Bleeding on probing is an early sign of gingival inflammation and is commonly used to assess periodontal disease status. It occurs when increased crevicular fluid and breakdown of gingival tissues due to inflammation allows blood vessels to rupture upon gentle probing. Local factors like poor oral hygiene and systemic conditions like vitamin deficiencies or coagulation disorders can contribute to abnormal gingival bleeding. The bleeding point index is used to evaluate gingival inflammation by recording the number of bleeding sites after probing specific areas in the mouth.

1. Bleeding on
probing
Guided by: Dr. Mayank Parmar
Dr. Bansari Shah
Dr.Mayur Parmar
Prepared by: Meera Dobariya

2. Content
 Introduction
 Gingival bleeding on probing
 Local factor
 Systemic factor
 In diagnosis
 bleeding point index
 Conclusion

3. Introduction
 The bleeding on probing is a widely used
clinical sign as indicator of the periodontal
condition & disease progression.

5. Gingival bleeding on probing
 The two earliest signs of gingival inflammation
preceding established gingivitis are
1. Increased gingival crevicular fluid production
rate.
2. Bleeding from gingival sulcus on gentle
probing.
 It has been shown that bleeding on probing
appears earlier than a change in color or
other visual signs of inflammation.
 Gingival bleeding on probing indicates an
inflammatory lesion both in the epithelium &
in the connective tissue.

7. Local factor associated with BOP
 Contributing factors to plaque retention may lead
to gingivitis & ultimately leads to gingival bleeding
on probing.
 Example: caries,malpositioned teeth, mouth
breathing, partial dentures, lack of attach
gingiva,orthodonic treatment & fixed orthodontic
treatment.
 CHRONIC & RECURRENT BLEEDING:
 Most common cause is inflammation.
 Bleeding is chronic or recurrent & is provoked by
mechanical trauma.
 e.g.: from tooth brushing, toothpicks or food impaction.
 it also occur by biting in to solid food such as apple.

8.  Histological evaluation revealed that in early stages of
gingivitis, cytokines are responsible for connective tissue
breakdown.
 Matrix metaloproteinases also play a role in tissue
breakdown.
 Histopathologic alteration that result in abnormal gingival
bleeding include dilatation & engorgement of the capillaries &
thinning or ulceration of the sulcular epithelium.
 After the vessels are damaged & ruptured interrelated
mechanism induce hemostasis.
 Vessel wall cntract,blood flow diminishes,blood platelets
adher to the edges of the tissue , & a fibrous cloat is
formed,which contracts & results in approximation of the
edges of the injured area.bleeding recurs when the area Is
irritated.
 In case of moderate or advanced periodontitis the presence
of bleeding on probing is a sign of active tissue destruction.

9.  Laceration of gingiva by toothbrush bristales
during aggressive toothbrushing or by sharp
pieces of hard food can cause gingival
bleeding even in the absence of gingival
disease.
 Gingival burn from hot foods or chemicals
increases the ease of gingival bleeding,.
 Spontaneous bleeding or bleeding on slight
provocation can occur in ANUG.

10. Acute necrotizing ulcerative gingivitis
Gingival burns

11. l SYSTEMIC FACTOR:
• Hemorrhagic disprdets in which abnormal gingival
bleeding is encounterd include:
1. Vitamin C deficiency(scurvy):interdental &
marginal gingiva is bright red with
swollen,smooth,shiny surface.in fully develope scurvy
gingiva becomes boggy,ulcerated & bleeds.
2. Platelet disorders(thrombocytopenic purpura):
abnormalreduction in number of circulating blood
platelets.so patient develops focal hamorrhage into
tissue & organs,including skin & mucous membrane.
3. Vitamin K deficiency:it is involved in prothrombin
synthesis. It also regulates the level of factorVII,IX &
X(proconvertin,Christmas factor & Stuart-Prower
factor, respectively.)So leads to gingival bleeding.

12. Oral manifestation of scurvy Oral manifestation of purpura

13. 4. Other coagulation defects:
 Hemophilia: characterized by prolonged coagulation time
& hemorrhagic tendencies. Gingival hemorrhage may
massive & prolonged.
 Leukemia: progressive overproduction of white blood
cells which usually appear in circulating blood in an
immature form. Oral manifestations are gingivitis, gingival
hyperplasia, hemorrhage & ulceration of the mucosa.
 Christmas disease: Also known as Hemophilia B,in which
deficient level of coagulant factor IX(Christmas factor).
5.The effect of hormonal replacement therapy, oral
contraceptives, pregnancy & the menstrual cycle
are also reported to affect the gingival bleeding.
6.Diabetes: marked inflammation affects both epithelium &
C.T., which leads to destruction of reticulin fibers.
7.Medication: Anticonvulsant, antihypertensive &
immunosuppressant are known to cause gingival
enlargement.

14. Drug induced gingival enlargement
Gingival inflammation in pregnancy
Hemophilia Leukemia

15. In diagnosis
 The insertion of probe to the bottom of the
pocket elicits bleeding if the gingiva is
inflamed & the pocket epithelium is atrophic
or ulcerated.
 To test for bleeding, the probe is carefully
introduced to the bottom of the pocket &
gently moved laterally along the pocket wall.
 Sometimes bleeding appears immediately
after removal of the probe; other times it
may be delayed for a few seconds.
 Therefore rechecking for bleeding 30 to 60
seconds after probing.

17. Bleeding point index
 It is used for evaluation of gingival inflammation.
 For record the index retract the cheek & place the
periodontal probe 1mm into the sulcus or pocket at the
distal aspect of the most posterior tooth in the quadrant on
the buccal surface.
 Carry the probe lightly across the length of the sulcus to the
mesial interproximal area on the facial aspect.
 Wait for the 30 sec. & record the presence of bleeding on
the distal, facial & mesial surface.
 Repeat the same for palatal/lingual surface.
 Percentage of the number of bleeding surfaces is calculated
by dividing the number of the surfaces that bled by the total
no. of tooth surface(4 per tooth) & by multiplying by 100.
 Goal of 10% or fewer bleeding points is good, but 0 is ideal.

18. conclusion
 Bleeding on probing is indicates the
progression of attachment loss.
 If periodontal treatment is successful,
bleeding on probing will cease.