Gingivitis and periodontitis - 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. NHS dental treatment costs £18.00 for basic treatment (band 1) and £49.00 for more advanced treatment (band 2).

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.