When you build a house, you need great foundations. The foundations ensure stability, strength and longevity.

The gums are the foundations of the teeth. Healthy gums ensure that the natural teeth and any fillings, crowns, bridges or dental implants have the best chance of lasting a long time. Additionally, the mouth is the gateway to the rest of the body so having an unhealthy mouth can be detrimental to general health. 

What does it mean when the gums bleed?

The gums have early warning signs that they are unhealthy - swelling and bleeding. You might notice bleeding when you brush your teeth, floss or even eat. If this bleeding is allowed to persist it can lead to gum disease where the gums recede and the teeth become loose, as the bone under the gum breaks down. It is really important to address bleeding gums quickly, before it reaches the bone, because the bone cannot grow back. 

Why do the gums bleed?

The most common cause of inflamed gums is plaque. Plaque is the thin film on the teeth that builds up throughout the day. It is mainly made up of bacteria and is hardly visible at first. It is mainly found where the tooth and gum meet, and may feel a bit “furry” when you run your tongue over it.

Bacteria in the plaque irritates the gums and can cause them to become inflamed and swollen which can then either be seen by redness or bleeding when touched.

There are certain situations where the gums bleed more, which will be explained later in this article. There are also general conditions affecting the body that negatively influence gum health which will we will also explore.

How does smoking influence gum health?

Smoking masks signs of gingival inflammation and bleeding. This is because the small blood vessels pull away from the surface of the gum due to the localised effect of the smoke. Smoking also increases the risk of developing gum disease by 10 times! The combination of masked inflammation and increased risk often results in smokers having more severe gum disease which can go unnoticed for longer if they are not regularly seeing a dental professional. Treatment for periodontal disease is less successful in smokers, as is the longevity of dental implants.

How do you prevent the gums bleeding?

In most cases the gums won’t bleed if the teeth are cleaned efficiently every day. Getting rid of plaque daily with an effective oral hygiene routine reduces the chance of developing gingivitis and therefore the chance of subsequent gum bleeding is lowered. An effective oral hygiene routine includes toothbrushing (ideally with an electric toothbrush) and cleaning in between the teeth with either floss or interdental brushes. Brushing the teeth right down to the gums is the most effective way to prevent plaque build-up, using a 45degree angle into the gum line. If using a manual toothbrush, use small massaging circular motions with the brush at the gums. If using an electric toothbrush, ensure to keep the brush still at the gum line to get the full effect of the vibrations or oscillations of the electric brush. In both techniques it is important to brush one tooth at a time and not scrub backwards and forwards.

Mouthwashes should not be used as a replacement to brushing or flossing the teeth, that would be like using a perfume or aftershave without showering! A mouthwash might make things feel fresher temporarily but mouthwashes cannot penetrate the plaque layer. They should only be used at a separate time to brushing otherwise it washes away the ingredients in the toothpaste.

How do you treat bleeding gums?

Once the gums have started to bleed it is important to get on top of a proper teeth cleaning routine. A small amount of bleeding can often be resolved at home with more dedicated and concentrated oral care (i.e. flossing or using interdental brushes daily). If the bleeding persists after one week seek professional help from your dental hygienist.

Dental hygienists are specially trained in the health of the gums; they diagnose and treat gingivitis and periodontal disease. They will assess the oral health using a combination of visual examination, probing of the gums to check for bleeding and “pockets” and possibly x-rays to assess bone levels. Gingivitis and Periodontal disease can only be diagnosed by a dental professional. This is why it is so important to regularly attend a dental practice to ensure any issues are caught and treated early.

A dental hygienist will normally give the teeth a thorough professional clean (scale and polish) at your appointment to get rid of remaining plaque, any harder calcified deposits and lift any staining off the teeth. They will also help you get to grips with an effective oral hygiene routine to do at home.

They can either be seen alongside a general dentist appointment or can even be booked independently without the need for seeing a dentist first. Most people should attend a dental hygienist appointment every 6 months as a matter of course, although there are situations where more frequent visits may be needed.

