The term " gingivitis " ( gingivitis ) refers to an inflammation of the gums (Latin gingiva ). It can be divided into different degrees of severity and appear chronically or acutely.
Untreated, it often leads to inflammation of the periodontium, periodontitis.
Gingivitis can be triggered by the following causes:
The causes of gingivitis can be manifold. In most cases, however, it is triggered by bacterial plaque, which remains on the tooth surface for a long time. Lack of or simply incorrectly performed oral hygiene is the main cause. Plaque is a tough biofilm that consists of leftover food as well as waste products from bacterial metabolism and bacteria. The formation of a harmful bacterial flora can also be promoted by unhealthy respiratory techniques, such as mouth breathing.
Since the tooth surface is not perfectly flat even with healthy enamel, dental plaque can easily adhere. With irregular removal of the plaque deposits, these can even penetrate to below the gingival margin. Over time, these deposits deepen around the tooth root and cause deep gingival pockets over a relatively short period of time.
The result is usually the emergence of severe inflammatory processes that cause enormous damage to the gums. Even at an early stage of the disease, most patients notice minor bleeding around the gums
However, it has long been recognized that a number of other factors may also be responsible for the development of inflammatory processes in the gum and periodontium. These risk factors include:
It is estimated that one out of three patients in the age of about 40 suffers from inflammatory processes in the gum area. For most people, however, there is no gingivitis (general gingivitis) that is distributed over the entire gum. In the majority of cases observed, only isolated areas are affected. Particularly at risk are those areas that are difficult to access during dental care (bridges, crowns, interdental spaces, interlocking teeth).
Gingivitis is so widespread in Europe that it can be assumed that every second person develops at least one gingivitis during his lifetime.
In addition to the reasons already mentioned, a prolonged stress of the organism seems to promote the development of inflammatory processes of the gums. In many of those affected, this not only develops gingivitis but also inflammation of the periodontium with involvement of the jawbone (periodontitis).
For a long time the connection between stress, a mental phenomenon, and caries or gingivitis was not proven. However, modern studies indicate that people with high levels of stress are much more likely to be affected by these conditions. Causes can be, for example, a neglected by lack of time oral hygiene. In addition, messengers are released during stress, which attack the immune system. Since then not enough antibodies are available, diseases can spread faster.
For more information, see also: Bleeding gums due to stress?
During pregnancy, the risk of gingivitis is significantly increased. The reason for this is the hormone change with elevated estrogen levels in the first 12 weeks of pregnancy. In addition to bleeding gums, gum proliferations also develop. These are to be found above all in the area of the toothed jaw, thus where still teeth are present. These tumors, for example, can be easily injured by crumbly foods and then inflame, resulting in severe pain.
Furthermore, these growths form pockets to the adjacent teeth. These are so-called "pseudo pockets", as they disappear after the disease has resolved.
Nevertheless, there is a risk with this type of bag that there accumulate more deposits and caries arises. Oral hygiene is therefore important in pregnant women. Also to avoid bad breath and tooth decay, the teeth should be cleaned properly every day. If the pain is too severe, a doctor must be consulted to fight the disease.
Although this is a special form of gingivitis, it is still possible here without treatment for a disease of the periodontium (periodontitis) to follow.
As a rule, the gums calm down after pregnancy with the normalizing hormone balance.
Studies have shown that smoking increases the risk of developing periodontitis. In addition, smoking suppresses important warning signs. The constant contact with nicotine-containing smoke narrows the blood vessels in the gums. The symptom of gum bleeding, which often occurs in gingivitis, is thereby suppressed. The actually sick smoker is therefore apparently healthy, since an important symptom is eliminated.
The smoke disturbs wound healing, resulting in slower regeneration reactions of the immune system. In addition, the risk of developing a malignant tumor of the oral mucosa is greatly increased in smokers.
Smokers should therefore have good oral hygiene and regular check-ups in order to detect a gingivitis or a periodontal disease in good time.
