Bleeding Gums

Sometimes you might notice bleeding gums when you brush or floss and sometimes they can just bleed for no apparent reason. When this happens it can be a sign of gum disease or an underlying health condition. When you notice your gums bleeding it can be a concern and this article will address everything to do with bleeding gums, what they are, possible causes, potential complications, when to see a dentist, and how bleeding gums are treated.

What are Bleeding Gums and Dental Bleeding?

Bleeding gums and dental bleeding is when bleeding occurs in the mouth, gums, or tooth sockets. When gums are healthy they are light pink and do not bleed. Unhealthy gums are red, inflamed and can be tender. When inflammation occurs, the body’s natural response is to increase blood flow to the area which is why swollen gums bleed easily. Usually gums bleed in a specific spot like around a tooth or molar. Bleeding in one specific area of the gums is a sign of localised inflammation.

Symptoms Related to Dental Bleeding

Dental bleeding is obvious when blood is noticeable from the gums or mouth. However there are other symptoms that can occur in conjunction with bleeding, that may be an indication of a more serious gum issue. Other symptoms that can relate to dental bleeding are:

• Pain: Sometimes pain in the gums or teeth are associated with dental bleeding. Gums are more sensitive when swollen and likely to hurt more than healthy gums. Toothache and bleeding gums can be an indication of an infection when bacteria infiltrates the root of the tooth through a crack or cavity.
• Swelling: Swollen gums are abnormally larger than usual and may be protruding. They are often dark red compared to the healthy light pink colour of healthy, unswollen gums. Swelling usually occurs in the triangle shaped areas of gum between teeth and is often associated with bleeding gums.
• Bad breath: When tartar or calculus is deposited on the gums, it can lead to bad breath. The tartar builds up and calcifies onto the surface of the tooth, making it impossible to remove without a dentist. The longer the tartar is there, the more chronic the irritation which causes the odour known as bad breath.
• Loose teeth: When teeth in adults become loose, it is because there is lack of support from the gum. When this occurs, the tooth will slowly detach from the gum and eventually fall out. Gum disease is one cause of loose teeth, particularly when combined with bleeding and swollen gums.

Causes of Bleeding Gums

There are numerous potential causes of bleeding gums, from gingivitis to poor oral hygiene and even stress. Causes of bleeding gums can be classified into three different categories – dental issues, underlying health conditions, and trauma and lifestyle.

Bleeding Gums Caused By Dental Issues

Dental issues are one of the most common causes of bleeding gums from gum disease and lack of dental care. These are the main dental issues that cause gums to bleed.

• Gingivitis: Gingivitis develops when plaque stays on the gums for too long and develops into tartar or calculus. This hard substance sticks to teeth and has a bacteria in it that causes gum irritation. Gingivitis is the early stages of gum disease and causes the gums to become inflamed and bleed, usually when you brush or floss. At this stage there is no bone loss and it is reversible with dental treatment.
• Periodontitis: This occurs when gingivitis is left untreated and advances, causing the inflammation to continue to spread. Periodontitis is an infection of the gums, surrounding tissue and jawbone. Deep pockets form between the gums and teeth, fill with plaque and tartar and become deeper in time. This leads to chronic bleeding, inflammation, receding gums, and possible bone loss. Most adult tooth loss is due to untreated peridontitis. At this stage, periodontitis is not reversible but can be managed with dental care.
• Trench mouth: Also known as necrotizing ulcerative gingivitis, trench mouth is an advanced form of gum swelling. It occurs when there is too much pathological bacteria in the mouth and causes ulcers and lesions between the teeth and destroys gum tissue.
• Poor oral hygiene: Good oral hygiene is essential for healthy teeth and gums. That means having a healthy routine of brushing, flossing and regular dental visits and teeth cleaning. The mouth is the starting point for the digestive system where bacteria helps break down food particles. When oral hygiene is poor, germs can build up from the bacteria and reach levels that lead to infections like gum disease and tooth decay.

