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Treating gum disease

NHS ChoicesMedical Reference

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The best way to treat all gum disease, including periodontitis and acute necrotising ulcerative gingivitis, is to practise good oral hygiene.

Gum disease and periodontitis

Good oral hygiene involves:

  • brushing your teeth for 2-3 minutes twice a day (in the morning and at night)
  • using an electric toothbrush if possible (unless you have ANUG, see below)
  • using toothpaste that contains  fluoride if your water supply is low in 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 1-2 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. 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 soft, sticky substance that forms when bacteria collect 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 is not suitable for women who are pregnant or breastfeeding. It can also stain your teeth brown if you use it regularly. Rinse your mouth thoroughly in between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash from working.  

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. Possible treatments are described below.

Antibiotics 

On their own, antibiotics are not effective at treating periodontitis, and they may only be recommended in severe cases of gum disease.

Metronidazole or amoxicillin are the most common antibiotics that are prescribed for ANUG. You will usually have to take these antibiotics 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 taking the contraceptive 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. Therefore, it is a good idea not to drink alcohol while you are taking metronidazole and for 48 hours afterwards.

Metronidazole and amoxicillin may also cause the following side effects:

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.  Children under 16 years of age should not be given aspirin.

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. They are usually used 2-3 times a day.

See the advice above regarding the use of chlorhexidine mouthwash during pregnancy and breastfeeding.

Good oral hygiene

As with gum disease and periodontitis, you should continue to practise good oral hygiene (as described above) if you have ANUG.

However, because ANUG can cause painful ulcers, brush your teeth with a very soft toothbrush and avoid using an electric brush.

Dental treatments

The following dental treatments may be recommended to treat gum disease, periodontitis and ANUG:

  • scale and polish
  • root planing (debridement) 
  • antibiotics (see above) 
  • surgery

These are described in more detail below.

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 a special instrument, 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. NHS dental treatment cost £17.00 for basic treatment (band 1) and £47.00 for more advanced treatment (band 2).

Read more about NHS dental charges.

Root planing

In some cases of gum disease or periodontitis, 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 an 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, periodontitis or ANUG, 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 will also be able to refer you to a specilaist.

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.

Medical Review: March 21, 2012

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