Knowledge Gum problems explained From gingivitis to periodontitis

Our oral cavity is normally colonised by around 500 different strains of bacteria, which in small concentrations are easily kept in check by our immune system. If oral hygiene is neglected, sticky plaque forms in which the bacteria can multiply en masse. Bacterial toxins then cause inflammation of the gums (gingivitis), which is usually characterised by an increased tendency for the gums to bleed when brushing the teeth.

• Gums bleed when brushing teeth or when biting into an apple, for example
• Reddened, painful gum line
• Slight swelling at the gum line
• Bad breath

• Insufficient oral hygiene, bacterial plaque and tartar
• Poorly fitted, protruding crown or filling margins
• Slippage due to crooked or crowded teeth
• Hormonal changes: Pregnancy, puberty, menopause
• General diseases such as diabetes, leukaemia, disorders of the immune system
• Mucosal diseases such as lichen planus of the oral mucosa
• Certain medications, such as nifedipine (antihypertensive)
• Hydantoin (anti-epileptic drug)

Cyclosporine (Sandimmun, immunosuppressant, suppresses the normal immune system and must be taken for life, e.g. after kidney transplants or other organ transplants).

A special form of gingivitis is gingival hyperplasia, which is characterised by gum growths. Gingival hyperplasia is often triggered by the above-mentioned medications, but the problem is usually exacerbated by suboptimal oral hygiene and sometimes also by a genetic predisposition.

The development of gingivitis into periodontitis is a gradual but well-understood process. It is a progressive inflammation of the periodontium - the connective tissue and bone that anchors the teeth in the jaw. Here is a simple overview of how it occurs:

If gingivitis is left untreated, the bacterial biofilm in the gum pocket becomes interspersed with minerals from the saliva and becomes very hard. It can no longer be removed with a toothbrush. The bacteria, which have now entrenched themselves in a "bunker" so to speak, ensure that the superficial inflammation slowly develops into a chronic inflammation, known as periodontitis (periodontal disease). This happens like this.

• The bacteria penetrate deeper into the gum line by releasing enzymes that dissolve tissue.
• The biofilm is mineralised and sits firmly on the tooth surface.
• This rough surface attracts more and more bacteria. The process accelerates.
• The body reacts with an immune response because it wants to defend itself against the bacteria. It breaks down its own bone and replaces it with inflammatory tissue, which contains many more blood vessels and can perform better defence work.
• Deeper and deeper gum pockets develop, in which even more bacteria colonise.

Periodontitis is a physiological process in which the body tries to protect the entire organism from the ongoing bacterial attack. This can ultimately lead to the "rejection" of a tooth.

• If the periodontitis is not treated or only treated inadequately, the body goes into survival mode.
• This means that the body withdraws more and more to preserve the entire organism and rejects the infected tooth in the long term.
• This leads to chronic inflammation with progressive tissue degradation.
• Symptoms:
  • Deep gum pockets
  • tooth loosening
  • bad breath
  • Tooth loss in the late stages
• Not completely curable, but controllable with good therapy

• Gingivitis can be recognised and cured at an early stage.
• If it is not treated, it can develop into periodontitis - often irreversible damage that often requires long-term dental care.