The presence of bleeding gums usually when brushing or flossing is usually a sign that you have some form of periodontal disease but it can also mean a greater risk is present. Persistent gingival bleeding can be due to something far more serious. This type of bleeding has been linked to diseases such as leukemia, blood platelet disorders, and even scurvy.
Many people sometimes mistakenly believe that bleeding upon brushing or flossing is normal. They might say that their gums always bleed when brushing and so do some of their other family member’s.
Are bleeding gums normal?……NO! Healthy gums do not bleed from normal brushing and flossing.
Bleeding gums in their earliest form is a sign of ginigivits. Gingivitis is simply inflammation of the gum tissues. It is the earliest stage of periodontal disease and is reversible if treated before it progresses. Periodontal disease is a progressive disease that will advance without proper treatment. Periodontal disease is inflammation and infection that breaks down and destroys the tissues that support the teeth. This includes the gum tissues, the periodontal ligaments (PDL), and the bone supporting the teeth.
Gingivitis comes from the long term effects of deposits of plaque on your teeth. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed protein layer,( the pellicle) on the teeth. The pellicle is like a microscopic cuticle which grows out from under the gum tissue and allows bacteria to use it as a scaffold to build upon. This pellicle layer is removed during a professional cleaning, it does not come off with a toothbrush.
The accumulated plaque bacteria and the toxins produced cause the gums to become infected, swollen, and tender. The body responds by sending blood cells ( inflammatory cells) to attack the bacteria, and the bleeding begins.
If you watch television at all, you have probably heard of gingivitis. A very big industry has been built with various types of products that are supposed to eliminate gingivitis. The problem is that most of these products do not work on their own to eliminate ginigivitis or advanced periodontal disease. They work to make your teeth “feel” clean and as a helpful aid in between visits to maintain oral hygiene. Nothing replaces visits to the dentist and hygienist for a proper examination and thorough cleaning to remove the pellicle and bacteria film.
If the plaque is not removed, eventually it will stick to a harder substance known as tartar. While the tartar is not formed directly from the plaque it is able to stick more readily to teeth because of the presence of the plaque. The tartar will be hard and will trap food particles, plaque and bacteria below the gum line.
Researchers have long recognized that there are at least 11 different strains of bacteria that can cause periodontal disease. These bacteria thrive in dark, moist areas. This includes the gingival tissues around the teeth. Our immune systems react to the problem by sending out cells to remove the bacteria. Blood to the infected area is also increased to help flush away the invading bacteria. However, if the invading bacteria do not leave, our gingival tissues become filled with blood and our gums can bleed when we brush. This makes it very difficult to maintain oral hygiene for the patient. This will ultimately advance to more progressive forms of periodontal disease called periodontitis. Periodontal disease at this stage unfortunately is not truly reversible. Modern dentistry has newer techniques to deal with periodontal disease. These include emdogain, a gum and bone growth factor, and arestin, a tetracyline type antibiotic.
There is a new product on the market called Periogen. This product is used as an adjunct to professional cleanings to help dissolve some of the tartar, plaque and stains that builds up in the mouth. This product has shown the ability to dissolve subgingival (below the gum line) calculus through an in-home, daily irrigation regimen. It is recommended to use this product with a waterpik ultra to allow penetration of the product below the gum line. The results of this innovative treatment include a reduction to many gum infections and the reduction of many periodontal pockets. This product has been shown to be very helpful in the reduction of periodontal disease.
What Raises your Risk for Ginigivitis and Periodontal Disease?
-Certain infections and systemic diseases. There are some very serious reasons for gums that bleed. These can include blood disorders, clotting disorders, liver problems, kidney disorders, artery or capillary diseases, and diabetes and heart problems. Vitamin C and K deficiencies can also result in bleeding gums. Fungal infections are also linked with bleeding tissues, as well as certain medications such as aspirin, high blood pressure medications, (calcium channel blockers) and blood thinners.
-Maintaining poor oral hygiene. If you do not keep your teeth clean with a diligient at home oral hygiene program coupled with regular visits to the dentist you will eventually develop some form of gingivitis as well as increased posssibility of more advanced periodontal disease.
-Pregnancy. Hormonal changes at this time will cause changes to your oral cavity. These changes can increase your chances of developing cavities, gingivitis, and advancement of periodontal disease.
Studies have shown that women with periodontal disease are 7X more likely to have preterm births and low birth weight babies. Preventive dental cleanings and regular dental exams during pregnancy are not only completely safe, but are highly recommended by both dentists and physicians alike.
-Uncontrolled diabetes. Diabetes impairs white blood cells, which are the body’s main defense against bacterial infections. These bacterial infections can affect everything in the mouth as well as the rest of the body. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.
-Misaligned, crooked teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (braces, dentures, bridges, and crowns). Crowded teeth are much more difficult to maintain and keep clean. This will pose a greater challenge for those patients and mean they need to work a little harder to avoid the pitfalls of periodontal disease.
Many people have some amount of gingivitis. It usually develops during puberty or early adulthood due to hormonal changes. It may persist or recur frequently, depending on the health of your teeth and gums.
Dental and Periodontal Examinations
The dentist will examine your mouth and teeth and make notations if soft, swollen, reddish-purple gums are present. This gum tissue is usually painless or slightly tender at this point. Plaque and tartar will more than likely be present to some degree. A periodontal probe will be used to measure around the teeth to see if your periodontal disease has progressed past just gingivitis. Remember, once bone loss has occurred you now have a more advanced form of periodontal disease.
Following examination, your dentist will recommend a course of treatment for your periodontal disease. This will include a professional cleaning along with extra home care instructions. The goal in treatment is to reduce the inflammation and not allow the periodontal disease to progress. An antibacterial rinse may also be recommended for at home use. A good example of this is Listerine. Your dentist may also recommend repair of misaligned or crooked teeth to aid you in your home care efforts. Also, most people do fine on a 6 month schedule but, everyone accumulates pellicle and plaque at different rates, your dentist may recommend a more frequent schedule for you.
Once the plaque and tartar are removed, bleeding and tenderness of the gums should lessen within 1-2 weeks after professional cleaning and careful oral hygiene. Warm salt water or antibacterial rinses can reduce gum inflammation. Taking an over the counter anti inflammatory medication can also aid in pain and inflammation reduction.
Healthy gums should look pink and firm with no bleeding upon brushing or flossing. Strict oral hygiene must be maintained for your whole life, or periodontal disease will come back and possibly advance past the gingivitis form into advanced periodontal disease (also called periodontitis).
Home Care to prevent periodontal disease should include:
-Regular dental visits. Usually recommended every 3- 6 months for examination and professional cleaning.
-Brushing after every meal and flossing at least once a day.
-Rinsing with antiseptic rinse as recommended by dentist.
Consult your physician if the bleeding is severe or chronic, gums continue to bleed even after dental treatment, or you have other unexplained symptoms along with the bleeding from your gums. These could all be the sign of a more serious condition than periodontal disease and should be checked out as soon as possible.
Periodontal disease in its earliest stages is very treatable and should be stopped in its tracks. Everybody has it in their power to keep periodontal disease from progressing to more advanced stages.