One of the best ways to treat all kinds of gum disease (gingivitis), including periodontitis and acute necrotising ulcerative gingivitis (ANUG), is to practise good oral hygiene.
Gum disease and periodontitis
Good oral hygiene
Good oral hygiene involves:
- brushing your teeth for 2-3 minutes twice a day (in the morning and last thing at night)
- using an electric toothbrush if possible (unless you have ANUG, see below)
- using a toothpaste that contains fluoride if your water supply is low in fluoride (fluoride is a natural mineral that helps to protect against tooth decay)
- flossing your teeth at least three times a week
- not smoking
- seeing your dentist regularly (at least once every one to two years, but more frequently if necessary)
For more information about good oral hygiene, see the teeth-cleaning guide.
Antiseptic mouthwashes that contain chlorhexidine or hexetidine are available over-the-counter (OTC) from pharmacies. There is some debate about whether these are necessary for people with healthy gums.
Your dentist may recommend that you use a 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 tell you 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 used 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 (ANUG)
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.
Metronidazole or amoxicillin are the most commonly prescribed antibiotics for ANUG. You will usually have to take these antibiotics for three days.
Amoxicillin is not suitable for people who are allergic to penicillin. Amoxicillin can also cause the contraceptive pill to fail, so women 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 any alcohol while you are taking metronidazole and for 48 hours afterwards.
Metronidazole and amoxicillin may also cause the following side effects:
- nausea (feeling sick)
Paracetamol and ibuprofen are the most commonly prescribed painkillers. They are also available over-the-counter (OTC). They may help reduce the pain and discomfort that is caused by your ulcers.
Paractemol and ibuprofen are not suitable for everyone, so read the manufacturer's instructions before taking them. Aspirin should not be given to children who are under 16 years of age.
A mouthwash that contains chlorhexidine or hydrogen peroxide may be prescribed. Some chlorhexidine mouthwashes are also available OTC, although they may not be as effective as a hydrogen peroxide mouthwash.
Always read the instructions before using mouthwash because some types may need to be diluted in water before they are taken. They are usually used two or three times a day.
Chlorhexidine mouthwash is not suitable for women who are pregnant or breastfeeding. It can also stain your teeth brown if used regularly. Rinse your mouth well between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash from working.
Good oral hygiene
As with gum disease and periodontitis, if you have ANUG, continue to practise good oral hygiene as described above. However, because ANUG can cause painful ulcers, brush your teeth with a very soft toothbrush and avoid using an electric brush.
If your GP refers you to a dentist, they may recommend the following treatments:
- scale and polish
- root planing
These are described in more detail below and can be used for gum disease, periodontitis and ANUG.
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. A scale and polish is a type of 'professional clean' that is usually carried out at your dental surgery by a dental hygienist.
A scale and polish involves having the plaque and tartar scraped away from your teeth with a special instrument, before your teeth are polished to remove any marks or stains. If a lot of plaque or tartar has built up on your teeth, you may need to have more than one scale and polish.
The price of scale and polish treatments can vary depending on what exactly is being carried out, so ask your dental hygienist how much the treatment will cost beforehand. Treatment on the NHS should cost £16.50 for basic treatment, or £45.60 for more advanced treatment. For more information, see NHS dental services.
In some cases of gum disease or periodontitis, root planing may be required. Root planing is a cleaning procedure to clean 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 feel some pain for up to 48 hours after having root planing.
If you have severe gum disease, periodontitis or ANUG, you may need further treatment, such as surgery, to remove the affected tooth. Your dentist can tell you about the procedure that is required and how it is carried out.
If you are having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether these are necessary.
Gum disease (gingivitis)
Inflammation of the gums, normally due to a build-up of dental plaque.
This is when the inflammation of the gums also affects the bone surrounding the tooth and can cause your teeth to become loose and fall out.
Plaque is a sticky substance that is made up of bacteria. It can build up on your teeth if you do not brush them.
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.
An ulcer is a sore break in the skin or on the inside lining of the body.