Effects of gum disease

The unexpected dangers of gum disease

Gum disease is common and unpleasant, but, according to a growing body of evidence, it could also play a role in a surprising range of seemingly unrelated health problems.

Share on PinterestCleaning your teeth may be even more important than you thought.

Plaque — a sticky substance that contains bacteria — builds up on teeth. If it is not brushed away, the bacteria can irritate the gums.

The gums may then become swollen, sore, or infected; this is referred to as gingivitis.

In general, gum disease can be treated or prevented by maintaining a good oral health regime.

However, if it is left to develop, it can result in periodontitis, which weakens the supporting structures of the teeth.

Gum disease, which is also called periodontal disease, is widespread. According to the Centers for Disease Control and Prevention (CDC), almost half of adults in the United States have some degree of gum disease.

The mechanisms behind periodontal disease are relatively well-understood, and newer research shows that this health problem may play a role in the development of a number of other conditions, including Alzheimer’s disease, cancer, and respiratory disease.

In this Spotlight, we will cover some of the surprising links between gum disease and disparate health issues.

Gums and the brain

Although spatially the gums are near the brain, one wouldn’t normally associate dental complaints with neurological conditions.

However, some studies have found a link between periodontal disease and tooth loss and cognitive function. One study looking at cognitive performance followed 597 men for up to 32 years. The authors conclude:

“Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.”

Researchers have also linked periodontal disease with an increased buildup of beta-amyloid in the brain — the neurological hallmark of Alzheimer’s.

Other experiments have produced evidence that one type of bacteria commonly found in cases of periodontitis — Porphyromonas gingivalis — can be found in the brains of individuals with Alzheimer’s.

Following on from that discovery, in a more recent study, researchers showed that P. gingivalis infection boosts the production of beta-amyloid in the brain.

In this study, the researchers paid particular attention to an enzyme produced by P. gingivalis called gingipain. They found that this protease was toxic to tau, another protein that plays a pivotal role in Alzheimer’s.

It is worth noting that other researchers have concluded that beta-amyloid is produced in response to a pathogen. The way we view Alzheimer’s is slowly changing.

In the future, scientists hope that targeting gingipain enzymes might help stop neurodegeneration in some people with Alzheimer’s disease. They have already designed a gingipain inhibitor, which they are testing in humans.

The researchers hope that it will “slow or prevent further neurodegeneration and accumulation of pathology in patients.”

The heart of the matter

Although not everyone with heart disease has gum disease, and not everyone with gum disease has heart disease, there does appear to be a correlation.

Of course, individuals who smoke or drink large quantities of alcohol are more likely to have both oral and cardiovascular issues, but there appears to be more to the relationship than shared risk factors alone.

Whether gum disease is an independent risk factor for heart disease is still being discussed, but there are some theories as to how the two might be related.

Share on PinterestWhat links the gums with the heart?

Some think that the link could involve inflammation.

Primarily, inflammation is a response to irritants or pathogens; it is a protective mechanism. However, if it continues for an extended period, it can damage tissues and organs.

It is possible that inflammation in the gums sets off a cascade that, ultimately, sparks inflammation in the cardiovascular system.

Alternatively, the link between heart and gum diseases may be due to bacteria.

Bacteria in the gums can enter the blood supply and be propelled to distant destinations, including the heart, where they can cause inflammation and damage.

As evidence that this is possible, researchers have shown that P. gingivalis is the most commonly found bacterial species in the coronary artery.

Cancer risk increase

Once again, gum disease and cancer do not, on the surface, appear to have much in common.

A study published in 2008 investigated tooth loss and cancer in 48,375 men. The authors concluded that there was, indeed, a link between gum disease and cancer. They write:

“Periodontal disease was associated with a small, but significant, increase in overall cancer risk.”

Another, more recent, study involving more than 68,000 adults found a strong association between gum disease and overall cancer risk; the link was also significant between gum disease and pancreatic cancer.

Why might this be the case? A paper published in Nature goes some way toward an explanation.

