Flap surgery can cure gingivitis

Periodontal disease

Periodontal disease (often inaccurately referred to as periodontal disease): Inflammation of the tooth supporting structure. The dentist distinguishes periodontitis from periodontitis, which is much rarer, which means gum recession without accompanying inflammation.

With periodontitis, not only the gums are superficially inflamed, but the entire periodontium. Therefore, the bone is also affected and slowly degrades. In people over 35, periodontitis is the most common cause of tooth loss - unlike tooth decay, however, it hardly hurts and often goes unnoticed for a long time.

Periodontitis should be treated in any case, as it is also a widespread inflammation in the body regardless of the dentition problems and, among other things. carries an increased risk of premature birth, heart attack and stroke.

Leading complaints

  • Regular bleeding gums
  • Bad breath
  • The teeth become "longer" because the gums recede.
  • The teeth loosen and change their position.
  • The gums turn dark red to blue-purple in color.

When to the doctor

Within the next 4 weeks if the bleeding gums persist, individual teeth move or rotate, or all teeth feel loose.

The illness

Periodontitis begins with inflammation of the gums and develops later Gingival pockets(Tooth pockets), when the epithelial attachment of the gums separates from the tooth. In the pockets, tartar is deposited on the dental cement. They are colonized by anaerobic bacteria and can also become inflamed. The gums and the bony tooth sockets lose substance, eventually teeth loosen and fall out.

Gum pockets have formed in the upper third of the tooth roots, the two middle teeth are only anchored in the jaw with the lower third of the roots (bone is missing in the dark areas).
Georg Thieme Verlag, Stuttgart

Long-term inflammation of the gums can spread to the jawbone, the periodontal membrane and the dental cement. The cause is bacteria in plaque: they excrete metabolic products to which the body reacts. It forms phagocytes that are supposed to destroy the bacteria. However, these also break down the bones and the retaining fibers - ultimately, the teeth holding apparatus is destroyed by the own immune system.

As a rule, periodontal disease is caused by inadequate oral hygiene. Every periodontitis started as an inflammation of the gums. However, this development is not inevitable - especially in children and adolescents, gingivitis can persist for months without affecting the gums. However, some people are extremely susceptible to periodontal disease, men more often than women - even with good or very good oral care. The cause is evidently due to an oral flora that is unfavorable for the gums. Luck in misfortune: Such periodontitis risk carriers usually hardly have any tooth decay.

Apical periodontal disease. In rare cases, apical periodontitis (inflammation of the root tip after the dental nerve has died) can be the cause of the tooth-holding apparatus becoming inflamed from the root tip.

Juvenile periodontal disease. Juvenile periodontitis is a special form that occurs in adolescence and specifically affects the 6-year-old molars (six) and the central maxillary incisors (ones). The cause is unclear. Only through meticulous oral hygiene can one fight against the early loss of these teeth, they are often lost anyway. Girls are four times more likely to get sick than boys.

That's what the doctor does

To determine how far the inflammation has progressed, the dentist will check the gums and measure the depth of the tooth pockets. To do this, he carefully inserts a special, graduated probe into the space between the gum and the tooth. Depending on the depth of the pockets, periodontitis of different degrees is present; a pocket depth of 4 mm or more is deemed to require treatment. This test procedure is called Periodontal Screening Index(PSI) and is paid for by the health insurance fund every two years. To confirm the diagnosis, X-rays are made - this allows the condition of the bony tooth sockets to be better assessed.

Periodontal screening index: Everything is okay in picture 1, the pocket depth in pictures 2 and 3 indicates a gingivitis, pictures 4 and 5 show moderate or severe periodontitis.
Georg Thieme Verlag, Stuttgart

Periodontal Therapy. Periodontitis can only be cured through systematic treatment; normal, superficial cleaning is no longer sufficient. At the beginning of Periodontal Therapy The hygiene phase takes place, during which all tooth surfaces and spaces between teeth are cleaned by professional tooth cleaning, faulty fillings are repaired, sharp edges are removed and severely damaged teeth are extracted if necessary. This also checks whether the patient's oral hygiene can be improved. The hygiene phase alone often brings a significant improvement in the symptoms.

In the subsequent closed treatment phase, the affected area is numbed with a syringe before the doctor cleans and polishes every tooth down to the bottom of the tooth pocket. This is done with small, sharp scrapers (scaler) and ultrasonic instruments. Some dentists also use fine vibrating electric files. The initial scratching noise during smoothing disappears as the treatment and cleaning of the surfaces progresses. At the same time, the doctor removes the inflamed parts of the gums with a curved knife (curette) (it is "freshened"). Only the interaction of these two components achieves the desired success.

After the mouth has been thoroughly rinsed out, the doctor rinses the tooth pockets with a chlorhexidine solution. This significantly reduces the remaining germs in the pockets.

