Three levels of urgency
Same day — ring us, or use the out-of-hours service
- Swelling of the cheek, jaw or under the eye, especially with fever or feeling unwell
- Difficulty swallowing or opening your mouth
- Pus coming from the gum, or a taste of pus that keeps returning
- Severe, throbbing pain that painkillers barely touch
- Painful, ulcerated gums with a greyish film and marked bad breath, coming on within a day or two
- Heavy bleeding that will not stop, particularly if you take blood thinners
Facial swelling is the one that outranks everything else here, because an infection with a swelling has left the tooth and entered the surrounding tissue. Evenings, weekends and public holidays are covered in Germany by the dental out-of-hours service (zahnärztlicher Notdienst); you do not need to wait until Monday.
Within a week
- Gum pain that is more than tenderness, even without swelling
- A tooth that feels loose, or a bite that suddenly feels different
- A lump or a growth on the gum
- Bleeding together with a bad taste that returns within an hour of brushing
- Gums bleeding while you are pregnant, diabetic, undergoing cancer treatment or taking medication that suppresses the immune system
- Bleeding around a specific tooth with a filling or crown, rather than generally
At the next available appointment
- Bleeding on brushing that has run for more than two weeks despite genuinely careful cleaning
- Visible tartar (Zahnstein) — hard yellowish-brown deposits, most often behind the lower front teeth
- Gums that have pulled back so teeth look longer, or dark triangles between teeth
- Persistent bad breath
- You smoke and your gums bleed at all
- You have not had a check-up in more than a year
The signals people talk themselves out of
“It doesn’t hurt, so it can’t be serious.” Gum disease is largely painless until it is advanced. That is its defining clinical feature, and the reason it is usually found at a routine check-up rather than reported by the patient. Pain is a late arrival here, not an early warning.
“It only bleeds a bit, and only sometimes.” Healthy gums do not bleed when brushed. Not lightly, not occasionally, not “only with floss”. Any regular bleeding is inflamed tissue reporting itself.
“My gums have always looked like that.” Familiarity is not health. Margins that have been red and puffy for years are years of inflammation, not a personal gum type.
“I’ll wait until it gets worse.” Gum disease is the wrong condition for that instinct, because the point at which it becomes obvious is generally the point at which supporting bone has already been lost — and lost bone does not come back.
“It stopped bleeding, so it’s fine now.” Sometimes true. But smoking narrows the small vessels in the gums, so smokers often bleed less while the tissue underneath does worse. If you smoke, quiet gums are not evidence of healthy ones.
What happens at the appointment
Knowing the sequence removes most of the dread, so here it is in order.
We ask before we look. How long it has been going on, where it bleeds, whether anything hurts, what you use to clean between the teeth, whether you smoke, what medication you take, whether you have diabetes, whether anyone in your family lost teeth early. Several of these change the diagnosis.
We measure. A fine probe is placed gently into the small natural groove between gum and tooth, at several points around each tooth, and the depth is read off. This is not a matter of opinion: shallow readings with healthy tissue mean inflammation confined to the surface; deeper readings mean it has moved towards the bone. German practices commonly record a screening index for this (Parodontaler Screening-Index, PSI), which gives each part of the mouth a simple grade.
We take X-rays only where they change something. Small images show the bone level between the teeth, which is the one thing probing cannot see directly.
We explain what we found, in writing where treatment follows. You should leave knowing which of the two situations you are in — reversible inflammation, or established disease — and what the plan and the cost are. If that has not been made clear, ask. It is a reasonable question and a good practice answers it.
Treatment often starts the same day. For simple inflammation, removing the deposits and correcting the cleaning is frequently the whole treatment.
What it costs, and who pays
This is the part that puzzles newcomers most, so a short map of the German system.
The examination itself is standard dental care and is covered by the statutory health insurance (gesetzliche Krankenversicherung, GKV), which roughly 90 % of people here are in. You bring your health insurance card (Gesundheitskarte, eGK) and there is nothing to pay on the day. With us, a first consultation is free in any case.