The researchers found that an enzyme produced by a type of bacteria commonly associated with gum disease — Treponema denticola — commonly appears in certain tumors of the gastrointestinal system.

The enzyme, known as T. denticola chymotrypsin-like proteinase, helps the bacteria invade tissue in gum disease. The researchers found that it also activated other enzymes that promote cancer cells as they advance into healthy tissue.

Erectile dysfunction

An estimated 50 percent of men over the age of 40 experience erectile dysfunction. It is a complex condition that can result from both psychological and physiological factors.

Some well-known risk factors include smoking tobacco, drinking alcohol, and hypertension. According to some scientists, periodontal disease might also increase the risk of erectile dysfunction.

For instance, the authors of a literature review published in 2016 identify an association between erectile dysfunction and chronic periodontitis.

In fact, they suggest “that physicians should refer patients with to oral healthcare providers for a comprehensive oral evaluation and treatment.”

Share on PinterestThe importance of dental hygiene may extend to the bedroom.

Because erectile dysfunction and gum disease have shared risk factors, including smoking and diabetes, it has been difficult to ascertain whether gum disease is an independent risk factor for erectile dysfunction.

Although sexual dysfunction and gum health seem worlds apart, there are a number of potential ways in which they could influence each other.

Once again, inflammation might be the culprit. As mentioned earlier, inflammation in one part of the body — the mouth, in this instance — can spread via chemical messengers in the blood and impact other regions.

Erectile dysfunction is often due to malfunctioning blood vessels; specifically, the smooth muscles lining the walls of blood vessels lose their ability to relax. This is referred to as endothelial dysfunction, and it prevents vasodilation in the penis and, consequently, erections.

A so-called proinflammatory state may promote endothelial dysfunction and, therefore, increase the risk of erectile dysfunction.

However, the link has not been definitively proven. The authors of a review published in 2016 concluded that, although this link seems likely, more large-scale studies are needed.

Gums and lungs

Of course, the mouth is a shared gateway to the gums and the lungs, making a link between gum and lung diseases less surprising than some of the others that we have encountered.

A study published in February 2019 investigated the records of 1,380 men. The authors found a significant relationship between chronic periodontitis and a reduction in respiratory function.

This link remained significant, even after controlling for confounding variables, such as smoking.

Once again, inflammation may be the link between the two conditions. If the tubes in the lungs that carry air are inflamed, they become narrower and air flow is restricted.

Aside from the probable role of inflammation, bacteria present in the mouth might also be breathed into the lungs. Once in the lungs, the bacteria could trigger infections that directly lead to inflammation.

A recent meta-analysis investigated potential links between gum disease and lung cancer. The authors concluded that “patients with periodontal disease are at increased risk of developing lung cancer.”

In their paper, they outline some potential ways in which gum disease might increase lung cancer risk. For instance, breathing in bacteria, such as P. gingivalis, from the mouth could cause infections.

Similarly, enzymes produced during the course of gum disease might pass into the lungs. Once there, they could help pathogens take root and colonize the lung tissue.

These changes spark inflammation; over the long term, inflammation causes changes in cells that raise the likelihood of cancer developing.

The take-home message

One could read this article as a worrying collection of conditions made all the more likely to occur, courtesy of gum disease.

If we adopt the opposite approach, though, the take-home message could be much more positive: Good dental hygiene may reduce our risk of developing a range of serious health problems.

As the authors of the lung cancer analysis, mentioned above, write, “periodontal disease is a preventable and treatable disease.” Managing it at an early stage might reduce the risks of a multitude of ills.

How does gum disease affect my body?

