Bleeding Gums: Causes, Gum Disease and What Helps

Many people notice a little pink in the basin when they brush and think nothing of it, or assume they are brushing too hard. Bleeding gums are so common that they feel normal. They are not. In most cases they are the first sign of gum disease, which is very common and, caught early, very treatable. This guide explains what is happening and what to do.

What causes bleeding gums

Gum disease is caused by a build-up of plaque, a sticky film of bacteria, on the teeth. If plaque is not removed by brushing and cleaning between the teeth, it irritates the gums, which become red, swollen and sore, and bleed easily (NHS). Over time, plaque hardens into tartar (calculus), which a toothbrush cannot remove.

Things that make gum disease more likely include:

• Smoking and tobacco, including gutkha and other chewed tobacco. Poor oral hygiene and tobacco use are the main risk factors for gum disease (WHO).
• Diabetes, especially when blood sugar is poorly controlled.
• Pregnancy, when hormonal changes can make gums more prone to bleeding.
• Crowded teeth, old fillings or crowns with rough edges, which trap plaque.
• Some medicines, and conditions that affect the immune system.

Occasionally, bleeding gums can be a sign of a medical problem, such as a blood disorder or a side effect of blood-thinning medicines. If your gums bleed a lot, bleed without brushing, or you bruise easily, tell your dentist and see your doctor.

Early and advanced gum disease

The WHO estimates more than 1 billion cases of severe gum disease worldwide. In its more severe form the gum can come away from the tooth and bone, causing teeth to loosen and sometimes fall out (WHO). Because it is often painless until late, many people do not know they have it.

Gum disease and diabetes

Diabetes is common, so this link matters for many families in Pune. An international consensus report found that gum disease and diabetes affect each other in both directions: people with diabetes are more prone to gum disease, and gum disease is linked to worse blood sugar control. Gum treatment in people with diabetes was found to be safe and was associated with a modest improvement in HbA1c (a measure of long-term blood sugar) at three months (Sanz et al., 2018).

If you have diabetes, tell your dentist, have your gums checked regularly, and mention any gum problems to your doctor.

How gum disease is treated

Treatment depends on how advanced it is (NHS):

1. 1

   Examination

   Your dentist checks your gums, measures the depth of the spaces (pockets) between gum and tooth, and may take X-rays to look at the bone.

2. 2

   Professional cleaning

   A scale and polish removes plaque and tartar above and just below the gum line.

3. 3

   Home-care coaching

   Advice on brushing, cleaning between the teeth with floss or interdental brushes, and stopping smoking.

4. 4

   Deep cleaning

   For deeper pockets, cleaning of the root surfaces under the gums, usually with local anaesthetic.

5. 5

   Further treatment

   For advanced disease, sometimes antibiotics, gum surgery, or removing teeth that cannot be saved.

6. 6

   Maintenance

   Regular reviews and cleanings, because gum disease can return if plaque builds up again.

What you can do at home

• Keep brushing, even if your gums bleed. Bleeding usually settles as the gums get healthier. Use a soft or medium brush and brush for about two minutes, twice a day, including last thing at night (NHS).
• Use fluoride toothpaste and spit after brushing; do not rinse straight away.
• Clean between your teeth every day. A Cochrane review found that floss or interdental brushes, used with brushing, may reduce gum inflammation more than brushing alone, and interdental brushes may be more effective than floss (Worthington et al., 2019).
• Do not use wooden toothpicks to dig out food; they can damage the gums.
• Stop smoking and chewing tobacco. It is one of the most effective things you can do for your gums.
• Do not use mouthwash straight after brushing, as it washes away the fluoride from the toothpaste. Use it at a different time if you use one.

When to see a dentist

See a dentist if your gums bleed when you brush or eat, are painful and swollen, or you have bad breath. Ask for an urgent appointment if your gums are very sore and swollen, teeth are becoming loose, or you notice ulcers, red patches or a lump in your mouth or on your lip (NHS).

This article is general information, not a diagnosis or treatment plan. What suits you depends on an examination at the clinic, and every treatment plan and cost is explained before treatment begins.

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