Gingivitis: How to recognize gingivitis
Do your gums bleed when you bite into an apple or brush your teeth? Then you could have gingivitis. We explain how you can recognize gingivitis and what you can do about it.
Gum inflammation is the first step towards tooth loss
Almost all of us have had acute gum inflammation at some point. With thorough care and hygiene, it usually heals within a few days. However, if the gums remain inflamed for longer than a week, we are talking about chronic inflammation. In this case, it becomes dangerous! Untreated inflammation quickly spreads from the gums to the periodontium. If gingivitis has progressed this far, the inflammation is called periodontitis - the most common cause of tooth loss.
In medical terminology, gum inflammation is called gingivitis (1).
These are the symptoms of gingivitis
Gingivitis is a mild form of inflammation. It heals without consequences if you do something about it quickly. It is therefore important that you take the first signs seriously to prevent it from becoming severe and leading to periodontitis.
The four most important signs of gum inflammation are:
- Bleeding gums
If your gums are healthy, they will not bleed. If it starts to bleed when you brush or floss your teeth or when you bite into solid food, this is a sign of gingivitis. Even if your gums only bleed sometimes, you should take this alarm sign seriously.
- Red, swollen gums
Normally, your gums should be pink and firm. If the gums are red and swollen, this is a sure sign of inflammation!
- Bad breath
Our mouth is full of bacteria, which even ensure a healthy balance in the oral cavity and, with regular hygiene, hardly develop any foul-smelling substances. If it starts to smell, inflammation-promoting bacteria have colonized or taken over (2).
- Gum recession
If your gums are healthy, they enclose the tooth tightly and fit snugly. However, inflammation can cause it to pull away from the tooth (3). Initially there may only be a small gap between the tooth and gum, but later the tooth necks are exposed and clearly visible.
Gingivitis: The most common cause is poor hygiene
Your oral cavity is home to countless different types of bacteria, which are normally harmless. However, if you don't clean your teeth regularly, food debris accumulates, which the bacteria feed on and form a dense coating known as biofilm or bacterial plaque.
As they break down food residues, they form acids and toxins that irritate your gums and lead to inflammation. As soon as the gums loosen a little, the bacteria penetrate the gap between the tooth and gum and are no longer accessible for brushing and flossing. This is why it is so important that you care for your teeth regularly.
Brushing and threading are part of brushing your teeth
It is particularly critical for you if you have an implant. To ensure that the artificial root grows well into the bone, its surface is designed in such a way that cells can easily adhere to it - but it's not just bone cells that are happy about this adhesive surface, bacteria also find a perfect base. Careful hygiene is therefore a must for all people with dental implants (4).
You can use interdental brushes and dental floss to clean the gap between the visible crown and the implant. However, sometimes some bacteria manage to penetrate deeper into the gap and multiply there. In this case, only a thorough cleaning by a dentist or dental hygienist can help - sometimes the crown even has to be removed.
Mechanical injuries also allow bacteria to attack your gums. This is often caused by toothbrush bristles that are too hard or pressing too hard when brushing your teeth.
What you can do yourself against acute gingivitis
If you notice an acute inflammation of the gums, you should brush your teeth and especially the spaces between them particularly thoroughly at least twice a day. Bacteria-inhibiting mouthwash or special ointments can also help you to get the inflammation under control quickly. With careful care, quickly recognized gingivitis should be history after a few days.
However, if you have bleeding gums "every now and then" or the inflammation lasts longer than a week, this is an important alarm signal. In this case, you should see a dentist immediately. This is because the transition from chronic gingivitis to serious periodontitis only takes a few days. Why is a visit to the dentist so important? Periodontitis is the most common cause of tooth loss (5).
Important: Does collagen breakdown take place?
Your dentist or dental hygienist can determine whether pockets have already formed and how deep they are. However, even if there are no pockets yet, the inflammation may have already led to the breakdown of connective tissue and bone. This breaks down the supporting structures, the collagen framework.
The enzyme aMMP-8 (activated matrix metalloproteinase-8), which your dentist can detect with a simple diagnostic test, is responsible for the breakdown. If the value is elevated, you are already experiencing collagen degradation. Now is the time to get to the bottom of the cause.
If you have an implant, periodontitis progresses particularly quickly and is often more aggressive. In this case, experts speak of peri-implantitis (6). You should therefore not take gum inflammation that lasts longer than a week or frequently bleeding gums lightly: Now is the time to call your dentist and make an appointment as soon as possible.
List of sources:
- (1) Lang NP, Schätzle MA, Löe H. Gingivitis as a risk factor in periodontal disease. J Clin Periodontol. 2009;36 Suppl 10:3‐8. doi:10.1111/j.1600-051X.2009.01415.x (https://pubmed.ncbi.nlm.nih.gov/19432625/)
- (2) Aylıkcı BU, Colak H. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013 Jan;4(1):14-23. doi: 10.4103/0976-9668.107255. PMID: 23633830; PMCID: PMC3633265. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/)
- (3) Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and types, and the importance of orthodontic treatment. Dental Press J Orthod. 2016 Jun;21(3):18-29. doi: 10.1590/2177-6709.21.3.018-029.oin. PMID: 27409650; PMCID: PMC4944726. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944726/)
- (4) Gulati, Minkle & Govila, Vivek & Anand, Vishal & Anand, Bhargavi. (2014). Implant Maintenance: A Clinical Update. International Scholarly Research Notices. 2014. 10.1155/2014/908534. (https://www.researchgate.net/publication/264427840_Implant_Maintenance_A_Clinical_Update)
- (5) Irfan UM, Dawson DV, Bissada NF. Epidemiology of periodontal disease: a review and clinical perspectives. J Int Acad Periodontol. 2001;3(1):14‐21. (https://pubmed.ncbi.nlm.nih.gov/12666973/)
- (6) Natto ZS, Almeganni N, Alnakeeb E, Bukhari Z, Jan R, Iacono VJ. Peri-Implantitis and Peri-Implant Mucositis Case Definitions in Dental Research: A Systematic Assessment. J Oral Implantol. 2019;45(2):127‐131. doi:10.1563/aaid-joi-D-18-00097 (https://pubmed.ncbi.nlm.nih.gov/30557088/)