Current models of mucosal surfaces of oral, gut, lung, and skin tissue postulate that local bacterial antigens, derived from biofilms on surfaces, regulate local tolerance, local immune response, and systemic response by way of an “information relay system” through a series of nuclear factor-kappa beta pathways to synthesize and secrete cytokines and chemokines to regulate the inflammatory process at local as well as distant sites. Evidence is also accumulating that the predominant cells of the periodontium, gingival fibroblasts, are capable of producing prostaglandins, interleukins (IL-1beta , IL-6, IL-8), tumor necrosis factor-alpha (TNF-α), and interferon- gamma (IFN-γ). It is hypothesized that these mediators modulate inflammation locally as well as at a distant site of infection.
One presupposes the direct role of oral bacteria or their products in the pathogenesis of atherosclerotic plaque in myocardial infarctions. An alternative explanation is the possible role of mediators in inflammation initiated by periodontal pathogens in the development of chronic complications. There is general agreement that chronic diseases, such as atherosclerosis, stroke, and diabetes, are multifactorial in origin. But there is growing evidence that these diseases are influenced by gingival inflammation and chronic periodontal infections. In a series of cross-sectional studies, a strong relationship has been found between acutephase C-reactive protein (CRP) in serum and the severity of periodontal diseases. CRP is triggered by infections, trauma, necrosis, and malignancy, and is also linked to heart disease and diabetes. CRP is synthesized in the liver in response to proinflammatory cytokines such as IL-1α, IL-1β, and IL-6. TNF-α, IFN-γ, and transforming growth factor also participate in the production.
The current therapeutic strategy to control periodontal infections involves mechanical removal of deposits, both supra- and subgingival.

Why your gums are so important to your health

Periodontal disease may increase the risk of diabetes, heart disease, and dementia.

Published: May, 2016

Regular flossing, along with brushing, are key in preventing periodontal disease.
Image: Canstock

Periodontal disease (periodontitis) has long been known as the leading cause of tooth loss in adults. But the damage isn’t confined to the mouth. Gum disease has also been associated with an increased risk of serious degenerative diseases.

How gum disease starts

Like our intestines, our mouths house complex ecosystems of bacteria, known as the oral microbiome. And as in the gut, different types of bacteria compete for space. When all the species are in balance, the gums are protected from disease-causing bacteria. Disturbing this balance provides an opening for pathogens to invade, causing periodontal disease, which further disrupts the bacterial balance.

Pathogenic bacteria initiate periodontal disease; however, they aren’t the only—or even the major—culprits. “Yesterday we used to think that bacteria destroyed tissue; today scientists understand that it’s inflammation caused by the bacteria that destroys tissue,” says Dr. Thomas Van Dyke, chair of the Department of Applied Sciences at Harvard-affiliated Forsyth Institute. That is, the disease-causing bacteria trigger a response from the body’s immune system, and the white blood cells summoned to eradicate them produce substances that not only destroy bacteria but also damage gum tissue.

Gum disease’s effects throughout the body

The effects of periodontal disease range from mild redness and swelling of the gums (gingivitis) to complete destruction of the tooth’s bony support structure (advanced periodontitis), which is responsible for tooth loss.

Over the years, people with perio-dontal disease have been found to be at higher risk for cardiovascular dis-ease, diabetes, chronic respiratory disease, pregnancy complications, and dementia. We don’t yet know if periodontal disease actually causes other health problems, or if people with chronic health issues have more difficulty taking care of their teeth and gums. “It’s an association, not a cause-and-effect relationship, says Dr. Van Dyke. “But inflammation, which plays a role in all these conditions, seems to be the link.”

Moreover, the association probably works both ways. For example, diabetes research has determined that successfully treating periodontitis reduces the severity of diabetes and vice versa.

Preventing periodontal disease

The following, which either help to prevent bacterial infection or reduce inflammation, are still the best ways to reduce your risk of gum disease.

Brush and floss. Brush your teeth at least twice a day, and floss before bedtime. If you have bridges, implants, or wide spaces between your teeth, you may want to use interdental brushes—toothpick-like implements with tiny bristles at one end—to clear trapped food.

Don’t smoke. People who smoke up to a half a pack of cigarettes per day are almost three times as likely as nonsmokers to have periodontitis; those who smoke more than a pack and a half of cigarettes per day have almost six times the risk.

