Bleeding Gums
Healthy gums don't bleed. Bleeding when you brush or floss means the gum is inflamed by plaque bacteria, which is gingivitis at first and periodontitis once bone is involved. It is a common early sign of gum disease, and an easy one to dismiss.
“I have been going to Austin Periodontal Associates since 2008...that’s 15 years. I’ve had all 4 quadrants of gum area worked on. My oral health has improved so much since then. All of the staff are incredibly friendly and helpful.”
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Four Signs It Is Time to Be Seen
- Bleeding that continues after two weeks of careful brushing and daily flossing.
- Bleeding along with gums pulling away from the teeth, bad breath, or loose teeth.
- Your dentist measured pockets of 5 millimeters or more.
- You have diabetes or a family history of tooth loss from gum disease.
Any one of these is reason enough to request a consult. Bleeding with swelling, pain, or a bad taste can mean an abscess; call the office and we will try to get you seen as soon as possible.
What It Usually Means
Plaque that isn’t removed hardens into tartar, and the bacteria in it inflame the gum. The gum swells, turns from pale pink to red, and bleeds when touched. At this stage, gingivitis, nothing permanent has happened; the American Dental Association describes it as still reversible, usually eliminated by a professional cleaning followed by daily brushing and flossing. Löe, Theilade and Jensen demonstrated that sequence experimentally in 1965: healthy volunteers who stopped brushing developed gingivitis as plaque built up, and their gums returned to health once brushing resumed. If it continues, the inflammation destroys the fibers and bone that attach the gum to the tooth, and a pocket forms that no toothbrush can clean. That is periodontitis, which the CDC describes as not reversible, though it can be slowed and managed with professional treatment, and which the CDC lists alongside tooth decay as one of the two leading causes of tooth loss.
How fast that happens varies enormously from person to person. Löe and colleagues examined 480 Sri Lankan tea laborers repeatedly between 1970 and 1985, a group with no access to dental treatment and heavy plaque throughout, and found three distinct courses: roughly 8 percent lost attachment rapidly, about 81 percent moderately, and about 11 percent never progressed beyond gingivitis. Bleeding gums are the point at which it is still cheap to find out which group you are in.
Bleeding can also be worse with blood thinners, pregnancy, diabetes, smoking (which paradoxically can hide bleeding), and certain blood pressure and seizure medications that enlarge the gums.
When to See a Periodontist
The American Academy of Periodontology lists bleeding while brushing, flossing, or eating hard food among the warning signs of gum disease, along with red or swollen gums, receding gums, loose teeth, and persistent bad breath. The four signs at the top of this page are the ones that most often turn out to need treatment below the gumline.
What We’d Do
Not all bleeding is gum disease; the exceptions are in Bleeding gums: when it’s gum disease and when it isn’t.
A full periodontal exam and X-rays, then a diagnosis in plain terms. For gingivitis, a thorough cleaning and instruction in what will keep it from returning. For periodontitis, scaling and root planing under local anesthetic, re-evaluation in six to eight weeks, and further treatment only if pockets remain. Gum disease treatment.
How we treat it: Gum Disease Treatment, or request a consult.
Frequently Asked Questions
Should I stop flossing if it makes my gums bleed?
No. Bleeding means the gum needs more cleaning, not less. Floss gently every day, and if bleeding hasn't stopped within two weeks, have the gums examined.
Can bleeding gums be serious?
They are the first sign of a disease that, untreated, is one of the two leading causes of adult tooth loss, alongside tooth decay. They are also more common with uncontrolled diabetes, some medications, and pregnancy, all of which are worth knowing about.
What will a periodontist do?
Measure the pockets around every tooth, check the bone on X-rays, and tell you whether this is gingivitis, which a thorough cleaning reverses, or periodontitis, which needs treatment below the gumline.