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Introduction
 

Gingivitis and periodontitis

Gingivitis and periodontitis

 

Gum disease is a very common condition where the gums become swollen, sore or infected.

It's estimated to affect more than half of all adults in the UK to some degree 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. This stage of gum disease is known as gingivitis.

If gingivitis is not treated, a condition called periodontitis can develop. This affects the tissues that support teeth and hold them in place. In the UK, up to 15% of adults are estimated to have severe periodontitis, with many more affected less severely.

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.

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, which forms when you eat and drink.

Some bacteria in plaque are harmless, but some are 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 redness, swelling and soreness.

Seeing your dentist

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

Your dentist can carry out a thorough dental examination to check the health of your gums, which may involve inserting a thin metal stick with a bend in one end (periodontal probe) beside your teeth.

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

Preventing and treating gum disease

Mild cases of gum disease can usually be treated by maintaining a good level of oral hygiene. This includes brushing your teeth at least twice a day and flossing regularly. You should also make sure you attend regular dental check-ups.

In most cases, your dentist or dental hygienist 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 usually need to have further medical and dental treatment and, in some cases, surgery may need to be carried out. This will usually be performed by a specialist in gum problems (periodontics).

Dental check-ups

It is important to have regular dental check-ups so that any problems with your teeth and gums can be detected and treated early.

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

You may need to visit your dentist more frequently if you have had problems with gum disease in the past. 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 – you may be advised to visit your dentist more often so your teeth and gums can be closely monitored.

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)

  • receding gums

  • loose teeth

  • loss of teeth

There is no need to register with a dentist.

Simply find a practice that's convenient for you, whether it's near home or work, and phone to see if any appointments are available.

Symptoms of gum disease 

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

Early symptoms

The initial symptoms of gum disease can include:

  • red and swollen gums

  • bleeding gums after brushing or flossing your teeth

This stage of gum disease is called gingivitis.

Advanced symptoms

If gingivitis is untreated, the tissues and bone that support the teeth can also become affected. This is known as periodontitis.

Symptoms of periodontitis can include:

  • bad breath (halitosis)

  • an unpleasant 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

In rare cases, a condition called acute necrotising ulcerative gingivitis (ANUG) can develop suddenly. The symptoms of ANUG are usually more severe than those of gum disease and can include:

  • bleeding, painful gums

  • painful ulcers

  • receding gums inbetween your teeth

  • bad breath

  • a metallic taste in your mouth

  • excess saliva in your mouth

  • difficulty swallowing or talking

  • a high temperature (fever)

When to see a dentist

You should make an appointment to see your dentist if you think you may have gum disease or ANUG.

If you do not currently have a dentist, search for a dentist near you.

Causes of gum disease 

Gum disease can be caused by a number of factors, but 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

Your mouth is full of bacteria that combine with small food particles and saliva to form a sticky film known as plaque, which builds up on your teeth.

When you consume food and drink high in carbohydrates (sugary or starchy foods), bacteria in plaque turn carbohydrates into the energy they need, producing acid at the same time.

Over time, acid in plaque begins to break down your tooth's surface and causes tooth decay.

Bacteria in plaque can also irritate your gums, making them inflamed and sore.

Plaque is usually easy to remove by brushing and flossing your teeth, but it can harden and form a substance called tartar if it is not removed. Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist or dental hygienist.

Who is most at risk?

As well as poor oral hygiene, a number of things can increase your risk of developing problems with your gums. These include:

  • smoking

  • your age – gum disease becomes more common as you get older

  • a family history of gum disease

  • diabetes – a lifelong condition that causes a person's blood sugar levels to become too high

  • a weakened immune system – for example, because of conditions such as HIV and AIDS or certain treatments, such aschemotherapy (powerful cancer-killing medication)

  • malnutrition – a condition that occurs when a person's diet does not contain the right amount of nutrients

  • stress

Treating gum disease 

The best way to treat gum disease is to practise good oral hygiene, although additional dental and medical treatments are sometimes necessary.

Oral hygiene

Good oral hygiene involves:

  • brushing your teeth for two to three minutes twice a day (in the morning and at night), preferably with an electric toothbrush

  • using toothpaste that contains 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 one to two 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, although 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 sticky substance that forms when bacteria collects 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 can stain your teeth brown if you use it regularly. Rinse your mouth thoroughly between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash working.

Dental treatments

Some of the dental treatments described below may also be recommended if you have gum disease.

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 special instruments, 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, 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 a local 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, 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 can refer you to a specialist.

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.

Acute necrotising ulcerative gingivitis

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

As well as the oral hygiene advice and dental treatments mentioned above, treatments for ANUG may also include antibiotics, painkillers and different types of mouthwash. These are described below.

Antibiotics 

Treatment with antibiotics, such as metronidazole or amoxicillin, may be recommended if you have ANUG. You will usually have to take these 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 on the 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. You should therefore not drink alcohol while you are taking metronidazole and for 48 hours after you finish the course of treatment.

Other side effects of metronidazole and amoxicillin can include nausea (feeling sick), vomiting and diarrhoea.

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.

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.

Stopping smoking

Smoking is one of the most significant risk factors for gum disease.

Giving up smoking can greatly improve your oral hygiene.

Your GP can give you information and advice about giving up smoking.

Complications of gum disease 

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.

You may develop further complications if you do not treat periodontitis (where the tissue that supports teeth is affected), 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 and loss of 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 the future. This can cause persistentbad breath (halitosis) and bleeding gums, as well as gradually receding gums.

In very rare cases, ANUG can lead to a condition calledgangrene affecting the lips and cheeks. This occurs when tissue starts to die and waste away. If you develop gangrene, you may need to have the dead tissue removed.

Other complications

Gum disease has also been associated with an increased risk for a number of other health conditions, including:

  • cardiovascular disease

  • lung infections

  • if affected during pregnancy, premature labour and having a baby with a low birth weight

However, while people with gum disease may have an increased risk of these problems, there is not currently any clear evidence that gum disease directly causes them.

Complications of gum disease 

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.

You may develop further complications if you do not treat periodontitis (where the tissue that supports teeth is affected), 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 and loss of 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 the future. This can cause persistentbad breath (halitosis) and bleeding gums, as well as gradually receding gums.

In very rare cases, ANUG can lead to a condition calledgangrene affecting the lips and cheeks. This occurs when tissue starts to die and waste away. If you develop gangrene, you may need to have the dead tissue removed.

Other complications

Gum disease has also been associated with an increased risk for a number of other health conditions, including:

  • cardiovascular disease

  • lung infections

  • if affected during pregnancy, premature labour and having a baby with a low birth weight

However, while people with gum disease may have an increased risk of these problems, there is not currently any clear evidence that gum disease directly causes them.