Gum inflammation - information and specialists

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Inflammation of the gums (gingivitis) is characterized by a reddish discoloration of the gums and bleeding gums. Inflammation of the gums should always be taken seriously. It can lead to periodontitis and, in the worst case, to complete tooth loss. Improving your own oral hygiene routine often helps against inflamed gums.

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ICD codes for this diseases: K05.0, K05.1

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Article overview

What is gingivitis?

Inflammation of the gums (gingivitis) is almost always caused by a pathological proliferation of bacteria in the oral cavity. If oral hygiene is inadequate, the germs can spread unhindered and attack the gums.

Almost 80 percent of Germans are affected by gingivitis. However, as gingivitis does not cause any pain, only very few people notice the disease. Symptoms such as

  • occasional bleeding of the gums when brushing teeth and
  • reddened gums

often go unnoticed or do not prompt a visit to the doctor. However, gum inflammation is by no means harmless. Without proper treatment, it can quickly turn into periodontitis. In the worst case scenario, this can lead to loosening of the teeth and total tooth loss.

However, it does not have to come to this if countermeasures are taken in good time. At the beginning of an inflammation of the gums, simple measures are often enough to put a stop to it. Good oral hygiene is essential.

However, if the gum inflammation does not disappear within a week, you should consult a dentist.

Causes of gingivitis

More than 300 different types of bacteria live in the human oral cavity. Together they are known as oral flora. With normal oral hygiene, they do not pose a problem for the human body.

If the teeth are not brushed properly and regularly, these bacteria multiply to an unhealthy extent. Unremoved food residues on the teeth and in the spaces between the teeth provide good food for the bacteria.

They process the leftovers into a tough, invisible coating on the teeth - plaque. Bacteria multiply particularly well in this plaque. As a result, they release toxins that attack the gums and cause inflammation.

However, gum inflammation is not always a symptom of poor oral hygiene. In some people, even a slight build-up of plaque leads to gingivitis. For others, even pronounced tartar does not cause any symptoms.

There are several factors in addition to oral hygiene that can also promote gingivitis. These include, among others

  • A weakened immune system (e.g. due to AIDS or the use of immunosuppressants),
  • chronic diseases such as diabetes mellitus,
  • smoking,
  • stress or
  • hormonal changes during puberty or pregnancy.

Some medications can also lead to gum inflammation as a side effect, e.g.

  • certain antihypertensives,
  • drugs for epilepsy and
  • the immunosuppressants mentioned above.
Zahnfleischentzündung
Reddened and bleeding gums when brushing teeth are signs of gingivitis © Siniehina | AdobeStock

    What types of gingivitis are there?

    Acute gingivitis

    Acute gingivitis causes few symptoms and is therefore often easily overlooked. Healthy gums are soft pink and do not bleed when you brush your teeth or eat.

    If the gums are irritated or injured, bacteria can penetrate. The body then reacts with bacterial defense and triggers an inflammatory reaction. This is intended to restore the gums to their normal state.

    The gums, reddened by the inflammation, become sensitive, swell and bleed from time to time. Acute gingivitis has developed. Bleeding gums are almost always caused by gingivitis.

    Other causes of gingivitis are

    • An incorrect brushing technique: too much pressure when brushing the teeth irritates the sensitive but not inflamed gums and they bleed. This is known as acute gingivitis. The gum injury caused by the manual friction and the associated bleeding heal on their own and the inflammation disappears.
    • Meals eaten too hot: This can cause real burns in the oral cavity. They heal on their own within a few days.
    • Ingesting strong acids and alkalis: Patients who suffer from severe heartburn are particularly at risk. In these patients, stomach acid repeatedly rises into the mouth area.

    Chronic gingivitis

    If gum inflammation persists over a longer period of time, it is referred to as chronic gingivitis. In around 80 to 90% of adults, acute gingivitis has already developed into a chronic form.

    It often occurs together with a strong build-up of tartar. This further favors the continuous inflammation of the gums.

    Factors such as

    • hormonal changes during puberty or pregnancy,
    • the long-term use of medication such as immunosuppressants or
    • chronic diseases such as diabetes mellitus

    favor chronic gingivitis. If these factors are eliminated and oral hygiene is sufficient, chronic gingivitis also recedes.

    Chronic gingivitis shows the typical symptoms, i.e. reddened gums and bleeding gums. Other symptoms such as toothache and often strong bad breath also occur.

    In very severe cases of chronic gingivitis, pus can form under the gums. It comes out when pressure is applied. The inflammation can also lead to swelling of the surrounding lymph nodes, spread to the oral mucosa and cause inflammation (gingivostomatitis).

    Acute necrotizing ulcerative gingivitis (ANUG)

    Acute necrotizing ulcerative gingivitis (ANUG) is also known as Plaut-Vincent gingivitis. It is a special form of acute gingivitis that is not contagious.

    It usually affects adolescents and young adults between the ages of 15 and 30. The patients are often smokers. Young people who are under a lot of stress, e.g. during exam periods, also have a higher risk. In addition, a latent viral infection is suspected of being able to trigger ANUG.

