Sore and bleeding gums are a widespread dental problem. Most individuals, however, tend to ignore this sign and pay attention only when it starts to pain. Bleeding gums are a sign of gum disease. It can have multiple causes, the most common cause of bleeding gums is gingivitis. Gingivitis is inflammation of the gums.  Improper brushing, scurvy, nutritional deficiencies, systemic conditions like diabetes can all cause bleeding gums. Certain medications such as phenytoin can also cause gingivitis. Hormonal changes, pregnancy, certain oral infections are all predisposing factors for gingival bleeding.

Bleeding from gingiva can only occur in the presence of plaque and tartar. Effective brushing and flossing will thus prevent the chances of bleeding gums. Regular scaling in the dentist’s office is the best way to maintain optimal gum health.

Let us see how to stop bleeding gums and what are the leading causes with signs and symptoms.

Bleeding gums causes

Plaque and tartar deposits

Long-term deposition of plaque causes gingivitis which is the most common cause of bleeding gums. Marginal gingivitis due to plaque and tartar is often asymptomatic and bleeds under pressure. When not treated in due time, this gingivitis can proceed to periodontitis.

Improper brushing technique

Brushing too hard abrades the gingiva. When too much pressure is applied during brushing on a daily, gingival abscess can also form. Gum injury due to extremely vigorous brushing or flossing can develop gum inflammation.

Nutritional deficiencies

Deficiency of vitamin C, causing scurvy, leads to bleeding gums. Scurvy causes swelling of the gums throughout the mouth (1). This leads to deposition of food particles in the pockets that develop leading to bleeding. Pellagra caused due to niacin deficiency also affects the gum health.

Systemic diseases

Systemic diseases, such as thyroid disorders, nutrient deficiencies, diabetes can contribute to various gum diseases. Uncontrolled diabetes contributes to periodontitis which can cause spontaneous bleeding of gums (2). Bleeding or clotting disorders can aggravate bleeding due to gingivitis (3).

Medications

Certain medications, including phenytoin, birth control pills can cause pseudo gingivitis (4). Blood pressure medications on long-term use can have some permanent changes in the gums.

These changes in the gum make it difficult to maintain adequate cleanliness leading to deposition of plaque and tartar. Taking blood thinners or other medications can also cause spontaneous bleeding of gums (5).

Malposed teeth

Misaligned teeth are difficult to clean. Due to this difficulty in cleaning they easily develop pockets and gum diseases. In sum cases, gum abscess can also form due to overlying of the tooth.

Gingivitis may occur in the gums surrounding an impacted tooth. This condition, called pericoronitis is frequently seen with the wisdom teeth.

Improper restoration

Ill-fitting crowns, bridges, and braces, or rough edges of fillings are also predisposing factors for periodontitis. Ill-fitting or unclean mouth appliances and dentures can abrade the gum tissue causing it to bleed.

Hormonal changes

Hormonal changes that occur during puberty and menopause can cause gum sensitivity (6).  Hormonal changes during pregnancy, resulting in pregnancy gingivitis which subsides post pregnancy (7).

Immunocompromised conditions

Chronic debilitating disease such as leukemia and other blood dyscrasias cause gingival inflammation and bleeding (8). Individuals with AIDS also have advanced periodontitis that causes bleeding gums (9).

Smoking and tobacco

Habits such as smoking or chewing tobacco can aggravate any existing gum disease (10). Areca nut chewing, betelnut or any other tobacco products can severely affect the gums.

Infections

Herpes virus causes acute herpetic gingivostomatitis causing severe gingival bleeding. Fungal infections such as candida albicans in the mouth, resulting in candidiasis or thrush may cause gingivitis.

Allergic reactions

Allergic reactions to any food preservatives and chemicals can cause aphthous ulcers on the gums. Heavy metal toxicity due to bismuth and lead can also cause swelling and bleeding of the gums.

Signs and symptoms of gum disease

  • Gum disease can be painless, so it is essential to be aware of any of the following symptoms:
  • Bright red, dusky red gums with a shiny appearance
  • Bleeding gums, even with gentle brushing or touching
  • Tender gums, especially when touched
  • Swollen gums with rolled out gum margins
  • Visible pus surrounding the teeth and gums
  • Gums that recede from the tooth
  • Halitosis or bad breath
  • Loose teeth
  • Mouth sores

Pathophysiology of gum disease

The most common type of gingivitis is marginal gingivitis, and it involves the marginal gingiva. It is brought on by the accumulation of microbial plaque and calculus due to inadequate maintenance of oral hygiene.

Gingivitis is an initial stage which then progresses to advanced disease, periodontitis. The initial stage of an acute inflammatory response begins within four or five days of plaque accumulation.

Both gingival fluid and transmigration of neutrophils increase. Deposition of fibrin and destruction of collagen begin at this stage. At approximately one week, a transition to early lesions occurs.

With time, the lesions become chronic, and as this chronic local inflammation progresses, pockets develop wherein the gingiva separates from the tooth.

These pockets deepen and may bleed during tooth brushing, flossing, and even regular chewing. As this tenacious inflammation continues, periodontal ligaments begin to break down, and destruction of the local alveolar bone occurs.

Teeth loosen and eventually fall out.

How to stop bleeding gums?

The most practical way to stop bleeding gums is to visit your dentist. The dentist will make appropriate diagnosis and advise you the required treatment.

By following the mentioned measures, you can lower the incidence of bleeding gums.

  1. Use a soft toothbrush and brush covering all the areas of your mouth. Brush your teeth for at least two minutes, twice daily and after meals. Hard brushing can damage the soft tissues of your mouth, so brush with gently without applying too much force.
  2. Flossing should be done at least once a day. Learn the proper flossing technique from your dentist.
  3. Rinse your mouth thoroughly with lukewarm salt water after every meal till the symptoms subside.
  4. Diluted hydrogen peroxide helps to reduce the swelling in the gums and also allows to keep the sulcus clean.
  5. Mouthwashes containing alcohol should be avoided as they can dry out your mouth. Opt for prescription mouthwashes instead.
  6. You must avoid smoking, betel nut, areca nut and other tobacco products which can aggravate bleeding gums.
  7. Eat a balanced diet with adequate vitamins and minerals. Supplement vitamin B and C in the diet. Limit snacking between meals. The bacteria present in dental plaque feed on the carbohydrates and sugars and causes gingivitis.
  8. Try an oral irrigation device, commonly known as a water pick helps clear debris from around the gum line.
  9. If you have ill-fitting dentures get them aligned to prevent trauma to your gums.
  10. Clean your dental appliances and retainer regularly and maintain adequate hygiene.

Final words on how to stop bleeding gums

Bleeding gums should never be ignored. It can be a sign of developing gum disease. If you find your gums bleeding frequently, the gum disease could have been advanced. The best protocol to follow is to brush twice daily.

Visit your dentist every six months for your routine scaling and polishing. Avoiding sugary food and drinks, eating fresh fruits and vegetables and cutting down on processed food and carbonated beverages will prevent the plaque bacteria from growing.

Avoid smoking and tobacco consumption as it can have detrimental effects on the gums.

Improper brushing, nutritional deficiencies, smoking, etc. can cause bleeding gums. Hormonal changes, pregnancy, certain oral infections are all predisposing factors for gingival bleeding. Effective brushing and flossing can stop bleeding gums.