Periodontitis (serious gum disease): symptoms, causes and treatment

The NHS says how gum disease is treated depends on how severe it is. In the early stages your dentist will advise on keeping your teeth clean, such as using interdental brushes, advise you to stop smoking if you smoke, and advise you to get your teeth cleaned by a hygienist. If gum disease is serious, you may need deep cleaning under your gums, antibiotics, some teeth removed or gum surgery.

The Oral Health Foundation says your dentist or dental hygienist will thoroughly clean your teeth to remove plaque and hardened plaque (tartar), show you the best way to clean your teeth and gums at home and recommend the right tools, and that you may need several appointments, especially if gum disease is more advanced.

NICE CKS describes the same core approach for primary care: advising dental treatment including professional scaling and polishing and root surface instrumentation to remove plaque, recommending good oral hygiene, and providing smoking cessation advice where appropriate.

The Oral Health Foundation says gum disease is very common and often painless at first, and that if your gums bleed when you brush or clean between your teeth this is usually an early warning sign. NICE CKS says that in periodontitis symptoms, including pain, are commonly absent, but some people have the features below.

• Gums bleeding when you brush, floss or eat hard foods such as apples (NHS).

• Gums that are swollen, red and sore (NHS).

• Bad breath and a bad taste in the mouth (NHS, NICE CKS).

• Gums shrinking or receding, sometimes with root sensitivity (NHS, NICE CKS).

• Teeth becoming loose or drifting, making eating difficult, or falling out (NHS, NICE CKS).

• A periodontal abscess, which may cause pain (NICE CKS).

The Oral Health Foundation describes gum disease as swelling, soreness or infection of the tissues supporting the teeth, with two main types: gingivitis, the early stage, and periodontal disease, also called periodontitis. It says periodontitis damages the bone and tissues that hold teeth in place, can cause gums to pull away from the teeth, and may lead to loose teeth or tooth loss.

NICE CKS adds that, if untreated, periodontitis can progressively lead to damage to the periodontal attachment and the bone, recurrent gum abscesses, the formation of periodontal pockets where the gum detaches from the tooth, and loss of multiple teeth.

The NHS says gum disease is caused by a build-up of plaque on your teeth. If you do not remove plaque by brushing and cleaning in between your teeth regularly, it builds up and irritates your gums. The Oral Health Foundation describes plaque as a sticky layer of bacteria that builds up on teeth and along the gumline.

NICE CKS lists risk factors for plaque-associated gingivitis and periodontitis: ineffective oral hygiene, cigarette smoking, diabetes mellitus, and local factors including calculus, tooth position, overhanging restorations and partial dentures. The NHS also says to see a dentist and hygienist for regular check-ups, especially if you are pregnant or have type 2 diabetes.

The NHS says your dentist will check your teeth and gums and may refer you to a specialist for further tests and treatment. NICE CKS says assessment includes excluding serious underlying or alternative diagnoses. The sources reviewed do not detail the measurements used, so ask your dentist what was found and what stage of disease you have.

NICE CKS describes periodontitis as having largely irreversible tissue damage, and the Oral Health Foundation says it cannot be reversed but can be controlled with good daily care and regular professional support. The Oral Health Foundation says that you may need several appointments if gum disease is more advanced, and that regular dental visits continue as advised.

The sources reviewed do not give a typical treatment duration. Your dental team can tell you how often you need follow-up cleaning.

The NHS says gum disease can lead to bad breath and a bad taste, gums shrinking, teeth becoming loose or falling out, and a dental abscess. NICE CKS notes recurrent gum abscesses, periodontal pockets and the loss of multiple teeth.

The NHS says to see a dentist if your gums bleed when you brush your teeth or eat hard foods, your gums are painful and swollen, you have bad breath, or your child has sore, bleeding gums. It says to ask for an urgent dentist appointment if you or your child have gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in the mouth, or a lump in your mouth or on your lip.

If you cannot get an emergency dental appointment, the NHS says to call 111. NICE CKS says people with necrotizing gingivitis, with intensely painful bleeding gums and severe bad breath, should be referred to a dentist for urgent assessment.

The NHS and the Oral Health Foundation give the same practical advice.

• Brush your teeth with fluoride toothpaste at least twice a day for 2 minutes, last thing at night and once more during the day, and spit after brushing (NHS, Oral Health Foundation).

• Clean in between your teeth every day using floss or interdental brushes (NHS, Oral Health Foundation).

• See a dentist and dental hygienist for regular check-ups (NHS).

• Do not smoke (NHS).

• Do not use mouthwash straight after brushing your teeth (NHS).

The NHS says NHS dental treatment is free for some people, including children under 18, people who are pregnant or have had a baby in the past 12 months, and those on certain benefits, and that others usually pay NHS charges. Free dental care applies in pregnancy and for 1 year after birth with a maternity exemption certificate. Private dentists and hygienists also treat gum disease, and the treatment described above is the same.