Healthy gums do not bleed. That being said let’s find out some of the causes of bleeding gums.
As a dentist I see bleeding gums far too often. Not only during cleanings or scaling and root planing but also while taking impressions, removing dental dams, checking proximal contact points during conservative dental treatment.
If your gums are bleeding at home then you should book in to see your dentist as soon as possible. If you notice your gums are bleeding when you floss, brushing your teeth or you notice small amounts of blood on your pillow at night, these are other signs to hail it your oral care professional immediately.
Many of you may already know bleedings gums in the majority of cases is a sign of inadequate oral hygiene. How is that possible you may ask? Put on your science hat and let me explain.
Bleeding gums caused by poor oral hygiene starts off as gingivitis. An inflammatory condition of the gums, limited to the soft tissues without involving bone loss. Gingivitis is just one of the periodontal diseases and is the most common. The form of gingivitis most seen in clinical practice is due to plaque build up along the gum line – plaque-induced gingivitis.
How we diagnose gingivitis
The parameters we as dentists use to define gingivitis include: the oral health history and habits of the patient, swelling and redness of gums upon oral inspection and bleeding on probing. Bleeding on probing (BOP) is the use of a periodontal probe inserted into the space between your gum and tooth to take particular measurements.
If during this recording your gums begin to bleed, this is noted as a sign of gingivitis.
Gingivitis especially in its initial stage is REVERSIBLE and cheap to treat. Untreated gingivitis can progress to periodontitis which costs more money to deal with.
I invite patients to improve their brushing and flossing habits. We may then do a deep cleaning to remove plaque below and above the gum line and sometimes prescribe antibiotic mouthwashes such as chlorhexidine.
Why gingivitis occurs
I’ve already explained that plaque contains bacteria. The oral cavity is known to host over 150 species of bacteria in some individuals. These bacteria can use proteins within the saliva to adhere to any solid structure in the mouth: teeth, dental implants, crowns, veneers, orthodontic appliances. If teeth are not brushed properly, these bacteria are not removed and remain in contact with the gums.
These bacteria can then begin to destroy gum tissue by using their own enzymes to break down the tissue resulting in inflammation and bleeding. If left untreated this can reach the periodontal ligament and even the bone resulting in bone loss – periodontitis.
This is a very simplistic break down of one possible way gingivitis occurs. Hopefully it is enough for you to get the take home message that proper tooth brushing and flossing at home is fundamental to stopping gingivitis and hence bleeding gums.
Crowded teeth besides not being aesthetically pleasing for some, can hinder the efficient removal of plaque in some areas. If teeth are severely overcrowded speak to your dentist about possible orthodontic treatment to reduce the overcrowding and allow better oral hygiene.
Other types of gingivitis
We spoke about plaque-induced gingivitis but there are other types of gingivitis responsible for bleeding gums. Remember these other causes are determined in the absence of large accumulations of plaque.
Hormonal gingivitis – most commonly seen in pregnant women. Bleeding gums may not be a result of poor oral hygiene habits in this case. Regardless it is recommended that women seeking to become pregnant ensure that their oral health is in tip-top shape before.
Nutritional gingivitis– while scurvy is rarely seen in most populations in developed countries, deficiencies in Vitamin C can still occur. Lack of Vitamin C and Vitamin K can result in bleeding gums so please be careful in consuming calorie dense nutritionally poor foods.
Drug Induced gingivitis – ingredients in some oral contraceptives, anticoagulants, calcium channel blockers (treatment of high blood pressure), epileptic medications, chemotherapy drugs, can all play a role in causing bleeding gums. This is why I continue to reiterate the importance of general health in oral health and vice versa.
Risk factors in the development of gingivitis
Systemic conditions – diabetes; leukemia; hemolytic anemia and other blood dyscrasias.
Smoking and chewing tobacco
Genetic conditions – Crohn’s disease, Papillon–Lefèvre syndrome, Sjögren-Larsson syndrome (SLS)
In the next article I discuss treatment for bleeding gums.