Bleeding Gums Caused By Underlying Health Conditions

While gum disease is the number one reason for bleeding gums, sometimes it can be a symptom of an underlying health condition. These medical disorders may be the catalyst for dental bleeding:

• Diabetes: There is a common link between diabetes, gum disease and bleeding gums. Diabetes reduces blood flow to the gums which makes it harder for them to heal and more prone to infection from bacteria. When someone has diabetes, the disease causes the blood vessels to thicken which slows the movement of waste products like leftover food from the gums. People with diabetes are more likely to have dental issues and take a longer time to heal.
• Vitamin K deficiency: Anyone with vitamin k deficiency does not have enough vitamin k which is necessary for tooth and gum health. Vitamin k allows adequate amounts of calcium to be deposited in our teeth which keeps the enamel hard and resistant to acid. It is essential for jaw bone health and helps fight off bad bacteria that can harm gums and teeth.
• Vitamin C deficiency or scurvy: A severe vitamin c deficiency is known as scurvy. Scurvy results in your body not being able to make enough collagen which then leads to increased bleeding of gums, bleeding under the skin, and loose teeth.
• Pernicious anaemia: Pernicious anaemia is a form of anemia associated with vitamin b12 malabsorption that causes bleeding gums. People with pernicious anaemia are more likely to have peridontitis symptoms like gum pocket depth than those with the normal level of b12.
• Thrombocytopenia: This blood disorder called thrombocytopenia results in less platelets than normal in blood. These platelets help with blood clotting so fewer platelets means more bleeding gums, bruising and internal bleeding.
• Haemophilia: This is a genetic disease which causes blood clotting difficulties. People with haemophilia bleed a lot more and easily than those without it. If you have dental work or an injury to your mouth and bleed more than usual it could be a sign of haemophilia.
• Oral herpes: Also known as herpes simplex, oral herpes can cause sores and ulcers on the lips, inside the mouth, gums and throat. It can cause the gums to become swollen and bleed.
• HIV/AIDS: HIV weakens the immune system which makes it harder to fight dental infections in the mouth, gums and teeth. This can lead to sore, swollen and bleeding gums.
• Leukaemia: Some types of leukaemia can cause gums to become inflamed and enlarged which makes them more susceptible to bleeding. This is because leukaemia can be linked with low blood platelets and thus unsatisfactory blood clotting capabilities.
• Pregnancy: Hormonal changes in pregnancy can make gums susceptible to more plaque buildup which results in inflammation and a propensity for bleeding. This is known as pregnancy gingivitis which should return to normal after pregnancy.

Bleeding Gums Caused By Trauma or Lifestyle

• Blood thinning medications: Blood thinners may cause your gums to be more prone to bleed. They reduce the ability for your blood to clot which means bleeding occurs more easily. Brush and floss your teeth more gently on blood thinners.
• Chemotherapy: Chemotherapy treatment can cause a drop in platelets which increases a risk of bleeding. People on chemotherapy may experience gums that are swollen, red and shiny and prone to bleeding.
• Smoking: Smoking increases the likelihood of gum disease which then leads to bleeding gums. However, because the nicotine in tobacco decreases the blood flow to the gums, it can actually mask the bleeding even though the gum disease continues to develop.
• Stress: Stress and anxiety is linked to oral health and can cause dental bleeding. Stress increases inflammation in the body which makes gum bleeding more likely. When stressed, we can also be less likely to brush and floss or follow a healthy diet, all impacting gum and tooth health.
• Brushing or flossing teeth too hard: Although brushing and flossing is essential for oral health, sometimes brushing or flossing too hard can cause gums to bleed. You might be pressing too hard on the surface of the gums or perhaps using a toothbrush that is too stiff which can also contribute to bleeding.
• Ill-fitting dentures: When dentures are not fitted perfectly to the gums, it can create friction which causes the gums to bleed. Sometimes the mouth changes shape and dentures become ill-fitting which leads to irritation and inflammation.
• Dental procedures: Gums may bleed after having a dental procedure like a tooth extraction or dental implant.

