Bleeding gums? Why it might be more serious than you think

You may notice blood coming from your gums when you brush or floss your teeth, but not understand why. In this article, London-based specialist periodontist Dr Sulaman Anwar explains the possible causes of bleeding gums, and what can be done to protect your smile.

What causes bleeding gums?

Bleeding from the gums is one of the main characteristics of gum disease, as known as gingivitis, which is an inflammation of the gums that is caused by a buildup of plaque. Plaque is a film that forms when the bacteria in the mouth feed on particles of foods and drinks with sugar and starches. The bacteria release acids that will begin to deteriorate the gums and enamel, which is why it is strongly encouraged to brush your teeth twice a day to disrupt this film. Failing to do so will allow the plaque to thicken and harden into tartar, which can only be removed with professional intervention.

Bleeding gums can also be caused by other factors, such as diabetes, smoking cigarettes, hormonal changes, vitamin deficiency (particularly vitamins C and K), cancer, and even stress.

And sometimes, it is as simple and innocuous as brushing or flossing too hard, which can cause micro-abrasions to the soft tissues around the teeth.

What happens if bleeding gums worsen?

With gingivitis, in addition to bleeding, swollen gums, patients will also experience bad breath and dental sensitivity to pressure and temperature. And without treatment, gingivitis can worsen into periodontitis, which is a more advanced stage that will begin to damage nearby structures, leading to tooth loss, or further progress to trench mouth, where ulcers form in the mouth and the gum tissue begins dying, causing extreme oral pain, fever.

Gum disease can erode the quality of not just the teeth and gums, but the structures that lie deeper under the skin, like the ligaments and the bones that make the jaw and support the teeth. The bacteria can even spread to the cheeks and throat, causing deterioration of those tissues, and even affect the eyes, heart, and lymph nodes.

There is a well-known link between gum disease and the deterioration of systemic health – after all, the mouth is the portal to the internal structures of the body. Complications can arise with:

Diabetes, as it weakens the immune system. Coupled with gum disease, it becomes much easier to contract infections as well as contributing to higher blood sugar levels, impeding diabetes management.
Cardiovascular disease, where bacteria from the gums can enter the bloodstream and contribute to plaque buildup in the blood vessels, possibly leading to heart attacks and strokes.
Pregnancy, as low birth weight and premature birth are associated with periodontal disease, as harmful bacteria and a weakened immune system can take its toll on both parent and fetus.

How are bleeding gums treated?

To diagnose bleeding gums, a periodontist will examine your mouth, looking for where the bleeding is stemming from, inflammation and discolouration, if your teeth are becoming loose, and if your gums are receding. They may also order a dental X-ray to see if the jawbone is also affected.

Treatment will typically start with a thorough professional clean to create a ‘blank slate’ from which treatment can build upon to combat further bacterial growth and encourage healing.

You will be educated about how to properly clean your teeth daily, and what techniques and tools to employ, such as interdental brushes or antimicrobial mouthwashes. If you are a smoker, it is advised to cease or reduce intake.

Additional treatments that may be recommended include:

Scaling and root planning, which is tartar removal from under the gums and a smoothing of the teeth in order to give the bacteria fewer surfaces to adhere to.
Periodontal surgery
Tooth removal, for teeth that are severely damaged.

How to improve dental health and prevent gum disease

It is highly recommended to brush your teeth regularly, at least once every 12 hours or whenever your teeth feel ‘fuzzy’ to halt bacterial buildup. Flossing is very effective at dislodging debris and food remnants from in between teeth and tucked into the gums, where toothbrush bristles struggle to reach, and professional cleaning every year or so helps to maintain a clean mouth. If you experience persistent bleeding gums or other dental issues like chronic bad breath, it is encouraged to seek timely professional dental intervention; don’t feel ashamed, as that is what dentists and periodontists are there to assist with. Being proactive about your oral health will prevent any long-term or future issues that can be more resistent to conversative treatments.