In dentistry, gingivitis is a gum inflammation, either classified as acute or chronic gingivitis. In acute inflammation, not the entire gum (gingiva), but only its upper part (gingival margin or hem) is affected. An untreated or inadequately treated acute gingivitis becomes chronic, which has far-reaching consequences for the entire dentition of the patient. In addition, it can cause inflammation of the oral mucosa (gingivostomatitis).

Gingivitis is caused by various types of pathogens (mixed infection) and is one of the most common infections of the oropharynx: Health experts assume that 4 out of 5 adults suffer from chronic or acute gingivitis.

To prevent the condition from even occurring, the patient should brush his teeth thoroughly at least twice a day. It is also recommended to have a professional dental cleaning (PDC) done once a year by a dentist. It even cleans the areas that are hard to reach for toothbrushes.

Patients suffering from gingivitis should only use toothbrushes with soft, rounded bristles. They are also good for preventing gum disease if you tend to use more force when brushing your teeth. Interdental toothbrushes and flossing help to remove food debris and plaque from the interdental spaces and thus also prevent gingivitis

Overview of this article

Causes of gingivitis

Gingivitis is mainly caused by a bacterial mixed infection with various pathogens. However, fungi and viruses are also triggers of the disease. The oral cavity, with more than 500 different bacterial species, is one of the regions of the human body that is inhabited by most pathogens.

Inadequate oral hygiene due to infrequent or only superficial brushing of teeth ensures a rapid increase in the microbial oral flora. The bacteria release toxins, aggressive metabolic breakdown products and acids that can attack the gums. Under certain circumstances, it then develops into gingivitis. Only a thorough cleaning of the teeth helps to eliminate the harmful bacterial plaques: not even the human immune system is so effective.

In addition, gingivitis can be caused by gum injuries. This can happen if the person concerned scrubs their teeth too hard: the pathogens and toxins contained in the plaque penetrate the gums and cause inflammation there. Also, a gum irritation by certain dentifrice may be the cause of gum disease. Other causes are also diseases such as diabetes mellitus (diabetes) and certain metabolic diseases.

Other possible triggers of gingivitis include:

  • excessive alcohol consumption
  • too much nicotine
  • stress
  • changes in hormone levels (puberty, pregnancy)
  • vitamin C deficiency
  • heavy metal poisoning
  • certain medications (anti-epileptic drugs such as hydantoin, antihypertensive agents)

Ultimately, it is the immune system that determines whether gingivitis occurs despite the presence of bacterial plaque. Patients with a weakened immune system or those who need to take immunosuppressants (medicines that suppress abnormal reactions in the immune system) are at an increased risk of developing gingivitis. The same applies to people who eat unhealthily, prefer to breathe through the mouth or have a low salivary flow.

Symptoms and course of gingivitis

Symptoms and course of gingivitis

In acute gingivitis, the patient has an inflamed, red and swollen gum line. The gums are softer than usual and prone to bleeding. In addition, the person has strong bad breath.

In chronic gingivitis, the bacteria have already penetrated from the gingival margin of the jaw and damage there the entire periodontium. The gums have receded so that the necks and roots are exposed. The patient has severe pain and intense bad breath. The bacteria continue to multiply in the jaw, eventually causing the teeth to loosen and fall out. In this case, it is periodontitis.

In rare cases, even the gums between the teeth become infected. Then it is an acute necrotizing ulcerous gingivitis (ANUG). It causes the tissue of the interdental spaces to become ulcerated and eventually to decompose.

The acute necrotizing form of gingivitis is manifested with the following symptoms:

  • pain
  • sudden high-fever
  • drowsiness
  • bad breath

People who experience such symptoms should seek dental treatment as soon as possible to prevent worsening gum disease.

How is gingivitis diagnosed?

Gingivitis is visible to the naked eye. The dentist uses a special probe to check the firmness of the gums and see if it has already formed gingival pockets. This refers to pocket-like enlarged gaps between the gingival margin and the tooth. This gap is not deeper than a maximum of 2 millimeters for healthy gums. In these gum pockets, the bacterial pathogens like to settle and fill the cavities with pus. Gum pockets are an indication that the patient is already suffering from periodontal disease.

If the gingivitis is already very advanced, even the careful touch of the gums with the probe triggers gum bleeding and pain: even the periodontium is affected by the inflammation. To check suspected diagnosis, the dentist then x-rays the patient's jaw.

A saliva examination is used to determine the oral flora of the person affected. The laboratory analyzes all pathogens and marks the particularly aggressive germs on the test results sheet separately. This gives the dentist valuable information about which medications to administer for the treatment of gingivitis or periodontitis. In addition, the saliva test gives information about whether or not the salivary flow rate contributed to the development of gingivitis.

How to treat Gingivitis

How to treat Gingivitis

First, the dentist uses professional tooth cleaning to remove all dental plaque - even those in the interdental spaces. It removes the deposits in the periodontal pockets, drains the pathogens and pus and then thoroughly disinfects the cavities. Then the tooth surfaces are polished. The dentist then seals the teeth with fluoride varnish, so the pathogens can no longer settle on it.

The patient can also treat an acute gingivitis in the first few days. This often requires improved oral hygiene and some proven old home remedies. The patient may use anti-inflammatory and anti-bacterial natural agents at home. These include, for example, teas from chamomile flowers or a glass of water with apple cider vinegar for mouthwash. However, if there is still not any improvement after a few days, you should seek the help of a dentist as soon as possible.