You might also be interested in: smoking disorders
Several studies have shown that vitamin D deficiency increases the risk of periodontal disease.
Vitamin D is a vitamin, which is formed with the help of solar radiation in the body, so it is only sufficiently available if you spend a certain amount of time in the sunlight or it feeds from outside (via tablets or the like).
It is responsible for strengthening bones and regulating cell growth. If vitamin D is missing, it can lead to gingivitis, which is particularly associated with bleeding gums. Without treatment, puffing quickly occurs. Especially here and at the sores, bacteria can settle and then begin to attack the bone. Periodontitis develops, which leads to tooth loss without treatment.
Many home remedies and medicines available in pharmacies do not help very quickly in most cases. It often takes some time for the inflammation to heal. However, if there are acute pain, one always hopes for quick help. This can be done by the dentist. In practice, special ointments are in stock, which often bring relief through a single application.
Especially the cooling of the cheek helps against the pain in gingivitis. As a result, the pain disappears and a swelling goes back. Furthermore, one can also help with medication.
Local preparations, which are given directly to the inflamed area, can be purchased in the pharmacy. Dynexan® Gel is applied several times a day with a cotton swab to relieve the pain. This gel contains lidocaine, an active ingredient that is also injected during dental procedures to numb the teeth.
Kamistad® also works on the same basis. However, there are still chamomile flowers contained, which also have an anti-inflammatory effect.
Finally, you can also use tablets to achieve freedom from pain. Ibuprophen® or Paracetamol® are suitable here.
Especially the drug Dontisolon® works very fast. The active substance is prednisolone, a glucocorticoid. This prevents further inflammatory cells from penetrating into the tissue and thus has an anti-inflammatory effect.
In severe bleeding gums, the wound can be blotted with a drug containing hydrogen peroxide. This is used for disinfection and can stop bleeding quickly and effectively.
The most important factor, however, is the regular oral hygiene. Faster than medication, regular prophylaxis (daily 2x brushing your teeth!) Often helps to reduce inflammation very quickly and prevent it in the long term.
One possible ointment is Solcoseryl® acute. The best way to get detailed advice is which product is best for one. Many are enriched with extracts from nature, whose effects have been known for many years. So you can often find salves with sage, rhubarb root, chamomile or myrrh. Sage and chamomile have been known for a very long time to calm down inflammation in the mouth, relieve pain and fight inflammation.
You can help yourself with home remedies for gingivitis. Thus, the mouth is often rinsed with sage or chamomile tea, as this also has a positive effect on inflamed areas, such as after a wisdom tooth removal. Their greatest benefit is in the relief of pain, as this is the first thing one hopes for in a therapy.
In addition, some ointments contain surface anesthetics, such as lidocaine hydrochloride, which reduces the ability, external influences and irritants that occur in the oral mucous during an inflammatory process. The sensation is quasi-temporarily suppressed.
The ointments are applied after a thorough cleansing of the teeth, which may also include a mouthwash, in order to additionally combat existing bacteria in an existing inflammation. The ointment is applied to the affected areas and gently massaged.
It is not recommended to rinse your mouth or drink anything immediately after applying the ointment, as the ointment will take time to penetrate the tissue and otherwise be rinsed away directly.
A visit to a dentist is highly recommended, as only this can treat the gingivitis sufficiently. Ointments are usually not sufficient as the sole therapeutic agent.
In the case of acute gingivitis care should be taken to ensure good oral hygiene. In addition to daily 2x3-minute tooth brushing, this also includes the use of interdental brushes or dental floss as well as rinsing with a mouthwash. However, use should only be in combination with these other aids. The sole use of a rinse does not remove the bacterial film on the teeth.
There are different variants with and without alcohol, with natural ingredients and / or with disinfecting properties, which are available for purchase in drugstores. Fluoride-containing rinse solutions are also recommended.