Eat a healthy diet. A diet rich in vegetables and vegetable oils, fruits, legumes, nuts, and fatty fish not only provides all the essential nutrients, but it helps suppress inflammation. There is some evidence that people whose diets are high in omega-3 fatty acids, which are found in fatty fish, have a reduced risk of periodontal disease.

Have regular dental check-ups and cleanings. Your dentist or dental hygienist can remove bacteria-harboring plaque and spot the first signs of periodontal disease.

Get treatment at the first signs of gum disease. Swollen, bleeding gums; pockets of pus; or gums that have pulled away from your teeth are the most dramatic signs of periodontal disease. Subtler changes, such as widening spaces between your teeth, and bridges or partial dentures that don’t fit as well as they once did, may also signal periodontitis.

On the horizon

Today’s approaches to treating periodontal disease are directed at eradicating the bacteria that cause it with antibiotics and through scaling and root planting—a procedure in which a clinician uses tools to scrape bacteria-laden plaque from the surfaces and roots of teeth. Tomorrow’s therapies are likely to involve more targeted approaches.

Scientists have identified the 700 species of bacteria that inhabit our mouths, presenting the possibility of probiotic therapies that prevent harmful bacteria from getting a foothold. Research may also yield a new generation of therapies that wind down the inflammatory response rather than inhibit it completely, and thus may have fewer side effects than current anti-inflammatory medications do.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

What Gum Disease Can Mean for Your Overall Health

Not taking good care of your teeth and gums can lead to more than bad breath or a toothache. While the nature of the link isn’t always clear, oral health can say a lot about your overall well-being.

“To be considered truly healthy, you don’t want to have a part of your body with potential inflammation or infection,” says Angelo Mariotti, DDS, PhD, the chair of the division of periodontology at Ohio State University College of Dentistry in Columbus, Ohio. “The oral cavity is no different.”

Research has linked oral health problems such as periodontal or gum disease to many health conditions, including diabetes, heart and kidney disease, Alzheimer’s, asthma, osteoporosis, and cancer. Dr. Mariotti says there are more than 120 conditions that have been associated with dental problems. He points out, however, that the research has not established a clear cause-and-effect relationship between oral health and many of these conditions.

“It’s hard to show in these studies what the relationship is because these diseases are all multifactorial,” agrees Peter Loomer, DDS, PhD, the chair of periodontology and implant dentistry at New York University College of Dentistry in New York City.

Gum Disease and Diabetes

The connection between gum disease and diabetes is the strongest, according to Dr. Loomer.

Periodontal disease occurs when the gums recede or pull away from your teeth and form small pockets. Bits of food can get trapped in the pockets, and bacteria in your mouth can produce toxins that irritate the gums and cause inflammation. Without treatment, the bones and tissues that support the teeth start breaking down.

“People with diabetes have poor healing capacity because their immune system is not as robust,” Loomer says. “There is more breakdown of periodontal tissues because things don’t heal as well.”

People with severe periodontitis may have higher levels of HbA1C, a form of glucose-linked hemoglobin that is used to measure how well diabetes is controlled. According to the American Diabetes Association (ADA), the relationship between gum disease and diabetes goes both ways: Periodontitis may affect blood glucose control, and people who have diabetes may be more susceptible to bacterial infection, leading to gum disease.

“If plaque is left behind in the gum tissue, it induces a greater inflammatory response and people have more trouble ,” Loomer says. According to a study published in January 2017 in the journal BMJ Open Diabetes Research and Care, nearly 1 in 5 people with periodontitis had type 2 diabetes without knowing it. The researchers suggest that dental checkups may provide an opportunity to screen people for prediabetes and diabetes.

It’s very important for people with diabetes to make oral health a priority, Loomer says. Managing your blood glucose level combined with good oral hygiene and visits to the dentist every six months can help prevent dental problems associated with diabetes. But, as the ADA points out, nonemergency dental work should be postponed if your blood sugar in not under control.

