Many people have gingivitis (inflammation of gum tissue) now and then, and it usually does not cause any major problems. Yet it may spread to other parts of the periodontium (the bone and soft tissue responsible for keeping our teeth firmly anchored) and cause damage there. That is referred to as periodontitis. Over time it can loosen teeth, and it may become impossible to save them.
Bleeding gums that are also reddened or swollen are the main signs of gingivitis. The gums mainly bleed during tooth brushing, but they may also bleed at other times. Healthy gums are usually pink, while inflamed gums take on a red to dark-red color. Gingivitis frequently causes no pain or other symptoms and remains undetected for quite some time.
If the gums are inflamed, pockets often open up between the gums and the teeth. Bacteria can settle here and may cause tooth decay in the roots of the teeth. At a more advanced stage, periodontitis can cause the gums to recede, leaving larger gaps between the teeth and loosening them.
The most common cause of inflamed gums is plaque. Plaque is a thin, hardly visible film, made up mostly of bacteria. It is largely found along the gumline, and feels furry to the tongue. The bacteria in the plaque can cause the gums to become inflamed, and this inflammation can cause the gums to swell.
Poor oral hygiene and smoking can increase the risk of gingivitis and periodontitis. But other factors may also increase the likelihood of swollen gums. For example, it is possible that certain medications that suppress the immune system make these problems worse, for example some types of drugs used in cancer treatment.
Herpes and other kinds of infections may inflame the gum tissue as well. Hormonal changes during pregnancy can also sometimes suddenly make mild gingivitis more severe if left untreated. Metabolic diseases such as diabetes also increase the risk of gum inflammation.
If inflamed gum tissue starts to separate from the neck of the tooth, small gaps called pockets open up between the teeth and the gums. If they are more than just a couple of millimeters deep, bacteria can settle there. Hard-to-remove deposits that are darker than tartar may also form there. In larger gum pockets parts of the roots of the teeth may be exposed.
Periodontitis develops if bacteria and deposits in the gum pockets cause inflammation and affect the periodontium. This can destroy parts of the periodontium or bone tissue. If periodontitis gets worse, teeth can gradually become loose. They may either fall out or need to be removed.
Periodontitis can progress in episodes. This means that there are short periods where tissue is destroyed that alternate with longer phases where the disease does not progress, or where the tissue can even recover a bit. It is not possible for the gums to grow back, however.
One way to detect gingivitis is by having a dental check-up. In Germany, statutory health insurance provides for general dental check-ups twice a year for the teeth and gums to be inspected.
In Germany, people who have statutory health insurance are also eligible for a screening test called Periodontal Screening and Recording (PSR) once every two years. Here your mouth is checked tooth by tooth for possible gum pockets using a special periodontal probe. The dentist also looks for signs of bleeding or receding gums, and loose teeth.
Depending on the results of this test, other examinations may be necessary, for example, x-rays, to find out how much of the bone, if any, has been lost.
Plaque forms very quickly, but good oral hygiene can help to remove it. If plaque is not removed, inflammation of the gums can start within just a few days. Plaque can later harden to form tartar (calculus), further promoting bacterial growth.
Plaque can be removed from the teeth by brushing regularly and using dental floss or interdental brushes. You can have tartar removed at the dentist’s. In Germany, statutory health insurance covers the costs for having tartar removed once a year. It is also possible to have bacterial film removed as part of professional teeth-cleaning, but this must be paid out-of-pocket.
The earlier periodontitis is detected, the sooner it can be managed. Treatment aims to stop the disease from getting worse to prevent more damage and loss of teeth.
And besides being part of prevention, oral hygiene is also important in the treatment of periodontitis. Your dentist can also remove layers of bacteria below the gum line. Sometimes surgery is also needed to clean the surface of the root of the tooth or plane bone that has been affected.
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005; 366(9499): 1809-1820.
Poklepovic T, Worthington HV, Johnson TM, Sambunjak D, Imai P, Clarkson JE, Tugwell P. Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database Sys Rev 2013; (12): CD009857.
Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database Sys Rev 2011; (12): CD008829.
Zitzmann NU, Ramseier CA, Weiger R, Walter C: Parodontitis. Pathogenese, Risikofaktoren und Bedeutung für die Allgemeingesundheit. Schweiz Med Forum 2013;13: 183-186.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.