Gum disease - Treatment 

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).

Read more about NHS dental charges.

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.

Page last reviewed: 15/01/2014

Next review due: 15/01/2016

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Deneb said on 04 April 2014

For as long as I can remember I have had gingivitis. Two years ago some of my teeth became loose and all but ten were removed and upper and lower dentures fitted. When I mentioned my bleeding gums my dentist recommended that I brush them with a soft brush for a few minutes each day even as they bled. If I did this bleeding would eventually stop as the gums strengthened. I took her advice and within a couple of weeks bleeding stopped completely and hasn't occurred again since! That was two years ago and I am now 89. I used to use chlorohexidene digluconate prescribed by a hospital as an antiseptic mouthwash but it did absolutely nothing. Obviously I don't use it now.
The precedure outlined above may help others and save them considerable expense too.

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Beatrizita said on 23 January 2014

my dentist referred me to Kings Cross Dental Hospital but they turned me down, the reality is periodontist dont want to treat patients, they routinely turn them down on flimsy excuses, the only solution is pay up or loose your teeth, that is the unfortunate state of NHS periodontal options. My advice, pay up. Tories say.

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glowkeeper said on 09 December 2013

"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."

Untrue. My dentist tried to refer me to Guys for periodontal surgery, but they turned me down, saying that I should, 'find a GDP or local specialist who does provide the kind of treatment requested'. But that advice ignores the fact that there aren't any such nhs specialists! So Guys have basically condemned me to losing my teeth. Brilliant - thanks.

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colbart said on 24 July 2013

I try my best, but every visit to the hygenist is dreaded. And more expensive each time.

She insists on 3 monthly appointments, every time I exit with bleeding gums. (so bad this time she didn't polish the teeth so much blood).. after Ultrasonic and scarping. Gets more uncomfortable each time, and more blood flowing..and pain for days after...

Really dissapointed at the lack of NHS dentists. My dentist trained with NHS, then left to set up his own clinic, concentrates more on cosmetic than standard dentistry. A gold crown broke again, replaced with a Titanium post bonded to the remaining root, and a ceramic crown built up-cost £650.... Spent over £1,000 and I am still having problems with teeth, more frequent re-calls.

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escoces said on 09 September 2012

The ideas for prevention and treatment are fine but at the end of the day the greatest problem is when you need dental treatment in the UK, the standard of care is poor. Dentistry in the UK is abysmal. Most dentists (in London at least) seem only to be interested in trying to extract fat wads from your bank account if not, about the only procedure they seem willing to carry out on the NHS is to extract your teeth. I have lost most of mine, have ill fitting dentures with which it is nigh impossible to eat and believe me I've tried a good few dentists. I have a friend who had to go abroad as he had severe ANUG through years of poor British dentistry. Most of my friends in this country are foreign and the idea of going to a British dentist terrifies them. If only I had had the money perhaps years of pain and tooth loss could have been avoided and I don't mean by paying a dentist here inflated prices for better treatment. I mean escape abroad where more competent treatment could have been done.

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Stopping smoking

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

Giving up smoking can greatly improve your oral hygiene.

If you need help or advice about giving up smoking, call the free NHS Smoking Helpline on 0300 123 1044.

Your GP can give you information and advice about giving up smoking. You can also visit the NHS Smokefree website.

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