Gum Disease and Your Heart

There’s a lot of research supporting the association between periodontal disease and heart disease, Loomer says. But so far, the evidence is not conclusive.

According to Loomer, the connection may be related to inflammatory products such as c-reactive protein (CRP), a protein found in blood plasma. CRP is elevated in the bloodstreams of people with periodontal disease, and its level may rise in response to inflammation in the body.

RELATED: 10 Biggest Causes of Tooth Sensitivity

One possible explanation is that bacteria in infected gum tissue could enter the bloodstream and travel to other parts of the circulatory system, causing inflammation and arterial plaque. In one study, researchers discovered signs of oral bacteria in arterial plaque, and research published in 2010 found strong evidence to support the role of systemic inflammation caused by oral bacteria in the development of atherosclerosis.

The fact that gum disease and heart disease share risk factors in common, such as smoking and weight, may also help explain why they can occur simultaneously.

A 2014 study found that treatment of gum disease may lessen the adverse consequences of heart disease and other chronic conditions. Research published in 2013 indicated a significant relationship between periodontal health and the risk of stroke, and a 2012 study suggests that dental plaque bacteria could trigger blood clots.

Early Detection Is Key

While there is still no definitive proof connecting dental health to diabetes or heart disease, maintaining good oral health should be an important part of your overall healthcare.

“A lot of periodontal disease can be prevented with good oral hygiene and regular professional care,” Loomer says. “And if it’s caught at an early stage, it can be more easily managed. If you allow it to progress, once your teeth have lost too much bone support, it’s difficult to treat and may require extractions.”

The National Institutes of Health recommends brushing your teeth twice daily with fluoride toothpaste (fluoride helps remineralize the teeth, Loomer says) and flossing regularly. You should see your dentist twice yearly for a checkup and professional cleaning.

“If you want to live a healthy lifestyle, part of it has to revolve around your oral cavity,” Mariotti says.


85% of US adults have some form of gum disease. From the earliest stages of gingivitis to the more advanced stages of periodontitis, gum disease is one of the most prevalent diseases in our society, yet remains largely unknown. The study “Prevalence of Periodontitis in Adults in the United States: 2009 and 2010”, estimates that 47% of adults have moderate-severe gum disease, which translates to more than 64 million people. When you look at the population over 65, the percentage jumps to over 70% with moderate-severe gum disease.

Although the numbers vary, one fact is constant – millions of Americans have gum disease. And, unfortunately, the odds are you have it, too; you just don’t know it. Here’s what you need to know about gum disease and what you can do about it.

Gum Disease: The Silent Killer

Gum disease, also called periodontal disease, is an infection of the tissues and bone that support your teeth. It occurs when germs infect the gum tissues around the teeth, causing redness, swelling and bleeding. Gum disease has been linked to major health problems including heart disease, strokes, preterm and stillborn births, as well as certain cancers. It is the leading cause of tooth loss for adults.

Gingivitis and periodontitis are two stages gum disease. Here’s the difference between them:

Gingivitis: A less severe form of gum disease, gingivitis is inflammation of the gums caused by plaque build up. Plaque is the film found on your teeth. It is a sticky combination of germs and bacteria known as a biofilm. If not brushed away, plaque hardens into a barnacle-like material to form calculus, commonly known as tartar. Just like lime deposits on a shower drain, the hardened calculus is difficult to remove. The biofilm will continue to grow and infect your gums, sometimes causing redness and bleeding you may or may not see.

Periodontitis: Gingivitis, if left untreated, will progress to periodontitis. With periodontitis, calculus deposits expand on the surface of your teeth, edging down below your gum line. This condition causes your gums to separate slightly from the teeth and supporting bone, forming periodontal pockets. It creates swelling, bleeding, pain while chewing, teeth misalignment and looseness. Some patients also have sores inside the mouth, persistent bad breath, and sensitive teeth. A discharge of puss from the gums, called pyorrhea, is another a symptom of periodontitis.

