The gums (lat. Gingiva , German earlier also Biller ) are part of the oral mucosa . It is part of the masticatory mucous membrane (mucosa) that covers the alveolar ridge and surrounds the teeth cervically . The gum surrounds the neck of the tooth as an epithelial cuff (seam epithelium) and thus seals the entry point of the tooth into the jawbone from the oral cavity . The gums are the epithelial part of the teeth holding apparatus . Extensions and / or depressions of the gum line are known as gingival pockets . Apical , d. H. in the direction of the tooth root tips , the gums merge into the loose alveolar mucous membrane, from which it is separated by the mucogingival border ( Linea girlandiformis ). The palate and the alveolar process of the maxilla are covered with masticatory mucous membrane.
Free and attached gingiva
The gingiva is divided into free and attached gingiva. The free gingiva also includes the interdental gingival papillae , it extends from the gingival margin to the apical "free gingival furrow", which is approximately at the level of the enamel-cement boundary. The attached gingiva is bounded coronally by the free gingival furrow or by a line through the enamel-cement boundary. It is bounded apically by the mucogingival border (marks the transition into the alveolar mucosa). The attached gingiva is firmly connected to the underlying alveolar bone by connective tissue fibers.
The epithelium of the (masticatory) free gingiva is divided into
- the oral epithelium, which is directed towards the oral cavity,
- the oral sulcus epithelium, which is directed towards the tooth but is not yet in contact with the tooth, and
- the marginal epithelium, which makes contact between the gingiva and the tooth.
The attached gingiva is divided into
- the stratum basale (germinativum)
- the stratum spinosum
- the stratum granulosum
- the stratum corneum (orthokeratinized; however, if the nucleus is present: parakeratinized)
The groove between the tooth and the gum is called the sulcus gingivae ("gum groove "). In healthy periodontal conditions, the probing depth in humans is approximately 2 mm. The epithelium facing this groove is the inner border epithelium . This is divided into the sulcus epithelium , which glides freely on the tooth, and the adhesive epithelium connected to the root cement by hemidesmosomes .
The triangular gum between the teeth is known as the "interdental papilla" ( papilla interdentalis ), the borderline between the gum and the sliding, dark red oral mucosa as the mucogingival line or mucogingival border .
Regular cleaning of the sulcus of bacterial deposits and food residues is necessary to prevent gum inflammation ( gingivitis ), which can quickly develop into periodontitis without being noticed . When brushing your teeth yourself, there is often a temporary bacteremia , no matter which method of teeth cleaning is used.
Extensions and / or depressions of the gum furrow are called gingival pockets , whereby gingival pockets with a depth of 3.5 mm and more can be viewed as a sign of a disease. The metric depth at which there is a need for treatment for a pocket treatment varies from person to person and is largely determined by the degree of inflammation (bleeding) present there. At a pocket depth of about 5 mm, since the oxygen supply is no longer guaranteed there, the microbial spectrum of germs, anaerobes dominate.
In the case of inflamed gingival pockets, the underlying bone usually also recedes. Then the entire tooth support system is involved in the disease process and periodontitis has developed. One speaks of real gum pockets. If there is no bone loss and there is still a gum pocket (e.g. due to the increase in size of the gums when taking certain medications), we speak of pseudo pockets .
The treatment is covered by the statutory health insurance companies as part of the systematic treatment of periodontal disease .
The tooth is anchored in the tooth socket by means of a gomphosis , i.e. H. a tooth is simply suspended in its bone compartment via the Sharpey fibers and is not firmly attached to it. So there is a natural gap (= periodontal gap) between tooth and bone, in which the Sharpey fibers and the periodontal membrane are located. Bacteria can penetrate into this gap. In particular, those who feel very comfortable in this environment (= obligate anaerobes ), multiply and lead to inflammation in which the Sharpey fibers are damaged. The tooth-supporting apparatus recedes and inflammation niches, the so-called gingival pockets , appear in the periodontal gap , which can repeatedly and acutely fill with pus . Periodontal pockets are a sign of periodontal disease, see periodontitis (colloquially periodontal disease).
In the case of gum pockets, dentistry differentiates between real gum pockets and pseudo pockets. A pseudo-pocket occurs when the gums swell around the affected tooth, creating an artificial pocket. A “real” gingival pocket, on the other hand, occurs when a space is created between the gum and the tooth due to the breakdown of the alveolar bone. See also : Sulcus gingivae .
- Joseph Hyrtl : The old German made-up words for anatomy. Braumüller, Vienna 1884; Reprint: Fritsch, Munich 1966, p. 27 f.
- Steininger et al. a., Microscopic Anatomy (PDF; 83 kB), Thieme Verlag, 2010, ISBN 3-13-147141-7
- P. Eickholz, B. Dannewitz, Anatomie des Parodonts (PDF; 556 kB), Parodontologie Quintessenzverlag, 2012, 23 (4), pp. 415–420
- Prevention of Infective endocarditis. Guidelines From the American Heart Association. A Guideline ... ( Memento of the original from March 2, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.