Bleeding Gums: When It's Gum Disease and When It Isn't
Bleeding when you brush or floss is the most common reason patients call the office. Most of the time it is gingivitis or periodontitis. Sometimes it is something else. Here is how to tell.
Healthy gums do not bleed. That is the short version, and it is worth saying plainly, because most people who see pink in the sink have been told, or have told themselves, that it is normal. It is common. It is not normal. Lang and colleagues put a number on that in 1990: among treated patients followed for two and a half years, sites that repeatedly did not bleed when probed stayed stable 98 percent of the time, which is why the absence of bleeding, rather than its presence, is the signal periodontists trust most.
The Usual Cause: Inflammation from Plaque
Bacteria collect along and just under the gumline. Within days the gum responds with inflammation, the small blood vessels in it become fragile, and a toothbrush or floss is enough to make them bleed. This is gingivitis. It is reversible: two weeks of thorough brushing and daily flossing, plus a professional cleaning, and the bleeding stops. The American Dental Association describes this stage as still reversible and usually eliminated by a professional cleaning followed by daily brushing and flossing. That is not an inference drawn from watching patients; it was tested directly. Löe, Theilade and Jensen published the experiment in 1965, the study that gave periodontology its experimental gingivitis model: healthy volunteers who stopped all oral hygiene developed gingivitis as plaque accumulated, and gingival health returned to baseline once hygiene resumed.
When the inflammation has gone on long enough to destroy the fibers and bone that hold the tooth, it is periodontitis. The CDC puts the difference plainly: gingivitis is reversible, while periodontitis cannot be reversed, though it can be slowed down and managed with professional treatment. The bleeding looks the same. The difference is what is happening underneath, and only a periodontal exam with measurements and X-rays tells you which one you have. Bleeding that comes back within days of a good cleaning, bleeding along with bad breath that does not go away, gums that have pulled back from the teeth, or a tooth that has started to move all point toward periodontitis. Bleeding gums and gum disease treatment cover what is done about it.
Causes That Are Not Gum Disease
- Brushing too hard, or a new routine. Gums that have not been flossed in months will bleed the first week you start. If you have just started flossing, keep going. If it has not stopped after two weeks, it was not the flossing.
- Pregnancy. Hormone changes make gums react more strongly to the same amount of plaque. It is still gingivitis, but it needs more attention, not less, because gum inflammation in pregnancy is linked to other problems.
- Blood thinners and some other medications. Aspirin, warfarin, the newer anticoagulants, and some blood-pressure medications can make gums bleed more readily. The American Academy of Periodontology notes that drugs including oral contraceptives, anti-depressants, and certain heart medicines can affect oral health. Do not stop a medication over this; tell your dentist so it is accounted for.
- A poorly fitting filling or crown. A rough or overhanging edge traps plaque in one spot. The bleeding is always in the same place. Fixing the restoration usually fixes the bleeding.
- Vitamin deficiency, blood disorders, and a few rarer conditions. Gums that bleed heavily without much plaque, bleed on their own without brushing, or bleed along with bruising elsewhere or unusual fatigue deserve a visit to your physician as well as your dentist.
When to See a Periodontist
A specialist exam pays for itself at any of these points: your dentist has treated you for gingivitis and the bleeding keeps returning; you have been told you have “deep pockets”; a tooth feels loose; or bleeding comes with receding gums. We measure every tooth, read the X-rays for bone loss, and give you a written diagnosis that says whether this is reversible gingivitis, periodontitis that needs treatment, or one of the exceptions above.
Most patients who come in worried about bleeding leave with a plan that is smaller than they feared. The ones who wait are the ones who end up being treated for something bigger.
Having it measured is the only way to know which one you have, and the measuring is the short part. Request a consult in North Austin, or call (512) 346-6097.
Frequently Asked Questions
Is it normal for gums to bleed when brushing?
No. Healthy gums do not bleed when they are brushed or flossed properly. Bleeding is a sign of inflammation, and in most people the cause is plaque at the gumline.
What is the difference between gingivitis and periodontitis?
The CDC puts it plainly: gingivitis is reversible, while periodontitis cannot be reversed, though it can be slowed and managed with professional treatment. The bleeding looks the same either way. The difference is whether the fibers and bone holding the tooth have been destroyed, which only an exam with measurements and X-rays can establish.
What makes bleeding gums something other than gum disease?
Pregnancy, some medications including blood thinners, a new brushing or flossing habit, and less commonly a blood disorder or a vitamin deficiency. A single site that bleeds and nothing else can also be a broken filling or food packing between two teeth.
When is bleeding a reason to see a periodontist?
When it keeps returning after your dentist has treated you for gingivitis, when you have been told you have deep pockets, when a tooth feels loose, or when bleeding comes together with gums that have receded.
Will bleeding gums go away on their own?
Gingivitis often will, once plaque is removed properly and kept off. Periodontitis will not. That is why the distinction is worth establishing rather than waiting out.