Untreated gingivitis will progress and become periodontitis, a much more severe form of gum disease. The infection and the pockets may continue to deepen, eating away at the jawbone until your teeth become loose and fall out—unless you seek treatment.

Can I avoid getting gum disease?

Prevention is always the least painful and least expensive path to good health. If there are no infections, then your dentist or hygienist will suggest a plan that includes regular brushing, flossing and dental hygiene visits as your best bet for avoiding dental infections.

It is critical that you don’t skip your regular cleanings every six months. Make sure your dentist checks for the signs of gum diseases to help catch the disease in early stages. Dental professionals will do this by probing – inserting a small probe between your gum line and tooth to identify pockets. During the process, they may call out numbers – these numbers correspond to pocket depths. In this case, lower numbers are definitely better.

Take care of your gums to take care of your health.

If you are one of the 85% of adults with gum disease according to US Surgeon General statistics, don’t risk the health of your body by avoiding treatment of your mouth. Ask your dentist about the LANAP protocol to eliminate periodontal infection for healthier gums and a healthier body.

Take control of your health—and your life—by treating gum disease today, before you lose teeth tomorrow.

Robert H. Gregg II, DDS is a co-developer of the PerioLase® MVP-7™ pulsed Nd:YAG laser and the LANAP protocol. Dr. Gregg is a co-founder of Millennium Dental Technologies, Inc. and is the Program Director of the Institute for Advanced Laser Dentistry. Recognized as one of the top 250 Leaders in Dental Education by Dentistry Today for 2009-2012, he is a peer-review member of the Dentistry Today CE Editorial Board. He maintains a private practice in Cerritos, California.


Jan. 22, 2012— — Even if you brush your teeth daily, you may still have dangerous bacteria growing inside your mouth. Not only could that lead to periodontitis (an advanced form of gum disease that comes with symptoms such as bleeding when you brush and gum pain), but studies also find a link between poor oral hygiene and major health issues. Here are some ways that missing the mark on oral care could harm your heath.

It May Hurt Your Heart

People with gum disease are almost twice as likely to suffer from coronary artery disease compared to those don’t have periodontitis. Researchers aren’t exactly sure of why this might be, but one theory is that harmful bacteria from your mouth enters your blood stream and attaches to fatty plaques in your heart’s blood vessels, leading to inflammation and upping your risk of clots that can trigger heart attacks.

28 Days to a Healthier Heart

Your Memory May Suffer

Some research suggests there may be a tie between poor oral health and an increased risk of dementia. One study that followed 118 nuns between the ages of 75 and 98 found that those with the fewest teeth were most likely to suffer dementia. Experts think oral bacteria may spread to the brain through cranial nerves that connect to the jaw or through the bloodstream, and may contribute to the type of plaque that’s been linked to Alzheimer’s.

It Might Impact Your Blood Sugar

People with diabetes are more likely to have periodontal disease than those without diabetes. While this may be because diabetics are more susceptible to infections, there’s also been research that finds gum disease could make it harder to control your blood sugar, and that treating it helps improve diabetes symptoms.

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It May Affect Your Breathing

Gum disease may increase your risk of getting respiratory infections, such as chronic obstructive pulmonary disease (COPD) and pneumonia, according to the Journal of Periodontology. The infections might be caused when bacteria from the mouth are inhaled into your lungs, possibly causing your airways to become inflamed.

It Might Make it Harder to Have a Baby

Women of childbearing age with gum disease took an average of just over seven months to become pregnant – two months longer than the average of five months that it took women without gum disease to conceive, discovered researchers in Western Australia. Other research finds that pregnant women with gum disease might have higher odds of miscarriage.

Expert Teeth-Cleaning Tips

How can you tell if you’re hitting the mark when it comes to good oral care?

“Generally, your teeth and gums should not bleed, be painful, or feel rough or sharp to your tongue,” says Pam Atherton, RDH, a dental hygienist for Dr. John Carlile, DDS in Skaneateles, NY. “Your breath should be fresh for at least a couple of hours after brushing in the morning and after having eaten breakfast.”

