Bleeding gums indicate either a medical or non-medical oral health issue. The patient should take steps to resolve any instance of bleeding gums by first investigating all potential non-medical causes. Where lifestyle and oral health routine behaviours can be ruled out, the patient should seek medical attention from a dentist for diagnosis and treatment.
Have I got gum disease?
Bleeding gums may be an early warning sign of gum disease. Patients concerned that bleeding gums could be an indicator of a broader medical issue should beware of common symptoms.
Common symptoms of gum disease include:
- Receding gums
- Bad breath (and a bad taste in the mouth)
- Loose teeth or a change in the feel of the bite
- Pain in the mouth at rest that may worsen when biting
- Swollen gums that may also become discoloured (typically dark red)
What causes bleeding gums?
Although the most common cause of bleeding gums is often linked to gingivitis (see gingivitis definition below), there may be a much more serious underlying health condition. Medical conditions can develop over time, meaning that any untreated medical case of bleeding gums may lead to bone deterioration and tooth loss if not treated at an early stage.
Non-medical causes
Bleeding gums may be linked to an array of singular or overlapping non-medical causes. This means that although bleeding gums may not require medical attention, patients must change any habits proving detrimental to oral health. Left unchecked, poor choices in oral health that lead to bleeding gums could escalate to infections and other more serious medical conditions.
Examples of non-medical causes of bleeding gums include:
- Beginning to floss after not flossing for some time
- Ill-fitting dentures
Where patients have not flossed for some time, bacteria can accumulate between the teeth and irritate the gums, resulting in swelling and bleeding when starting to floss. This will typically stop after flossing diligently for 2/3 days.
Ill-fitting dentures that result in an uneven bite can irritate the gum tissue. Where this occurs, small lacerations can occur, resulting in noticeable bleeding in the mouth.
Overlapping lifestyle issues may exacerbate non-medical causes of bleeding gums. Two common overlapping issues among gum patients include smoking and emotional stress.
- Smoking constricts the blood flow in the oral tissues – this can mask gum disease, while also inhibiting the tissue’s normal response to promote healing (in effect speeding up the progression of gum disease in smokers).
- Emotional stress can trigger a fight or flight response, where temporary conservation of energy is achieved through turning off digestive functions – including saliva production. Where the mouth is not ‘flushed’ with saliva on a regular basis, infections become more likely.
Medical causes of bleeding gums
Where all obvious non-medical causes of bleeding gums have been investigated and ruled out, the underlying medical cause must be established. Medical issues linked to cases of bleeding gums range from common conditions with relatively straight forward treatments to much more serious causes that may require in-depth diagnosis of the conditions.
- Gingivitis
- Periodontitis
- Lack of Vitamin C
- Pregnancy
Gingivitis is an inflammation of the gums caused by the effects of a build-up of plaque on the teeth. Plaque is a sticky substance that produces toxins harmful to the tooth, gum, and bone.
Untreated cases of gingivitis can lead to periodontitis (or periodontal disease), where the infection spreads below the gumline. This can lead to abscess, deterioration of the tooth’s supporting structures, loose teeth, and tooth loss.
Vitamin C contributes towards collagen synthesis, which plays an important role in gum health. Therefore, lowered levels of Vitamin C in the diet can lead to bleeding gums upon slight agitation from cleaning (however, this is rare in Western countries).
Hormonal changes during pregnancy* can result in inflammation of the gums, which means a higher susceptibility to cuts, bleeding, and infection (gingivitis).
* Inflammation of the gums can also result from hormonal changes during puberty, menstruation, the menopause, or as a reaction in some people to oral birth control.
How to prevent bleeding gums and gum disease
The basic advice for avoiding or reversing the effects of bleeding gums and gum disease comes down to maintaining high levels of personal well-being, which includes oral hygiene.
Advice to prevent bleeding gums:
- Drink water after eating
- Develop a regular brushing and interdental cleaning routine
- Eat a balanced diet – ensuring to take in enough vitamin C and calcium
- Relax – high levels of the stress hormone cortisol can contribute to poor oral health
- Brush twice per day – use short circular motions (starting from the gumline), continuing for two minutes with the brush tilted to a 45 degree angle
Which toothbrush is best?
The daily removal of bacteria on the teeth is an essential step in preventing the formation of plaque (which can lead to infection, bleeding gums, and gum disease). A soft bristled toothbrush is always advised to help protect the gums – remember, the tooth brush is only meant to remove leftover food and brush away the lightly adhered plaque layer that develops on the teeth during the day, and should therefore not be considered as a scrubbing tool. Medium and hard bristled toothbrushes can cause irritation, bleeding, and infection, which means that the very act of cleaning the teeth can lead to the issues that brushing attempts to avoid.
For further advice on choice of toothbrush, proper oral care, and resolving any issues with bleeding gums or gum disease, always speak to your dentist.