When To See a Dentist/Healthcare Provider for Bleeding Gums

If you brush your teeth too hard and your gums bleed once or twice, there is probably no need to race to the dentist. However, if you are experiencing the symptoms of gum disease it is important to see your dentist earlier rather than later. You will need to find out why your gums are bleeding and get treatment early if you are experiencing any of the following reasons:

• If bleeding does not stop after two weeks: If your gums continue to bleed every time you brush or floss for two weeks, you may need some dental advice to see if it is gum disease or another underlying issue. Your dentist will evaluate your oral health and determine the reason for the bleeding, then recommend any treatment.
• If you notice pus between your teeth and gums: Pus between teeth and gums is a sign of infection and must be seen by a dentist.
• You have loose teeth or changes in your bite: Loose teeth and changes in how your teeth fit together can be symptoms of gum disease.
• If you have consistent bad breath: One of the main symptoms of gum disease is consistent bad breath and a bad taste in the mouth. While bad breath can be caused by other dental issues like tonsil stones, it is likely to be gum disease if combined with bleeding gums.
• You have a history of gum disease: If you have already had gum disease and notice bleeding, it is wise to see your doctor as soon as it begins. People who have experienced gum disease before may have a predisposition to it.

Diagnosis of Reason for Bleeding Gums

To diagnose a reason for bleeding gums, a dental visit will be required. During the appointment the dentist will perform a physical examination of the teeth and gums, looking for signs of inflammation, redness or bleeding. Using a probe, the dentist will measure any pockets around the teeth for signs of gum disease. Healthy pockets between the teeth and gums usually measure about 1 to 3 millimetres in depth. Any deeper can be a sign of serious gum disease.

The dentist may also order dental X-rays of the teeth and jawbone to determine if there is any bone loss associated with gum disease. Advanced gum disease called periodontitis can cause bone loss in the jaw. If there is bone loss, the X-ray will identify the extent and help the dentist determine the best treatment plan.

While it is not common for blood tests to be ordered to diagnose gum disease, dentists sometimes order a blood test called a CRP to see if the c-reactive protein is present. Chronic periodontitis is usually associated with a raised CRP.

After the physical examination and tests, the dentist will take a complete review of the medical history to identify health conditions like diabetes that may have contributed to gum disease.

Care and Treatment of Bleeding Gums

The care and treatment of bleeding gums will depend on the cause. If there is no sign of gum disease, home care will usually suffice. However, more serious gum disease conditions will need a treatment plan. We list the potential causes and how they would be treated here:

Gum disease

• In most cases, chronic bleeding gums is a sign of gum disease called gingivitis or periodontitis. Treatment of gum disease can be done by a dentist or periodontist ( a dentist who specialises in gum disease). The goal will be to clean the pockets of the teeth, remove plaque and prevent any further damage or bone loss. For this a dental treatment plan might incorporate home care, non surgical dental procedures or surgical dental procedures.
• Non surgical procedures – Gum disease that is not advanced can be treated less invasively but will still need to be treated by a dentist. To help reduce or eliminate gum disease the dentist may use these procedures:
  • Scale and clean: This is where the dentist removes tartar and plaque from the tooth surface and gum line using a handheld instrument called a scaler.
  • Root planning: This is a form of deep cleaning and the dentist performs root planning which removes plaque and tartar below the gumline and smooths the tooth roots.
  • Antibiotics: The dentist may prescribe topical or oral antibiotics to help eliminate infection and bacteria.
• Surgical procedures – For advanced and more serious periodontitis, surgical procedures may be the next course of action. In this case, a periodontist or oral surgeon may perform these operations.
  • Pocket reduction surgery: Also known as flap surgery, this operation involves the periodontist using tools to separate the gum from the tooth, do a deeper clean of the gum tissue, and reattach it in a new position. Sometimes the underlying bone will be reshaped if there has been significant bone loss.
  • Bone grafts: When periodontitis has destroyed the bone around the tooth, a bone graft can be performed. The purpose is to add more bone to create a stronger foundation for teeth and hopefully avoid tooth loss. It can also help new bones regenerate.
  • Soft tissue grafts: This procedure involves removing some soft tissue from the roof of the mouth and grafting it to the gumline. This can help reduce further gum loss and cover exposed roots.
• Underlying health conditions – Sometimes bleeding gums can be the result of an underlying health condition, particularly if it is a serious disease. If the root cause of bleeding gums is a health condition it must be identified and treated immediately. For patients experiencing bleeding gums that are caused or exacerbated by a health condition, the type of treatment might include anything from home care to dental treatments. If the cause of bleeding gums is an underlying health condition like leukaemia, the dentist might suggest using a softer toothbrush, flossing less, regular scale and cleans, applying ice packs to the affected area, and even taking vitamin supplements if there is a vitamin deficiency. For a person with a vitamin c deficiency or scurvy, the treatment would be to increase vitamin c intake in the diet.
• Lifestyle – If lifestyle is the reason for bleeding gums and there is no underlying issue of gum disease, there are straightforward ways to prevent it. This could simply be brushing the teeth with a softer toothbrush or investing in an electric toothbrush, having ill-fitting dentures refitted or even by stopping smoking.

How To Prevent Bleeding Gums

There are ways to prevent bleeding gums and avoid issues with gum disease. By looking after your oral health, there is no reason bleeding gums should occur unless there is an underlying health condition. The ways to prevent bleeding gums are:

• Brush your teeth regularly: Brushing teeth twice a day ensures you are removing any plaque buildup that may cause gum disease. To brush teeth properly, angle the bristles towards the gumline so they gently clean the gums and teeth. Brush each tooth individually in small, circular motions.
• Use the right toothbrush: Choose a toothbrush that comfortably fits in your mouth and can reach every tooth. A good toothbrush will have a slightly angled neck. Make sure the bristles are not too hard to avoid damage to your teeth and gums.
• Floss every day: Flossing is important to remove particles and bacteria that the toothbrush couldn’t get to. However, floss gently to avoid trauma to the gums.
• Use a mouth rinse: Antibacterial mouthwashes can help treat and prevent bleeding gums. However, salt water rinses can be just as effective at removing bacteria.
• Regular dental visits: For oral health and to avoid gum disease, it is imperative to have regular visits to the dentist. Regular visits give the dentist the chance to monitor your oral health, and ensure teeth cleaning to avoid plaque buildup is up to date.
• Avoid smoking: Smoking affects the immune system and makes it harder to fight bacteria that sticks to the gumline from plaque buildup. Avoiding smoking improves overall health, including oral health.
• Take care of your health: By taking care of your health and wellbeing, oral health will be a byproduct. Eat a healthy diet rich in vegetables and fruits, avoid sugary foods, drink plenty of water, exercise and have regular doctor’s checkups.

What Happens if Bleeding Gums Are Untreated?

If bleeding gums are untreated, and the cause is gum disease, it will only get worse over time. The only way to stop gum bleeding from gum disease is regular cleaning to remove plaque before it turns from simple gingivitis to more sinister periodontitis. Left untreated, gum disease can erode the jaw and tooth bones and lead to tooth loss. If bleeding gums are from an underlying health condition that you are unaware of, left untreated both the bleeding gums and the health condition may worsen.

Whenever bleeding gums occur it can be a great cause for concern. Sometimes bleeding gums happen simply from brushing teeth too hard, but gums that bleed for no reason could be a sign of a more serious issue. In this article, we have explained what bleeding gums are, possible causes, when to be concerned, treatment plans, and how to avoid it in the first place. If you do have bleeding gums, contact the dental experts at Hawthorn Road Family Dental.