Gum Inflammation - Information and Specialists

Gingivitis is almost always caused by an abnormal proliferation of bacteria in the oral cavity. If oral hygiene is inadequate, these bacteria can spread unchecked and attack the gums.

Nearly 80 percent of Germans are affected by gingivitis. However, since gingivitis does not cause pain, very few people notice the condition. Symptoms such as

• occasional bleeding of the gums while brushing and
• reddened gums

often go unnoticed or do not prompt a visit to the dentist. However, gingivitis is by no means harmless. Without proper treatment, it can quickly develop into periodontitis. In the worst case, this can lead to loose teeth and total tooth loss.

However, it doesn’t have to come to that if action is taken in time. In the early stages of gingivitis, simple measures are often enough to stop it from progressing. Good oral hygiene is essential.

If the gum inflammation does not subside within a week, however, you should see a dentist.

More than 300 different species of bacteria live in the human mouth. Collectively, they are referred to as the oral flora. With proper oral hygiene, they do not pose a problem for the human body.

If teeth are not brushed properly and regularly, these bacteria multiply to an unhealthy extent. Food particles left on the teeth and in the spaces between them provide a rich source of nourishment for the bacteria.

The bacteria convert these residues into a sticky, invisible film on the teeth called 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 buildup of plaque can lead to gum inflammation. In others, even significant tartar buildup causes no symptoms.

There are several factors besides oral hygiene that can also contribute to 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 cause gum inflammation as a side effect, e.g.,

• certain blood pressure medications,
• medications for epilepsy, and
• the immunosuppressants mentioned above.

Red and bleeding gums when brushing are signs of gingivitis © Siniehina | AdobeStock

Acute gingivitis

Acute gingivitis causes few symptoms and is therefore often easily overlooked. Healthy gums are a soft pink color and do not bleed when brushing teeth or eating.

If the gums are irritated or injured, bacteria can penetrate them. The body then responds by fighting off the bacteria and triggering 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 gum inflammation.

Other causes of gum inflammation include

• incorrect brushing technique: Applying too much pressure while brushing irritates the sensitive but non-inflamed gums, causing them to bleed. This is actually referred to as acute gingivitis. The gum injury caused by manual friction and the associated bleeding heal on their own, and the inflammation subsides.
• Eating meals that are too hot: This can cause actual burns in the oral cavity. They heal on their own within a few days.
• Ingestion of strong acids and alkalis: Patients who suffer from severe heartburn are particularly at risk. In these cases, stomach acid repeatedly rises into the mouth.

Chronic Gingivitis

If gum inflammation persists over a long period of time, it is referred to as chronic gingivitis. In about 80 to 90% of adults, acute gingivitis has already progressed to a chronic form.

It often occurs alongside excessive tartar buildup, which further contributes to ongoing gum inflammation.

Factors such as

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

contribute to chronic gingivitis. If these factors are eliminated and oral hygiene is adequate, chronic gingivitis will subside.

Chronic gingivitis presents with typical symptoms, such as reddened gums and bleeding gums. Additional symptoms, such as toothache and often severe bad breath, may also occur.

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

Acute Necrotizing Ulcerative Gingivitis (ANUG)

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

It most commonly affects adolescents and young adults between the ages of 15 and 30. Patients are often smokers. Young people under severe stress—such as during exam periods—are also at higher risk. In addition, a latent viral infection is suspected of triggering ANUG.

ANUG begins suddenly with an acute, fever-inducing inflammation. It causes permanent damage to the gums. It usually results in foul-smelling bad breath and severe toothache.

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

After ANUG has healed, the gum tissue is completely missing in these areas. It will not regenerate. Therefore, you should see a dentist at the first sign of ANUG.

Pregnancy Gingivitis

During pregnancy, the body undergoes hormonal changes. As a result, it reacts very sensitively to bacterial infection in order to protect the unborn child from harm. The immune system then triggers inflammatory changes very early on to fight the bacteria.

The gums are one of the most sensitive areas and are among the first to be affected by bacteria. This is especially true when oral hygiene is inadequate. Swelling, redness, and bleeding gums are therefore not uncommon in pregnant women. This condition is known as pregnancy gingivitis.

Pregnancy gingivitis must be taken seriously. Open wounds have formed between the gums and the tooth roots. Through these small wounds, bacteria can enter the bloodstream unimpeded.

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

The risk of preterm birth increases dramatically.

Thorough oral hygiene is essential

Gingivitis can usually be managed very effectively with regular, thorough oral hygiene.

You should brush your teeth at least twice a day for three minutes each time. Ideally, brush them about half an hour after every meal. This removes plaque and food particles from the teeth. As a result, bacteria can no longer spread as rapidly or extensively.

The spaces between your teeth must also be cleaned carefully. Use dental floss for this. Your dentist can explain the correct technique.

If you have gum inflammation, you should buy a toothbrush designed for sensitive teeth. A toothbrush with soft, rounded bristles is gentle on sensitive gums. Also, don’t use your old toothbrush for too long. At the very latest, when the bristles start to bend and fray, it’s time for a new toothbrush.

If you frequently suffer from gum inflammation, an electric toothbrush may help. These are far superior to regular toothbrushes due to the rotating oscillation of the brush head. Talk to your dentist about whether purchasing one would be worthwhile for you.

Over-the-counter treatments for gingivitis

Existing gingivitis is often painless. As a result, many people don’t think about seeking additional relief from the symptoms. However, in addition to daily brushing, this is a particularly important part of successful treatment. The right choice of toothpaste and the supportive effect of mouthwashes should not be underestimated.

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

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

Therefore, discuss with your dentist whether using it is appropriate for you.

Other mouthwashes and toothpastes (e.g., Meridol™) rely on 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 antiseptic and disinfecting effects. Mouthwashes such as Listerine® rely on the anti-inflammatory properties of active ingredients like

• thymol,
• menthol,
• eucalyptol, and
• methyl salicylate

.

Herbal active ingredients such as

• chamomile,
• 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 disinfecting mouthwash.

However, which products are best for you depends on the severity of the inflammation and your personal preference. It’s best to ask your pharmacist or dentist for advice before making a purchase.

Statutory health insurance plans cover the cost of two dental checkups per year. You should take advantage of these. Tartar removal is also covered by insurance once a year.

However, if your gums bleed consistently while brushing your teeth, you should not wait until your next checkup. Instead, see your dentist sooner rather than later. The inflammation can quickly spread from the gums to the periodontal ligaments and trigger periodontitis, which can have far more serious consequences.

In any case, be sure to seek advice and treatment from your dentist in a timely manner.

Dentists offer professional teeth cleanings. These do not replace your own daily oral hygiene routine but are intended to further promote healthy teeth. This includes

• the removal of stubborn plaque, even in the interdental spaces,
• tooth polishing, and
• fluoridation of the teeth with a varnish or gel for long-term protection.

A professional teeth cleaning costs between €80 and €150, depending on the extent of the cleaning. Statutory health insurance plans generally do not cover these costs. It is therefore considered an “Individual Health Service” (IGeL). However, some health insurance plans do cover a portion of the costs. It’s best to check directly with your health insurance provider.

According to the IGeL Monitor, the actual benefits of professional teeth cleaning as a preventive measure have not been sufficiently proven by studies. If you have supplemental dental insurance, professional teeth cleaning is usually included. In that case, you should definitely take advantage of it.