If the gum inflammation is more advanced more than one appointment might be needed to get things back on track. If periodontal disease has started to set in and destroy the surrounding bone it may be necessary to have a course of “periodontal therapy” which is deep cleaning under the gums over a few appointments usually with local aesthetic injections. This is to clean out bacteria and harder deposits from under the gums to give them a chance to heal. Patients having undergone this treatment should see their dental hygienist every 3 months.

Lots of people misguidedly turn to mouthwashes and other topical adjuncts when faced with gum bleeding. This is inappropriate because the bacteria that cause gum inflammation are chemically resistant but physically vulnerable meaning that they are much more effectively dealt with, by proper cleaning with tooth brushes and interdental cleaning! Mouthwashes, gels and other topical formulations should only be explored on the guidance of your dental professional once mechanical cleaning is at the best it can be.

Conditions and Medications

There are things that can make bleeding gums worse, these include;

Pregnancy - Due to hormonal fluctuations the gums can over react to plaque. This is known as pregnancy gingivitis. Pregnancy can also contribute to the formation of localised gum swellings that look like raspberries – these are known as pregnancy epulis. Both occur more in the first trimester and often resolve after the baby is born. Oral care at home should be kept up or even increased during pregnancy and it is advisable to see your dental hygienist during this time to help combat any gum inflammation.

Certain Medications -  These can either cause the gums to bleed or make the bleeding worse. The following are some examples (but not an exhaustive list):

• Oral Contraceptives -  The hormone progesterone in “the pill” can make the gum tissues more sensitive to irritants in the mouth such as food or plaque - this makes the gums bleed more.

• Anticoagulants (e.g. Aspirin or Warfarin) - Often used for people at higher risk of heart attacks or strokes to make the blood thinner, thus reduce the risk of clotting. This makes the gums more likely to bleed and to bleed for longer.

• Antidepressants - These have a negative impact on bone health, increasing the risk of developing gum disease and dental implant failure. These medications can also cause dry mouth, which can increase gum bleeding and worsen gum disease.

• Blood Pressure Medications -  Calcium channel blockers, beta blockers, and diuretics are prescribed for the treatment of high blood pressure. These medications sometimes cause over-growth or swelling of the gums. This swelling may cause the gums to bleed or make it difficult to clean the teeth properly.

Systemic Diseases - There may be other reasons why the gums are bleeding; this is why it is important to discuss your oral health with your dental professional on a regular basis.

• Diabetes - Bleeding or swollen gums can be a warning sign of type 1 or type 2 diabetes. In this case the mouth isn't as powerful at fighting bad bacteria, so gum disease is more likely. Also, the high blood sugar levels in diabetes patients makes it harder for the body to heal, which can make gum disease worse.

• Leukaemia - Bleeding gums can be a sign of this cancer. Blood platelets help the body stop bleeding, in leukaemia, the platelet count is low. This makes it harder for the body to stop bleeding including your gums.

• Haemophilia or Von Willebrand Disease - If someone has bleeding gums or heavy bleeding when they get a small cut or have dental work, it may be a sign of a disorder like these. With these conditions, the blood doesn't clot properly, so the gums bleed more.

• Vitamin Deficiencies - Vitamin C helps tissues grow and repair, healing wounds and strengthening the bones and teeth. If the body doesn't have enough vitamin C, it can cause weakness and irritability. Over time, the gums can swell and bleed. Vitamin K helps the blood to clot properly so deficiencies can be more severe. If there isn’t enough of this vitamin in the diet or the body doesn't absorb it well, it can cause bleeding problems.

An important take home message is that bleeding gums are not normal. It means that they are unhealthy. Ensure that the teeth are efficiently cleaned every day with a toothbrush and interdental cleaning methods. See your dental professionals as often as they suggest as a matter of course. However, if any gum bleeding is not resolved between appointments – for instance, 10 days from increasing your oral hygiene regime, or you are simply worried about your gums – seek the advice of a dental professional.

Want to keep learning? Find more articles from Frances Robinson:

• Meet the Expert - Frances Robinson, Dental Hygienist
• Understanding The Relationship Between Your Diet and Your Oral Health
• Visiting your Dental Hygienist: How They Can Help With Your Oral Health
• HealthHubble Podcast: Introducing Frances Robinson, Dental Hygienist