What you need to know about gum disease

A mild form of gum disease with inflammation of the gum is called gingivitis. Gum disease is also known as periodontal disease.

As gingivitis is usually very mild; many people may have it and not know. Gingivitis should be treated, because it can progress into serious gum disease.

If a person’s gums are red instead of pink, inflamed, swollen and bleed when they brush their teeth, they most likely have gingivitis. Gingivitis is mainly caused by inadequate oral hygiene – not brushing your teeth enough or properly, and not flossing. Plaque, a sticky substance made up of bacteria builds up in the teeth. The bacteria release toxins that irritate the gums.

Most of us will have a mild case of gingivitis some time during our lifetime.


Gingivitis always starts off with a build up of plaque – an invisible, sticky film made up mostly of bacteria. When starches and sugars in food interact with bacteria normally found in our mouths, plaque can form on our teeth. Brushing our teeth twice a day and flossing once a day removes plaque.

Plaque can re-form very quickly – within 24 hours of brushing your teeth. Plaque that remains in our mouths for longer than two or three days goes hard under the gum line, and forms tartar (calculus). Tartar makes plaque much harder to brush away and acts as an environment in which bacteria can thrive.

It is not usually possible to remove tartar by just brushing or flossing. It can only be effectively removed by a dentist or dental hygienist using a technique called scalingscale, or polish – the tartar is scraped away using a special instrument. If there are any marks or stains the teeth are then polished.

If the plaque and tartar remain in the teeth, the gingiva (the gum) will become more irritated and inflamed. Eventually, the gums will be swollen and more likely to bleed. If tartar build-up continues the condition can progress to periodontitis.

Gingivitis and periodontitis are typically caused by poor oral hygiene.

Risk factors

The following are known risk factors for gum disease:

  • A weakened immune system
  • Diabetes
  • Hormonal changes
  • Older age
  • Smoking
  • Some medications
  • Some viral and fungal infections
  • Substance abuse

Risk factors for ANUG (acute necrotizing ulcerative gingivitis) include:

  • A weakened immune system
  • Malnutrition
  • Mental stress
  • Poor oral hygiene
  • Smoking
  • Untreated gingivitis or periodontitis


Normal gums should be firm and pinkish, and should not bleed when you brush your teeth normally. Healthy gums keep our teeth anchored into place securely. Gingivitis primarily affects the gums.

Signs and symptoms include:

  • Painful or tender gums
  • Swelling in the gums
  • Soft gums
  • Gums become dusky red instead of healthy pink
  • Gums bleed after brushing or flossing teeth

As gingivitis is often painless, an individual may have it and not know. The first sign may be when the toothbrush bristles go pink; a sign of bleeding gums.

Patients who develop periodontitis may have the following signs and symptoms:

  • More intense pain than with gingivitis
  • More bleeding than with gingivitis
  • More swelling than with gingivitis
  • Halitosis (bad breath)
  • An unpleasant taste in the mouth
  • Gums ooze pus
  • Eating problems
  • Loosening of teeth
  • Teeth fall out
  • Abscesses

ANUG (acute necrotizing ulcerative gingivitis) – symptoms are more intense and severe than with periodontitis or gingivitis, and may include:

  • Elevated body temperature
  • General malaise
  • Very painful gums
  • Gums that bleed a lot (much more than with gingivitis or periodontitis)
  • Halitosis, which tends to be very strong
  • Excessive saliva production
  • Metallic taste in the mouth
  • Ulcers in between the teeth


Treatment options include the following:

  • A comprehensive cleaning of the teeth – all traces of plaque and tartar are removed (scaling). The procedure may be uncomfortable, especially if the patient’s gums are sensitive, or if plaque and tartar build up is considerable.
  • Antiseptic mouth rinse – this may be in the form of a spray or gel which is generally used for about a month. It helps clear away bacteria. The doctor may prescribe chlorhexidine or hexetidine. A wide range of antiseptic mouth rinses can be purchased OTC (over-the-counter, no prescription required).
  • Antibiotics – in some severe cases of periodontitis the dentist may prescribe a short course of antibiotics to help treat infection in the gums. Examples of medications commonly prescribed for this type of gum infection include metronidazole and doxycycline – they are usually taken three times daily for three days. Pregnant or breastfeeding women should not take doxycycline. Doxycycline can also interfere with the effectiveness of the contraceptive pill, so the patient should use an additional form of contraception, such as a condom during treatment and continue doing so until seven days after taking the last tablet.
  • Brushing teeth – the dentist will review the patient’s tooth-brushing technique, and if necessary, explain how to do this properly. Many dentists say that an electric toothbrush helps guarantee good tooth-brushing. If fluoride levels in the tap water are low toothpaste with fluoride should be used. Fluoride helps strengthen tooth enamel, which protects it from decay.
  • Flossing teeth – the dentist will review the patient’s flossing technique, and if necessary, explain how to do this properly.
  • Fixing dental problems – if there are any misaligned teeth, poorly fitted crowns, bridges or other dental restorations, they will need to be fixed. Removing plaque and tartar when dental restorations are causing problems is more difficult.

After professional cleaning gingivitis usually resolves itself; providing the patient pursues long-term good oral hygiene. The gums should return to their healthy pink color.

  • ANUG (Acute necrotizing ulcerative gingivitis)

ANUG cannot be self-treated; the patient needs to be treated by a dentist. If the first visit was to a doctor, he/she may provide some treatment to tide the patient over until arriving at the dentist’s. This may include:

  • Antibiotics – the most commonly antibiotics for the treatment of ANUG are metronidazole or amoxicillin. Patients who are allergic to penicillin should not take amoxicillin. Treatment usually lasts three days. Amoxicillin may interfere with the efficacy of the contraceptive pill; the patient should use additional contraceptive during treatment and for seven days afterwards.
  • Painkillers – these may include ibuprofen or Tylenol (paracetamol). Patients with asthma should not take ibuprofen. Children under sixteen should not take aspirin.
  • Mouthwash – the patient uses them two or three times daily. Examples include chlorhexidine or hydrogenperoxide.
  • Patients with ANUG should use a very soft toothbrush if they have painful ulcers, or if their gums are especially sensitive. Until the gums recover, those with ANUG should not use an electric toothbrush.

If even a soft toothbrush causes too much pain, tell your dentist. Sometimes patients may be advised to clean their teeth with a finger covered in a soft cloth. Ask your dentist how to do this.

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