One of the easiest ways to prevent gum disease is to clean your teeth properly, so try these tricks for a healthier mouth.

Rinse Your Mouth

If you use mouthwash twice a day, you’ll slash your risk of gum disease by 60 percent, says Marjorie Jeffcoat, DMD, Professor of Periodontology at the University of Pennsylvania School of Dental Medicine in Philadelphia. Ideally you should aim to rinse for about 30 seconds with a mouthwash that has microbial protection to fight plaque and gingivitis, such as Listerine®.

Floss First

You should floss before you brush your teeth, rather than after, says Jeffcoat. “That way you’ll be able to brush away any food that was stuck between your teeth to prevent bacteria from growing.” If you find dental floss hard to hold onto, Atherton suggests trying floss picks, such as Plackers® dental flossers, instead.

Get the Right Toothbrush

Soft or extra soft bristles are best. “Gum tissue can’t make a callous; therefore, when a person uses a medium or hard-bristled toothbrush, it literally scratches the tissue away over time, exposes the root surface underneath and leads to possible bone loss,” says Atherton.

Brush Smart

To really clean your teeth, aim to brush them for a full two minutes. “Make sure you brush both your tongue and cheeks as well as the chewing surfaces to improve the removal of harmful bacteria in the crevices,” says Atherton. To get your kids to brush the full two minutes, sing “Happy Birthday To You” or the “Alphabet Song” twice through at a normal speed for each half of your mouth. And be sure to replace your toothbrush about every three months.


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Gum disease

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 for more information and advice about good oral hygiene.


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 doctor before visiting a dentist, they may provide you with some treatment while you wait to see your dentist. Possible treatments are described below.


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:

  • nausea (feeling sick)
  • vomiting
  • diarrhoea


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 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.

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.

Periodontal (Gum) Disease

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Periodontal (gum) disease is an infection of the tissues that hold your teeth in place. It’s typically caused by poor brushing and flossing habits that allow plaque—a sticky film of bacteria—to build up on the teeth and harden. In advanced stages, periodontal disease can lead to sore, bleeding gums; painful chewing problems; and even tooth loss.

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Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

There are a number of risk factors for gum disease, but smoking is the most significant. Smoking also can make treatment for gum disease less successful. Other risk factors include diabetes; hormonal changes in girls and women; diabetes; medications that lessen the flow of saliva; certain illnesses, such as AIDS, and their medications; and genetic susceptibility.

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Symptoms of gum disease include:

  • Bad breath that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth

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At a dental visit, a dentist or dental hygienist will:

  • Examine your gums and note any signs of inflammation.
  • Use a tiny ruler called a “probe” to check for and measure any pockets around the teeth. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
  • Ask about your medical history to identify conditions or risk factors (such as smoking or diabetes) that may contribute to gum disease.

The dental professional may also:

  • Take an x-ray to see whether there is any bone loss.
  • Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

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The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The dentist may also suggest changing certain behaviors, such as quitting smoking, as a way to improve your treatment results.

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Helpful Tips

You can keep your gums and teeth healthy by:

  • Brushing your teeth twice a day with a fluoride toothpaste.
  • Flossing regularly to remove plaque from between teeth. Or, you can use a device such as a special brush, wooden or plastic pick, or a “water flosser” recommended by a dental professional.
  • Visiting the dentist routinely for a check-up and professional cleaning.
  • Quitting smoking.

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Additional Resources

  • Periodontal Disease​
    Information from the Centers for Disease Control and Prevention about the causes of periodontal disease, its warning signs, risk factors, and prevention and treatment.
  • MedlinePlus: Gum Disease
    The NIH National Library of Medicine’s collection of links to government, professional, and non-profit/voluntary organizations with information on periodontal disease and gingivitis.
  • How to Quit Smoking Information from the Centers for Disease Control and Prevention (CDC) on quitting smoking.

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  • Periodontal (Gum) Disease: Causes, Symptoms, and Treatments

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