Although as a dentist it is uncommon, to see bleeding gums without gum disease, other local or systemic factors have to be always at the back of your mind.

1. Bleeding Gums due to Gum Disease
Almost every cause of bleeding gums is caused by gum disease.
Although as a dentist it is uncommon other than trauma, to see bleeding gums without gum
disease, other local or systemic factors have to be always at the back of your mind. About 3
years ago, we saw a patient who was having bleeding gums from his upper front 4 teeth but
this was also accompanied by nasal bleeding. A referral was made and the cause was a
systemic cause.
It is also important to Note that systemic conditions May make someone more susceptible to
gum disease and bleeding gums. Medication such as in the Nifedipine or Phenytoin will tend
to cause the gums to swell up and therefore they are probably more likely to bleed. of course
we also have to consider smoking which also increases the likelihood of gum disease but
here at the same time it actually reduces the amount gums bleed due to the vasoconstrictor
effects of the chemicals in Smoke.
The Two Basic forms of gum disease are gingivitis and periodontitis. Periodontitis sometimes
comes under other names such as chronic gum disease common chronic periodontitis,
chronic adult periodontitis and periodontal disease.
Both forms of gum disease cause bleeding.
the bleeding from gum disease can be spontaneous bleeding and it is not uncommon for
patients to say that when they wake up in the morning, there is blood on the pillow or for
example when they are biting into an apple, traces of blood will remain on the white core of
the Apple. On the other end of the range, bleeding can only be elicited by fairly vigorous
brushing.
Out of the two forms of gum disease, it is periodontitis or chronic periodontal disease that will
ultimately cause you to lose one or more of your teeth affected. Periodontitis is always
preceded by gingivitis but gingivitis does not always lead to periodontal disease. At the
moment, we don't know exactly why some patients remain with gingivitis and why other
patients go on to lose their teeth through periodontal disease. Having said that, we do know
that there are certain risk factors which increase the likelihood of developing chronic
periodontal disease from gingivitis. These conditions are poor oral hygiene, lack of
professional dental scaling, smoking, diabetes and stress.
Periodontitis is not a linear disease. This means that it doesn't carry on at the same rate all
the time, scientific research shows that there are spikes of activity followed by periods of
remission. Although not fully understood, we do know that periods of acute stress can set off
a spike of activity of periodontitis leading to periodontal breakdown of the periodontium.

2. Gingivitis as a cause for bleeding gums.
Gingivitis is by far the most common cause why your gums are bleeding. Gingivitis is caused
by bacterial plaque in your mouth. The plaque in your mouth is the white sticky stuff that you
can scrape with your fingernail from the surface of your teeth if you have not brushed in a
while. Bacterial plaque is made up of how many different types of bacteria. Anaerobic
bacteria including Prevotella, Treponema, Filifactor alocis and Fusobacterium nucleatum. It
is thought that it is not just the amount of plaque that is allowed to accumulate that causes
gingivitis but also the actual makeup of the whole colony of bacteria. Whether or not you get
gingivitis also depends on the makeup of each individual person. There are certain
individuals who seem to be resistant more than others.
Bacteria in dental plaque produce toxins which cause the body's defensive immune network
to react. This process is inflammation. As a result, inflammation results in gums swelling up,
being tender and therefore bleeding occurs when touched. Although the inflammation is a
response to the bacteria, over the long-term, the inflammation itself leads to break down of
the periodontal tissues and hence periodontitis progresses.
The treatment of gingivitis is broken into three phases.
Phase number one
The first phase of treatment consists of oral hygiene instruction so that the patient knows the
best way to reduce the amount of bacterial plaque that forms on the surfaces of the teeth.
The area of your teeth which is most critical is along the gum line and in particular the
gingival sulcus. Oral hygiene instruction will consist of the best toothbrush to use, the actual
method of brushing and the use of supplementary oral hygiene devices such as dental floss
or interdental brushes.
Phase number two
The second phase consists of any conditions or secondary Factors in your mouth which
make plaque accumulations worse, or oral hygiene more difficult to achieve. These
secondary factors are commonly the build up of tartar or calculus in your mouth. Tartar or
calculus is simply plaque that has been there for a while and it absorbs calcium ions from the
saliva hence it becomes hard and attaches itself onto your teeth. Tartar or calculus attract
more plaque so that is why it is important to make sure that your mouth is clean of tartar or
calculus. Your dentist will accomplish this by carrying out a scale and polish. Scaling is
simply the removal of tartar or calculus and is either carried out by hand instrumentation or
more commonly by using an ultrasonic scaler. Ultrasonic scalers are very effective, quicker
and less uncomfortable than hand scaling. however your dentist or hygienist may prefer one
over the other. This second phase will also include looking at other factors in your mouth
which are causing plaque to become trapped or accumulate. these plaque trapping factors
could be rough edges of fillings, filling overhangs, poorly contoured crown margins, Lack of
Good Contact points between teeth resulting in food impaction, denture accumulation factors