In the pharmacy, preparations with CHX (chlorhexidine) are available. These have disinfecting properties and can kill all bacteria in the mouth. The disadvantage here is a brownish discoloration of the teeth when the rinse is used over a longer period of time. They should therefore only be used on the recommendation of the dentist and never longer than necessary.
If you do not like all artificially made rinses, you can also use a home-made conditioner made from strong chamomile tea, because chamomile has anti-inflammatory properties.
There are many home remedies for gingivitis. However, not all help alike. Below is a small list of useful resources:
Tea tree oil is a well-known home remedy that is not only used in the oral cavity. In addition to its anti-inflammatory effect, it simultaneously disinfects wounds. This can effectively protect it from further spread. Even small inflammations should be treated early with it, to mitigate worse gradients. Furthermore, it promotes the healing process.
Simply mix some tea tree oil with lukewarm water and rinse with this solution several times a day. Intensive treatment is also possible by applying the oil directly to the site of inflammation with a cotton swab.
The chamomile is a medicinal plant. It contains essential oils, which cause different effects. In the mouth, especially the anti-inflammatory and antibacterial effects are not to be despised. In case of gingivitis bacteria can be killed and the inflammation can be positively influenced. For this you have to cook a strong tea and then use it as a conditioner.
Furthermore, it also serves as an active ingredient in various medicines, such as in the Kamistad ointment. This is applied with a cotton swab directly on the inflammation.
Homeopathic remedies should only be tried at the beginning of gum disease. For bleeding gums and inflammations the agent Mercurius solubilis is used. It can also be used in pregnant women and babies. However, this should first be discussed with a naturopath, pharmacist or doctor.
If these remedies do not help or if the inflammation persists for an extended period of time, a visit to the dentist is highly recommended. The risk would be too great if an underlying disease remains untreated for too long.
Antibiotics are rarely used for gingivitis. There are many other remedies, such as ointments and home remedies, that can be good for healing. However, if nothing helps and the inflammation persists for the time being despite all recognizable causes, after a few weeks the antibiotics must be considered by the dentist. However, it really should only be used in an emergency. Such as with an "ANUG" (acute necrotizing ulcerative gingivitis ).
In general, the drug amoxicillin has proven itself in dentistry. This goes back to the penicillins and attacks the cell wall of the bacteria. It is given in tablet form, usually one tablet in the morning and one in the evening.
This active ingredient may be administered in conjunction with clavulanic acid, a substance which has a bactericidal effect, to achieve an even more extensive effect. Then, for example, the drug Amoxicomp® prescribed.
If there is an allergy to penicillin, another medicine must be used. It is important to tell this to the attending physician, otherwise severe side effects may occur. It can be used on the active ingredient clindamycin, which is also administered via tablets.
Targeted prevention of gingivitis can basically be carried out by any established dentist and trained specialist staff ( prophylactic aid, dental assistant).
Patients who want to prevent recurrence of gingivitis as part of prophylaxis, or who have previously experienced inflammatory processes in other structures of the periodontium, should consult a specialist in periodontics.
During the prophylactic session, the patient is struck by staining the pads with a special dye, where the oral hygiene must be optimized. This is followed by a specific instruction of a suitable brushing technique, which is adapted to the particular conditions within the oral cavity of the individual patient.
A so-called professional tooth cleaning, which is carried out at regular intervals should not be missing in any prophylaxis plan. In the course of this tooth cleaning every single tooth is freed from all sides with special instruments of plaque and calculus deposits. The curettes and ultrasound scaler can because of their individual cut both soft, as well as hard deposits from the tooth surface ablate.
Alternatively, during gingivitis prophylaxis, tooth cleaning may also be performed by using a small sandblaster-like device. From a technical point of view, however, this method is more than questionable, because the small particles of the radiator roughen the tooth surface and thereby create new dirt niches.
