at night. You should also floss (or use interdental brushes) every day. Dental floss or interdental brushes can remove plaque and small bits of food from between your teeth and under your gum line. These are areas you won’t always reach easily with a toothbrush.

You may prefer to use an electric toothbrush rather than a manual one. Some research studies show that certain types of electric toothbrush may be better at removing plaque than manual toothbrushes. It’s important to use the right technique to brush your teeth, so ask your dentist or hygienist for advice.

Toothpaste may make it easier for you to brush your teeth. It usually contains fluoride, which can help to protect your teeth from decay. Some toothpastes also contain other special ingredients that make it harder for plaque to build up on your teeth.

Some mouthwashes can help to reduce the number of plaque bacteria when used with regular brushing and flossing. If you 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.

It’s important to have regular check-ups with your dentist or hygienist. You may be asked to visit your dentist every three to six months. At your appointment, they can clean your teeth to remove tartar, especially below your gum line. Tartar can’t be removed when you brush and floss at home. Regular dental checks are particularly important if you have diabetes or other risk factors for gum disease.

Eating too much sugar can make you more likely to have gum disease and tooth decay. So limit the amount of sugar you eat and drink, especially between meals.



Frequently asked questions

  • Having healthy gums is as important for crowns as it is for natural teeth. Crowns are tooth-shaped caps that dentists use to cover or replace damaged teeth. You should floss between your crowns and under your gum line to prevent plaque from building up. You can also use interdental brushes to keep your crowns and teeth clean. Plaque build-up is a common cause of gum disease and tooth decay.

    The gold and porcelain surfaces of your crowns are artificial and can’t decay. But plaque can still build up under your gum line, causing inflammation and damage where your crown meets your tooth. Decay is a common reason why crowns eventually need to be replaced. Looking after your crowns carefully will help them last longer.

    Your dentist or hygienist can show you the best way to brush, floss and use interdental brushes.

  • Many women notice their gums look and feel swollen during pregnancy. This is because your pregnancy hormones can affect your gums and the bacteria in your mouth. If you’re pregnant, you may be more likely to develop gingivitis, which is a mild form of gum disease. Gingivitis can make your gums look red. Your gums may also bleed easily, especially when you brush them. If you already have gingivitis, pregnancy may make it worse. Gum disease usually gets better after you've had your baby.

    To prevent gum disease, brush and floss your teeth regularly. You may need to visit your dentist more often during pregnancy to make sure your teeth and gums are healthy. If you notice any signs of gum disease, such as bleeding gums, make an appointment with your dentist as soon as you can.

  • Sudden, painful ulcers can be a sign of a serious type of gum disease called acute necrotising ulcerative gingivitis (ANUG). ANUG is also known as trench mouth. If you have ANUG, the ulcers tend to bleed easily and the V-shaped bits of gum between your teeth start to disappear. ANUG can also cause bad breath (halitosis), sore gums and a high temperature (fever).

    ANUG is caused by bacteria that are found naturally in your mouth. You can’t catch it from another person. You're more likely to get ANUG if you:

    • smoke
    • don't brush and floss your teeth regularly
    • are under stress
    • have a weak immune system

    If you think you have ANUG, make an appointment to see your dentist as soon as possible. Your dentist may prescribe antibiotics for a few days and recommend pain relief while you wait for your dental appointment. Try to keep brushing your teeth, even if you can only do so with a soft toothbrush.

    Your dentist will remove the plaque and tartar from your teeth and gums. They may use a special ultrasonic device to do this. You may be prescribed an antiseptic mouth rinse to use with your regular brushing and flossing routine. Once your dentist starts to treat ANUG, your symptoms should get better within a few days.


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Related information

    • Gingivitis and periodontitis. Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2016
    • Gingivitis. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2017
    • Coventry J, Griffiths G, Scully C, et al. ABC of oral health: periodontal disease. BMJ 2000; 321(7252):36–39
    • Periodontitis. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2017
    • Restorative dentistry 1: periodontology. Oxford Handbook of Clinical Dentistry (online). 6th ed. Oxford Medicine Online. oxfordmedicine.com, published online August 2014
    • Some dental and periodontal diseases. PatientPlus. patient.info, last checked July 2014
    • Gingivitis. BMJ Best Practice. bestpractice.bmj.com, last updated August 2017
    • Gum disease. Oral Health Foundation. www.dentalhealth.org, accessed September 2017
    • Living with my brace. Oral Health Foundation. www.dentalhealth.org, accessed September 2017
    • Crowns. Oral Health Foundation. www.dentalhealth.org, accessed September 2017
    • Prevention and community dentistry. Oxford Handbook of Clinical Dentistry (online). 6th ed. Oxford Medicine Online. oxfordmedicine.com, published online August 2014
    • Restorative dentistry 2: repairing teeth. Oxford Handbook of Clinical Dentistry (online). 6th ed. Oxford Medicine Online. oxfordmedicine.com, published online August 2014
    • Oral medicine. Oxford Handbook of Clinical Dentistry (online). 6th ed. Oxford Medicine Online. oxfordmedicine.com, published online August 2014
    • Dental care for mother and baby. Oral Health Foundation. www.dentalhealth.org, accessed September 2017
  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, October 2017
    Expert reviewer, Steve Preddy, Dentist and Bupa UK Head of Clinical Services
    Next review due October 2020



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