The Causes Of Bleeding Gums

The causes of bleeding gums are related to oral disease and inflammation

"Have you noticed that your gums bleed when you brush or floss?" This is one of the most important questions dental professionals ask during the course of a dental appointment. The answer gives us an indication of the general level of health and disease in a person's mouth. From there we can further investigate the probable causes and direct our attention to reversing the disease process before it becomes irreversible. By effectively addressing the causes of bleeding gums, the infection is generally easy to reverse when caught early.

Bleeding gums are by far the most common symptom of oral disease that we see in dental practice today. It is so prevalent, in fact, that 60-70% of the entire population is currently suffering from this symptom of oral disease. The prevalence of gum disease increases in areas with low dental knowledge, poverty, and inadequate access to dental care. However, people from all walks of life are affected by bleeding gums and oral disease.

When caught early enough gum disease is completely reversible and need not progress to anything more serious. However, when allowed to progress, gum disease can eventually lead to more serious whole body damage. The symptoms of advanced gum disease are oral bone loss, loose teeth, tooth loss, chronic systemic inflammation and disease, chronic local and systemic infection, systemic toxicity, and in extreme cases death.

Gum Infection Symptoms

Bleeding gums are the result of prolonged irritation

The cardinal signs of inflammation are calor (heat), rubor (redness), tumor (swelling), dolor (pain), and when left long enough, functio laesa (loss of function.)

One or all of these gum infection symptoms may be present, but generally speaking it's a combination of a few of these symptoms.

Warning signs that you have an infection:

Gums that bleed when brushing or flossing
Gums that spontaneously bleed without being touched
Red, swollen, shiny, tender, and/or painful gums
Pus at the gum line when the gums are pressed
Gums that have pulled away from the teeth
Pain and sensitivity of the gums when brushing and flossing
Burning, tingling sensation, especially at the gum line and between the teeth

The Causes Of Bleeding Gums Are Related To Oral Disease And Inflammation

Healthy gums (above) vs. Infected gums (below)

The causes of bleeding gums are the result of a prolonged period of irritation of the gum tissues surrounding the teeth. Bleeding gums are the #1 indicator of gum disease; therefore healthy tissues will not bleed when you brush or floss.

When allowed to rest on the gum tissues undisrupted, plaque biofilm causes changes in the surrounding tissues. Plaque is made up of billions of oral bacteria that consume fermentable carbohydrates and excrete lactic acid and toxic byproducts into the surrounding tissue environment.

When the gum tissues have been continually subjected to lactic acid and exotoxins over a period of days, lesions begin to form within the gum tissues. Inflammatory mediator cells are sent throughout the body in response to the infection, which causes a cascade of systemic inflammation.

When left long enough this chronic inflammation contributes to the development of systemic diseases (diabetes, heart disease, etc.)

The longer plaque is allowed to irritate the gum tissues, the better environment it makes for worse and worse bacteria to move in (anaeorobic bacteria that excrete endotoxins.)

Over time the bacterial infection of the gums will progress from gingivitis (reversible, no bone loss) to periodontitis (not reversible, bone loss, tissue loss, tooth loss.) By removing the causes of bleeding gums, the tissues will heal relatively quickly.

How To Stop Bleeding Gums

Tilt the bristles of the brush into the gum line at a 45° angle

Bleeding gums treatments all involve maintaining a clean oral environment, free from plaque bacteria and toxic irritants. The main causes of bleeding gums are constant irritation from plaque at the gum line, causing an inflammatory cascade throughout the body.

Contrary to popular belief, if your gums are bleeding you do not want to stop brushing or flossing, but the very opposite: continue brushing and flossing. The active bacterial infection is due to undisrupted plaque sitting against the gum tissues. When plaque is continually dislodged and disrupted, tissues have time to breathe and will begin to heal.

One of the most common complaints is that the person is brushing, but they still get gingivitis or periodontitis. This is because most people don't properly brush the gum line and plaque continues to irritate the gums. It can be argued the gum line is more important to keep clean than the teeth themselves, as the end result of advanced gum disease is rampant tooth loss. Read on to learn proper brushing techniques!

Steps to proper oral hygiene:

1. Brush twice daily using a soft-bristled brush, preferably a Sonicare or other electric toothbrush

2. Soften the bristles with warm/hot water prior to brushing the teeth and gums. Do not skip this step, and avoid using cold water. Cold water stiffens and toughens the bristles, often causing more harm than good to the sensitive gum tissues

3. Tilt the bristles of the brush into the gum line at a 45-degree angle; this means tilt the bristles slightly upward on the upper teeth, and slightly downward on the lower teeth. Some of the bristles will go below the gum line, cleaning the area free from plaque

4. The goal is to gently massage the area where the gums meet the teeth all the way around all the teeth (top, bottom, insides)

5. Follow with a Waterpik water flosser to dislodge plaque at the gum line. This has been proven easier and 60% more effective at removing interproximal and gum line plaque than traditional string floss

6. Scrape your tongue using a tongue scraper. The tongue is like a bacteria sponge in the mouth, releasing bacteria back into the oral environment despite brushing. Stainless steel tongue scrapers like the one Dr Tung's makes is ideal and lasts for years

7. Use an oral mouth rinse that contains essential oils and does not contain alcohol. I recommend Listerine Zero. The teeth represent just 20% of the surface area in the mouth, with the oral tissues contributing 80%. Oral rinse removes these bacteria from the tissues and tongue to help decrease the bacterial load in the mouth

By following this routine, you will resolve the causes of bleeding gums (gingivitis) and its associated symptoms should resolve in 7-10 days. Consult with your dental hygienist if the bleeding persists, as bleeding gums may be a sign of more severe gum disease, or periodontitis. Periodontitis must be managed with the help of trained dental professionals and will not resolve on its own.

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