    ANUG begins suddenly with an acute inflammation that triggers a fever. It permanently damages the gums. It usually causes foul-smelling bad breath and severe toothache.

    The gums in the interdental spaces are affected first. The acute inflammation destroys the interdental papillae (the reddish gum triangles between the teeth).

    Once the ANUG has healed, the gums are completely missing in these areas. It will also no longer regenerate. You should therefore visit the dentist at the first suspicion of ANUG.

    Pregnancy gingivitis

    During pregnancy, the body undergoes a hormonal change. As a result, it reacts very sensitively to bacterial infestation in order to protect the unborn child from damage. The immune system triggers inflammatory changes at a very early stage in order to fight the bacteria.

    The gums are one of the most sensitive and most easily affected by bacteria. This is particularly true if oral hygiene is inadequate. Swelling, redness and bleeding gums are therefore not uncommon in pregnant women. This is referred to as pregnancy gingivitis.

    Pregnancy gingivitis should always be taken seriously. Open wounds have formed between the gums and the roots of the teeth. Bacteria can enter the bloodstream unhindered through these small wounds.

    In the worst case, bacterial inflammation can even affect the uterus and placenta. In response to this inflammation, the female body activates the body's own defense mechanisms. These in turn can trigger premature labor or a rupture of the amniotic sac.

    The risk of premature birth increases dramatically.

    How is gingivitis treated?

    Thorough oral hygiene is the be-all and end-all

    Gingivitis can usually be controlled very well with regular, thorough oral hygiene.

    Teeth should be brushed at least twice a day for three minutes each time. Ideally, you should brush them about half an hour after every meal. This removes plaque and food debris from the tooth region. This prevents bacteria from spreading as quickly and effectively.

    The spaces between the teeth must also be cleaned carefully. Use dental floss for this. Your dentist can explain the correct way to use it.

    If you suffer from gingivitis, you should buy a toothbrush for sensitive teeth. A brush with soft, rounded bristles is gentle on sensitive gums. Don't use your old toothbrush for too long either. At the latest when the bristles start to bend and become frayed, a new toothbrush is called for.

    If you frequently suffer from gingivitis, an electric toothbrush can help. These are far superior to normal toothbrushes due to the rotating oscillation of the head. Talk to your dentist about whether it would be worthwhile for you to buy one.

    Non-prescription active ingredients against gingivitis

    An existing inflammation of the gums is often painless. This is why many people do not think about additional symptom relief. However, in addition to daily tooth brushing, this is an important part of successful treatment. The right choice of toothpaste and the supportive effect of mouth rinses should not be underestimated.

    Disinfectants (so-called antiseptics) are contained in special toothpastes and mouth rinses. One of the most important active ingredients is chlorhexidine. It is commercially available as a mouthwash solution (e.g. Chlorhexamed®) or mouth spray. When used over a longer period of time, chlorhexidine can

    • cause disturbances in the sense of taste and
    • discolor the teeth and tongue brown.

    You should therefore discuss with your dentist whether its use is appropriate for you.

    Other mouthwashes and toothpastes (e.g. Meridol™) use the bactericidal effect of stannous fluorides. According to studies, they are just as effective as chlorhexidine and have no side effects.

    Various herbal active ingredients and essential oils also have an antiseptic and disinfecting effect. Mouthwashes such as Listerine® make use of the anti-inflammatory properties of active ingredients such as

    • thymol,
    • menthol,
    • eucalyptol and
    • methyl salicylates

    are used.

    Herbal active ingredients such as

    • camomile,
    • myrrh or
    • sage

    are most commonly found as additives in mouthwashes and toothpastes such as Parodontax®.

    Diluted chamomile or sage extract also works well on its own as a disinfectant mouthwash.

    However, which products are best for you depends on the degree of inflammation and your personal taste. It is best to find out from the pharmacy or your dentist before buying.

    When to go to the dentist?

    Statutory health insurance covers the costs of two dental check-ups per year. You should attend these. Once a year, the removal of tartar is also included as a health insurance benefit.

    However, if your gums continue to bleed while you are brushing your teeth, you should not wait for your next check-up. It is better to go to the dentist earlier. The inflammation can quickly spread from the gums to the periodontium and cause periodontitis. This can have far more serious consequences.

    Always seek advice and treatment from your dentist in good time.

    Professional teeth cleaning (PZR) against gum inflammation

    Dentists offer professional teeth cleaning. It does not replace your own daily oral hygiene, but is also intended to ensure healthy teeth. This includes

    • the removal of stubborn plaque, including in the spaces between teeth
    • a tooth polish and
    • fluoridation of the teeth with a varnish or gel for longer-term protection.

    Depending on the extent of the dental cleaning, a PZR costs €80 - €150. The costs are not usually covered by statutory health insurance. It is therefore an individual health service (IGeL). However, some health insurance companies cover part of the costs. It is best to enquire directly with your health insurance provider.

    According to the IGeL-Monitor, the actual benefit of PZR as a preventive measure has not been sufficiently proven by studies. If you have taken out supplementary dental insurance, professional teeth cleaning is usually included. If so, you should take advantage of it.

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