The costs of prophylaxis are not completely covered by the statutory health insurance. As a rule, only one grant is awarded or one meeting per year. The patient must therefore raise at least a partial amount himself.
The regular performance of a professional tooth cleaning is not enough to prevent gingivitis for a long time. Above all, the correct and regular oral hygiene of the patient is essential for the prevention of gingivitis.
Even home remedies can be used prophylactically.
When it comes to the question of whether gingivitis is contagious, the cause must first be considered. If it is just a mucosal injury that has kindled a little, you can negate this question. Injuries can be caused, for example, by crumbly, coarse-grained food.
However, if the disease is caused by bacteria, then they can be transmitted by kissing. For the "plugging" this direct fluid exchange is needed. Whether the illness really breaks out in the other person, can not be said exactly. This depends on other factors, such as a poor state of the immune system, etc.
Caution is advised with the ANUG, since this variant is very aggressive and also transferable.
Inflammations in the area of the gums can usually be detected very quickly. The gums quickly lose their rosy, light color in the affected areas and become progressively darker.
Bleeding along the gingival margin is considered the first and, at the same time, most important indication of the presence of gingivitis. Even at this stage of the disease, the patient may experience pain when brushing his teeth. In addition, severe redness and dark discoloration of the gingival margin are typical symptoms of gingivitis.
In addition to these early signs, a highly inflamed gum often reacts after a while with water and secretions within the tissue. The result is an increasingly swollen gum.
If pus occurs during gingivitis, it is essential to arrange an appointment with the dentist. There, the cause must be found and treated. Pus can occur on the gums in the following forms:
1.) As pustules on the gums - this is often a tooth root inflammation.
2.) As a secretion, which emerges from the gap between tooth and gums - this can be an acute osteomyelitis. Osteomyelitis is an inflammation of the bone caused by bacteria. The bacteria may have entered the bone via a jaw fracture, a tooth destroyed by deep tooth decay, or surgical intervention.
3.) As deposits on the inflamed gums - here is often an acute necrotizing gingivitis (ANUG), which is accompanied by a destruction of the gums.
All of these diseases can cause serious consequences. A quick clarification is therefore in the interest of the person concerned. The therapy is initiated individually depending on the underlying disease.
In very rare cases, gingivitis also causes the swelling of individual lymph nodes on the neck. They usually enlarge only when diseases already exist over a longer period of time and the body increasingly tries to fight the disease. Therefore, they point to chronic gingivitis in this case. However, as there can be many other diseases, with which enlarged lymph nodes are more often associated, a clarification at the dentist should be made in any case.
Gingivitis may cause periodontitis if left untreated for prolonged periods. Periodontitis is a disease of the periodontium. The periodontium is the "anchoring system" that connects the tooth to the jawbone. If it is affected, it can eventually cause teeth to loosen. If no treatment is initiated, this process progresses and eventually leads to tooth loss.
The difference between these two diseases is that the gingivitis is reversible, ie completely healing, but the periodontal disease is not. It can be achieved here in the best case, a stabilization of the condition found. However, destroyed tooth holding tissue can no longer be built up.
Another unpleasant side effect of gingivitis is an unpleasant halitosis. However, this sounds off again when the inflammation is healed by good oral hygiene again.
Gingivitis alone is not a risk to the heart. It is only when the inflammation spreads and periodontitis (inflammation of the periodontium, which can be associated with the loss of teeth) arises, the heart is at risk.
The risk of suffering from heart disease is then increased by about 50%. This is due to the bacteria that are in a periodontosis in the oral cavity. These are anaerobic bacteria that survive without oxygen. These can enter the bloodstream via gingivitis with bleeding gums and migrate over to the heart.
In HIV-positive patients, the immune system is weakened. The danger that diseases will break out more quickly here than in healthy people is therefore increased. Especially the necrotizing ulcerating gingivitis (NUG) occurs here frequently. It is an aggressive variant of gingivitis associated with the death and decay of the gums. There is also general malaise and pain. With this disease you should see the doctor immediately.