3. and braces. The treatment of these is individual depending on what the exact problem
actually is.
Phase number 3.
The final phase in the treatment of gingivitis is Regular reviews by your dentist. After a
patient has been treated for gingivitis, we commonly review the patient in 8 to 12 weeks.
This has the advantage of making sure that the patient has had enough opportunity
themselves to remedy the oral hygiene advice but also as the time period is short enough to
maintain their motivation and give further advice as necessary. During this Final phase, it is
also necessary to carry on with scaling and polishing to remove the secondary factors
causing gingivitis.
How do I know if I have gingivitis?
As a patient, you will notice bleeding when you are vigorously brushing. Your gums may also
feel painful or sore when bleeding and bad breath could also be evident.
As a dentist, we use a special probe called a periodontal probe and this is passed gently in
the gap around the neck of a tooth between the enamel and gum line into a space called the
gingival sulcus. If any inflammation due to gingivitis is present, bleeding will be elicited from
the gingival sulcus. The bleeding may be spontaneous or it may be delayed depending on
the severity of the gingivitis. In addition, the other sign is the appearance of the gum itself
which will be often more red in appearance and appear swollen.
Nearly all cases of gingivitis have a 100% success rate at our clinic depending on patient
motivation and their ability to keep up with their review appointments.
How do I know if I have chronic periodontal disease?
Chronic periodontal disease or periodontitis will have all the signs that gingivitis has but
there will also be additional very important factors.
These additional important factors will be gum recession. Gum recession occurs in chronic
periodontal disease because the actual periodontal tissues are irreversibly broken down.
Periodontal disease causes damage which is irreversible which means that it is important to
recognise and treat early so that further damage can be stopped.
if the periodontal disease is allowed to linger even for longer, it will then result in gaps
between the teeth, teeth being mobile and eventually gum abscesses causing tooth loss.
The gum recession will be accompanied naturally by sensitivity to hot, cold and sweet
substances due to the exposure of dentine.

4. As a dentist, all patients are screened for gum disease or chronic adult periodontitis. Firstly,
the visual appearance of the gums will typically be swollen gums, gum recession, gaps
between teeth and tooth mobility.
Secondly, a periodontal probe is used to measure probing depth or pocket measurement
along the gum line of each tooth. The readings are noted and analysed.
Thirdly dental X-rays or radiographs are taken to assess alveolar bone levels and the
presence of infrabony pockets.
What is the treatment of gum disease?
This is divided into 3 stages.
Stage number 1.
The first stage is same as in gingivitis where the patient is instructed in oral hygiene
education.
Stage number 2.
Any secondary plaque accumulating factors are addressed as in discussion of gingivitis
above.
This stage also involves deep cleaning under the gum line into the periodontal pockets. This
deep cleaning will also be known as root surface debridement or root planing. It is mostly
carried out under a local anaesthetic has the inflammation will generally make your gums too
sore and painful to withstand the rigors of a ultrasonic scaler under the gum line.
This deep periodontal cleaning is done in several stages doing a few or several teeth at a
time over more than one visit.
Not all cases of periodontal disease respond immediately.
Some patients, does not respond at all and may need specialist referral.
Stage number 3.
stage number 3 involves carrying out pocket depth measurements again in order to compare
them with the original readings to see if any improvement has occurred.
This stage will also give the dentist an opportunity to assess the patient’s oral hygiene and
recommend further changes. Finally, it is at this stage where there are review appointments
which are decided with the patient.
Your dentist will also discuss any systemic factors which have an influence on your gum
disease. These are typically smoking and diabetes.

5. Tooth loss from gum disease.
Chronic periodontal disease will result in ultimate tooth loss if it cannot be retreated, does
not become treated or does not respond to treatment.
Treatment is futile if disease has gone to a certain level, it is better to accept the tooth loss
as you have better options for replacement teeth. The reason for that is simply because
parodontitis results in alveolar bone loss which will make future denture, bridgework or
implant treatment more problematic.
It is generally accepted that once the bone levels are reduced by 50% or more, tooth loss
will be inevitable.
Conclusion.
the main points in this article are that bleeding can have different causes and at the earliest
opportunity you should ask your dentist to have a look and advise further. More teeth are lost
through gum disease rather than cavities however, gum disease in many cases can most
certainly be treated. Research also shows that chronic periodontal disease cannot be cured
once you have been diagnosed with the it, but what you can do is to stop the damage from
becoming worse by making your mouth stable again.
Mouthwashes for bleeding gums.
An extremely common question that patients always ask is, which is the best mouthwash to
use for bleeding gums?
To recap what we have already discussed in this article, it is the sticky bacterial film layer on
your teeth which causes bleeding gums. Unfortunately there is no mouthwash that can
actually disrupt this sticky bacterial film Layer on your teeth. This sticky film Layer must be
removed physically by physically brushing your teeth.
this means that using a mouthwash on its own will not remedy your bleeding gums however,
there are mouthwashes which can prevent the amount of plaque building up on your teeth or
by reducing the attachment of the bacteria onto your teeth in the first place. Mouthwashes
such as Listerine actually kill some of the bacteria which are implicated in dental plaque and
therefore by definition the amount of the bleeding will also be reduced. Another mouthwash
is called corsodyl which contains chlorhexidine. It attaches onto enamel surfaces and
prevents the further build-up of dental plaque. However for it to work the tooth enamel
surface must be clean and plaque free in the first place.
in conclusion, mouthwashes do have a place in the treatment for bleeding gums however
their function is secondary. Their function is secondary because it cannot be replaced by
effective oral hygiene measures such as toothbrushing, flossing and using interdental
implements. The function of mouthwash can also not be replaced by professional scaling

6. polishing and removal of any secondary plaque accumulating Factors in your mouth.
Therefore mouthwashes have a secondary function in the treatment for bleeding gums.