Gum inflammation

Bleeding gums are often regarded as a harmless quirk, occasionally even as a sign of thorough brushing. Both are wrong. Healthy gums are pale pink, lie firmly against the tooth, fill the interdental spaces to a point and do not bleed — neither with the brush nor with dental floss nor on biting into an apple.

How to recognise it

• bleeding when brushing or when cleaning the interdental spaces
• reddened gums that look darker
• swollen, rounded instead of pointed gum papillae between the teeth
• a gum margin that feels soft and loosened
• occasionally an unpleasant taste or bad breath

Pain is as a rule not part of it. That is the reason why many people carry the inflammation around with them for years.

Why it arises

If plaque stays at the gum margin, the body reacts to it. The defences become active, the tissue receives more blood, it swells and becomes more permeable — an inflammation in the medical sense of the word. At first it is a sensible reaction and only becomes a problem when it no longer stops, because the stimulus does not go away.

This is intensified by factors that change the reaction of the tissue:

• hormonal changes — pregnancy, puberty, the menstrual cycle
• smoking (which at the same time suppresses the bleeding and thereby masks the warning sign)
• diabetes, especially when poorly controlled
• mouth breathing, which dries out the gum margin
• some medicines, which can trigger an overgrowth of the gums
• places the brush does not reach: crowded teeth, protruding filling margins, braces

What helps

The inflammation disappears when the stimulus disappears. In practice that means: remove plaque, including where it is not visible. The decisive point is the daily cleaning of the Interdental spaces — gum inflammation almost always begins there.

Where the findings are pronounced, a professional tooth cleaning is added, which also covers hard deposits and the area just below the gum margin. A chlorhexidine rinse can support this for two to three weeks; it is a help for the initial period, not a permanent solution and no replacement for the cleaning.

The feedback comes quickly. With daily, complete cleaning the bleeding usually recedes markedly within one to two weeks. If it remains unchanged after three weeks, the findings should be examined: either there is a site that is not being reached with the chosen aids, or it is already more than a superficial inflammation.

The transition to periodontitis

Gingivitis affects only the soft tissue. If it is treated, it heals without consequences — nothing is lost. If it persists over a long period, the inflammation can move into the depth and affect the supporting apparatus of the tooth: the fibres that fix the tooth in the bone, and the bone itself.

From that point it is called periodontitis, and from that point the damage is permanent. Not every gingivitis takes this path — whether it does depends on the state of the defences, on predisposition and on risk factors such as smoking and diabetes. Only the direction is certain: without gingivitis there is no periodontitis.