However, normal gingivitis is not one of the typical initial symptoms of HIV infection. Everyone has been in his life ever before with a gingivitis acquaintance, one should not overestimate this. You should consult a doctor if the symptoms occur over a long period of time. Especially if there are other typical symptoms of HIV.
Gingivitis is a serious condition. In addition to the fact that the patient suffers a short time after their outbreak both pain during brushing and bleeding gums, there is a risk of the emergence of a periodontitis in the omission of a suitable therapy. It can be assumed that almost every untreated gingivitis changes into real periodontitis.
The rapid initiation of targeted treatment after the onset of typical symptoms is therefore essential for the prognosis of gingivitis. In those cases in which the affected patient visits a dentist early on, adequate treatment takes place and the patient participates regularly in scheduled follow-up sessions, gingivitis can generally heal completely.
It only becomes problematic if parts of the jawbone are already affected by inflammatory processes, a gum retreat has begun or the patient does not carry out proper oral hygiene despite training.
Every gingivitis is individual and dependent on general causes; therefore no information can be given for a precise period of time.
Acute gingivitis usually heals within a week. Of course, there are cases that take more or less time to heal.
If there is a local cause, such as a single periodontal pocket or a wisdom tooth that just breaks through, the dentist can often help you with the application of an ointment.
In a hormone change, as is the case in pregnancy, takes an inflammation ever slightly longer.
Other systemic causes, such as underlying diseases or vitamin deficiency, can weaken the immune system and often take a little more time.
In general: gingivitis should not be used. A clarification of all cases of unclear cause, which are present beyond one week, should be presented to the dentist. Here an adequate therapy can be carried out and the cause can be found, so that a periodontal disease can not arise in the first place.
Before the treatment of possible gingivitis, a comprehensive screening must be performed.
This screening includes both the assessment of the current status of the tooth and the evaluation of the periodontium. This means that in addition to documenting the condition of the tooth substance as well as the appearance of the gum is accurately assessed. For this purpose, the dentist measures the depth of possible periodontal pockets.
The measurement can basically be done in two different ways:
In addition, the preparation of an X-ray image ( Orthopanthomogramm, short: OPG) in patients with severe disease syndromes may be useful. The OPG completely depicts both the teeth in the jaw and the jawbone and joints. The dentist serves as an aid in estimating the condition of the involved bone structures. Only on the basis of the Orthopantomogram can be deduced how far the inflammatory processes have spread and how much damage they have already done.
Simple gingivitis is caused by the bacterial plaque. It shows in a superficial redness and swelling of the gingival margin and can bleed easily when touched, for example when brushing your teeth. There is no effect on bone loss and tooth loosening. The inflammation is not painful and is therefore often misjudged. The treatment consists in the removal of the plaque and may possibly be supported by rinsing with anti-inflammatory drugs.
After elimination of the causative factors, this form of gingivitis quickly heals. Untreated, however, it can spread to a disease of the periodontium.
Gingivitis gravidarum is a form of gingivitis that can occur during pregnancy. This form is not caused by bacterial plaque, it is hormonal. In contrast to the " normal " gingivitis, the removal of the plaque does not improve.
Die Blutungsneigung des geröteten und geschwollenen Zahnfleisches ist größer als bei der einfachen Gingivitis . Aufgrund der Schwellungen kommt es zu Pseudotaschen, in die sich leicht Zahnbeläge ansammeln können. Nach der Geburt des Kindes verschwindet auch diese Gingivitis durch die Umstellung des Hormonhaushaltes wieder.
Diese Form der Zahnfleischentzündung kann ebenfalls hormonell bedingt sein. Sie kann bei Frauen während des Klimakteriums/ Wechseljahre auftreten. Meistens ist sie jedoch die Erscheinungsform einer anderen Erkrankung. Deshalb ist hier die Zusammenarbeit mit Medizinern anderer Fachgebiete, insbesondere Hautärzten, notwendig.