Periodontal therapy usually extends over several sessions in which the jaws or jaw halves are cleaned one after the other. Some patients find the optical change as a result of the treatment unattractive, as the gums appear shorter due to the reduced swelling and the teeth appear longer. However, the same cosmetic problems would arise without treatment - a little later, but more of the teeth holding apparatus would be lost. There is therefore no alternative to periodontal therapy: this is the only way to stop the inflammation, which is a burden on the entire body, and to preserve the teeth.

Flap surgery and bone grafting. If the jaw is already severely damaged or check-ups show that the closed treatment did not bring the desired success, then open treatment is also necessary. In the Flap surgery(Flap operation, open curettage) the gums are cut open and folded to the side. Now the dentist can clean tooth roots and gum pockets particularly thoroughly and under sight.

If this is not sufficient, the bone is rebuilt in the same operating theater, which the health insurance fund no longer pays for. For the Bone augmentation there are two interlocking procedures: GTR(Guided tissue regeneration, controlled tissue regeneration) and GBR(Guided Bone Regeneration). If parts of the jawbone are toothless, e.g. B. due to removed wisdom teeth, bone chips can be removed as part of the GBR and transplanted to fill the diseased areas. Bones and tooth retention fibers can also be regenerated with growth-promoting agents. In the GTR, a membrane separates the gums and jaws during the treatment so that the slowly growing bone can rebuild undisturbed without being displaced by the faster growing gums. Both procedures are comparable in terms of effort, whichever is better depends on the location and extent of the bone defects. They can also be combined with the GTR following a GBR. The jaw condition improves significantly within 3–6 months due to the bone formation, but a complete restoration is usually not possible.

In addition, there is another treatment option Protein matrix (Emdogain®). This substance is applied to the root surface that has been cleaned and pretreated with citric acid. In 30–50% of cases it leads to significant bone growth in the area of ​​the root surface.

At the end of the operation, the doctor will sew or glue the gums. The treatment is continued with antiseptic mouthwashes (e.g. with chlorhexidine), then regular check-ups should take place - initially every 3–4 weeks, later every 6 months.

Every 2 years the statutory health insurance companies pay for an examination of the gum pockets (periodontal screening index) - if it takes place as part of a preventive examination, there are not even any practice fees. The actual periodontal therapy is carried out by the statutory health insurances after the results of the examination (periodontal status) have been submitted by the dentist. Accompanying treatment measures such as professional tooth cleaning, bone grafting and regular follow-up examinations must be paid for by those with statutory health insurance.

Your pharmacy recommends

Once periodontitis is present, it can no longer be cured by home care. You can only alleviate the discomfort and support periodontal therapy through your oral hygiene. Even if you are in pain, you should not stop cleaning your teeth - it is better to use a soft toothbrush.

Complementary medicine

Herbal medicine.

Anti-inflammatory rinses with chamomile or sage tea help with bleeding and swelling. Regular creaming of the gums with gum balm can also alleviate the symptoms.


From a homeopathic point of view, z. B. Acidum hydrofluoricum, Cistus canadensis, Lycopodium, Mercurius solubus, Psorinum or Silicea to alleviate the symptoms; However, existing periodontitis cannot be completely resolved in this way.


You can avoid periodontal disease by cleaning your teeth regularly, thoroughly and properly. If you have sensitive gums, gentle, careful brushing with an electric brush and soft bristles will help. In addition, the spaces between the teeth should be cleaned daily. This is best done with dental floss and, if that is not enough, also with interdental brushes. Chlorhexidine rinses and mouth rinses with essential oils such as eucalyptus, thymol, menthol and methyl salicylate are only superficially effective.

In addition, regular professional teeth cleaning is useful. Because it also removes tartar that cannot be removed by the person affected - and removes plaques very thoroughly. Depending on your budget and time budget, it should be repeated every 6, but at least every 12 months.

The risk of periodontitis is particularly high among smokers, teeth grinding and diabetics. The teeth holding apparatus is mechanically damaged by grinding teeth, but in smokers and diabetics, the blood circulation in the small veins in the gums is worsened. The supply of nutrients to the gums suffers and it loses its resistance. The relationship between smoking and periodontal disease is clear, but the precise causal relationship is still unclear. It is believed that smoking increases the body's immune response.

What is certain is that smoking makes treatment more difficult and reduces the chances of recovery - so it is worth stopping during treatment.

Further information

  • www.parodontosehilfe.de - Deutsche Parodontosehilfe e. V., Schwerte: With periodontal self-test and search for a dentist. The self-help group also publishes the magazine "Parodontose Info".
  • www.dgparo.de - German Society for Periodontology, Regensburg: You can use the "Member search" to find specialist doctors.


Dr. med. dent. Gisbert Hennessen, Thilo Machotta, Dr. med. Arne schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:09

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.