Treatment of gum disease that has reached the supporting tissue — periodontitis (Parodontitis) — is a statutory benefit, but like other larger dental plans it is applied for in advance: the findings go to your fund and the treatment starts once it is approved. We prepare that paperwork; you do not have to negotiate with your fund yourself. Private insurance (private Krankenversicherung, PKV) and supplementary dental cover (Zahnzusatzversicherung) work differently again, and the tariff decides.
A professional cleaning (professionelle Zahnreinigung, PZR) is generally a private service. Many funds contribute something towards it, and the amounts vary widely between funds, so it is worth one phone call or one look in your fund’s app.
Two things worth knowing that nobody tells you when you arrive in Germany. First, the check-up you attend for your gums also earns the stamp in your bonus booklet (Bonusheft) — and an unbroken booklet raises the fixed subsidy (Festzuschuss) your fund pays years later if you ever need a crown or denture, from 60 % of standard care to 70 % after five years and 75 % after ten. Second, we do not invent prices on the spot: anything private is written down before it happens.
Getting an appointment when your German is limited
The language barrier is a genuine reason people delay, and delay is the actual risk with gum disease. A few practical things.
You can book with us in English by phone or online — no rehearsed German sentences required. Bring your eGK, and if you have had treatment elsewhere in Germany, bring anything on paper. If you are describing symptoms in a second language, the three details that matter most are: how long, whether it hurts or only bleeds, and whether anything is swollen or loose. Everything else we can find by looking.
At weekends the out-of-hours service is organised regionally by the dental chamber, and the dentist on duty may not speak English — another reason not to let a swelling ride until Saturday. For everything else, English-Speaking Dentist in NRW explains how the system fits together for people who arrived recently.
What can wait — and what cannot
The method for that fortnight is set out in Can gum inflammation clear up on its own? — in short: gentle, complete cleaning of the gum line and one careful pass between all the teeth every evening.
Special situations
Diabetes. The relationship runs in both directions: gum inflammation is harder to control with raised blood sugar, and persistent inflammation makes blood sugar harder to control. Diabetic patients belong in the “within a week” group, not the watchful one.
Blood thinners. Gums that bleed heavily or for a long time need reviewing, and please tell us what you take before any treatment — it changes how we plan it, not whether we do it.
Children and teenagers. Bleeding around erupting teeth and during orthodontic treatment is common and usually a cleaning problem. Persistent gum bleeding in a child, though, is worth an examination rather than an assumption.
Nervous patients. If it is fear rather than time keeping you away, say so at booking. Gum examinations are gentle, and for anyone who needs it we offer sedation and laughing gas (Lachgas). Nobody is talked into anything on a first visit.
On its own, no. It becomes urgent when it is joined by facial swelling, pus, fever, severe pain or a loose tooth — that combination should be seen the same day, including through the out-of-hours service at weekends. Bleeding alone is a “book an appointment” matter, not a “go now” one.
It is better to be examined first. A cleaning treats deposits; the examination establishes whether the problem is confined to the surface or has gone deeper, and the two need different treatment. In practice both often happen in the same visit anyway.
Routine appointments are typically a few weeks; acute problems are seen far sooner, and practices keep slots for them. If you have swelling or pain, say that when you ring — it changes what you are offered. Our surgery also runs early mornings and Saturday mornings.
No. It serves no purpose and we do not do it. People arrive with all sorts of histories, including several years without a dentist, and the only useful conversation is about what happens next.
No. Dental care in Germany is accessed directly — you choose a practice and book. A referral (Überweisung) only comes into play for specific specialist procedures.
The honest rule of thumb: swelling, pus, pain or looseness means today; two weeks of unchanged bleeding, visible tartar, receding gums or persistent bad breath means an appointment in the near future; recent, mild, improving bleeding can be watched. Because gum disease is painless in its early stages, the absence of discomfort is the weakest possible reason to stay away. An examination takes a few minutes, tells you which side of the line you are on, and is the cheapest part of the whole business.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