Bei dieser Form der Gingivitis ist das Bindegewebe des Zahnfleisches verändert, und die Oberfläche lässt sich leicht ablösen. Das Zahnfleisch ist stark gerötet, glatt und glänzend, es ist schmerzhaft und blutet leicht. Es ist nicht das gesamte Zahnfleisch verändert, sondern kann sich nur auf einige Areale beschränken. Die zahnärztliche Behandlung besteht in der Schmerzbehandlung und der Vermeidung einer zusätzlichen Infektion durch sorgfältige Mundhygiene. Wichtig ist die Erkennung der körperlichen Grunderkrankung und deren Behandlung.
Hierbei handelt es sich um eineZahnfleischentzündung, die mit Geschwüren einhergeht. Sie beginnt an der Zahnfleischpapille im Zahnzwischenraum und greift dann auf den Zahnfleischsaum über. Die Folge sind Defekte des Gewebes. Die Geschwüre können auch auf die Mundschleimhaut übergreifen. Rechtzeitig mit Antibiotika behandelt kann eine Heilung erfolgen, andernfalls bleiben Defekte im Interdentalraum und ein Befall des Zahnhalteapparates.
Das vorherrschende Symptom bei dieser Form der Zahnfleischentzündung ist die Blutung aus dem Zahnfleischbindegewebe. Es beginnt im Interdentalraum und setzt sich dann auch auf den Rest des Zahnfleisches fort. Mit fortschreitendem Zerfall des Zahnfleisches kommt es zur Lockerung der Zähne und schließlich zu deren Verlust.
Dieses Krankheitsbild wird beim Skorbut, also dem Mangel an Vitamin C, beobachtet und kommt deshalb heute nur äußerst selten vor, da ein Vitamin C Mangel praktisch bei der heutigen Ernährung nicht mehr auftritt.
Hierbei handelt es sich um eine Wucherung der Papillen im Interdentalraum, die den ganzen Zahn bedecken können, vorwiegend im Frontzahnbereich auftretend. Es ist kein Entzündungsprodukt sondern anlagebedingt. Die Wucherungen sind gutartig und können chirurgisch entfernt werden. Allerdings ist mit großer Wahrscheinlichkeit ein erneutes Auftreten möglich. Ähnliche Wucherungen sind auch bei chronischer Einnahme von Antiepileptika möglich. Die Therapie besteht im Absetzen des Medikaments oder, wenn das nicht möglich ist, ebenfalls in der chirurgischen Entfernung.
Die toxische Gingivitis/ Zahnfleischentzündung beruht auf einer Schwermetallvergiftung mit Blei oder Quecksilber. Dabei bildet sich ein bläulich bis schwarzer Saum entlang des Zahnfleisches. Man vermutet, dass es sich dabei um Schwefelverbindungen handelt. Die Konzentration von Quecksilber, die aus Amalgamfüllungen vielleicht freigesetzt wird, reicht bei weitem nicht aus, um zu diesem Krankheitsbild zu führen. Vielmehr liegen die Gefahren bei Arbeitern, die mit dem Abbau oder der Verarbeitung von Schwermetallen zu tun haben.
Bei der Leukämie (Krebsform, die das blutbildende System betrifft), kann es zu Schwellungen und Entzündungen des Zahnfleisches kommen. Die Behandlung richtet sich natürlich nach der Grundkrankheit.
Zahnfleischentzündungen können bezüglich der Schwere, der Ursache, der Blutungsneigung und der Therapiemöglichkeiten sehr unterschiedlich sein. Die Therapie reicht von der sorgfältigen Mundhygiene, siehe auch: professionelle Zahnreinigung. bis zur chirurgischen Behandlung. Jede Änderung der normalen rosa Färbung sollte Anlass sein, den Zahnarzt aufzusuchen, um eine Klärung der Ursache herbeizuführen.