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Bleeding gums: causes and therapy

by Josephine Andrews
Published: Last Updated on 196 views

Bleeding gums are usually caused by a lack of oral hygiene: If there is blood on the toothbrush when brushing your teeth, it is often only a slight inflammation of the gums (gingivitis) that is the reason. It becomes more dangerous when an inflammation of the entire periodontium (periodontitis) is behind it. Read more about these and other causes of bleeding gums, what can be done about them and whether bleeding gums are dangerous.

quick overview

  • Causes of bleeding gums: often (bacterial) inflammation of the gums or inflammation of the periodontium ( periodontitis ), sometimes also other diseases (fungal infection, viral infection, diabetes, leukemia, etc.), nutrient deficiency, mucosal injuries, medication or hormonal influences (e.g. during pregnancy)
  • What to do if gums bleed? Depending on the cause, you can do something about the bleeding yourself through appropriate oral hygiene, diet and, if necessary, stopping smoking. Periodontitis is treated by the dentist. For other causes, he can consult other specialists.
  • Are bleeding gums dangerous? If periodontitis develops, in which gums and jawbone recede and there is a risk of tooth loss, then yes.

Bleeding gums: causes and possible diseases

The main cause of bleeding gums is bacteria, which usually multiply in the oral cavity due to poor oral hygiene. If they get stuck in the gap between the tooth and gums, inflammation can occur, which is expressed (among other things) by bleeding gums:

gingivitis

This is a superficial inflammation of the gums, which can be remedied by thorough cleaning. The gums are usually swollen and red in this case; a deepened gap between the tooth and gums (called a sulcus) is evident, and gum bleeding occurs.

Chronic periodontitis

In periodontitis, the entire periodontium is inflamed. The gums recede and the jawbone shrinks. If left untreated, the affected teeth can become loose and even fall out. Chronic periodontitis is usually purely bacterial and the result of unresolved gingivitis. If the patient cooperates well (careful oral hygiene!), bone and gum loss can be stopped (but not reversed).

Periodontitis is one of the most common chronic diseases worldwide. In Germany alone, around 11.5 million people suffer from it.

Aggressive periodontitis

This form of gingivitis usually occurs at a fairly young age (often before the age of 30). It is caused by very aggressive bacteria and is therefore particularly dramatic and fast. Without therapy, all teeth can fall out within about two years! Severe bleeding of the gums, swelling or reddening of the gums are rather rare here.

It has not yet been fully clarified why particularly aggressive bacteria multiply in the oral cavity of some people. Often, however, several members of a family are affected by the aggressive periodontitis and there are defects in the immune system.

NUG and NUP

NUG stands for Necrotizing Ulcerative Gingivitis. This rare but sudden onset disease begins with a painful inflammation in the interdental space, which then quickly spreads to the gums. Severe bleeding of the gums, yellow, greasy deposits on the gums, dying (necrosis) of gum tissue and bad breath are signs of a NUG. Younger people in particular are affected. Risk factors include poor oral hygiene, smoking and stress. But NUG is also often observed in people infected with HIV and in people in developing countries.

In the case of NUP (necrotizing ulcerative periodontitis), a loss of bone substance in the jaw can also be observed.

Bleeding gums from other diseases

But not only bacteria in the oral cavity can cause bleeding gums. Sometimes bleeding gums can also be a sign of a disease affecting the whole body or a deficiency. Examples are:

  • Diabetes mellitus: In diabetics, not only the sugar level in the blood but also in the saliva and in the sulcus fluid is increased. Due to the rich food supply, the bacteria in the mouth multiply, which promotes tooth decay and periodontitis. In addition, the immune system is weakened in diabetics with poorly adjusted blood values. This allows the bacteria to multiply even more easily. In addition, the ability of the periodontium to regenerate is reduced.
  • Leukemia: Signs of ” blood cancer ” can include frequent bleeding gums and nosebleeds. The reason for this is that the white blood cells produced in excess in the patients crowd out the healthy blood cells – including the platelets (thrombocytes). Blood clotting suffers as a result – the tendency to bleed is increased.
  • Nutrient deficiency: Malnutrition , anorexia or strong alcoholism can result in a protein or vitamin C deficiency (scurvy). Bleeding gums and receding gums are typical signs of this.
  • Viral infections: Infections with herpes viruses, the Epstein-Barr virus or cytomegalovirus often lead to changes in the mucous membranes. Rarely they express themselves through bleeding gums, especially in children.
  • Fungal infections: The yeast Candida albicans can also affect the gums. Typical of this are white, wipeable deposits on reddened, bleeding gums.
  • HIV: The gums of people infected with HIV often redden, swell and bleed.
  • Blood clotting disorders: Changes in blood clotting caused by blood-thinning medication such as heparin or coumarin, but also bleeding disorders such as hemophilia A or a lack of coagulants can cause severe bleeding from the gums.
  • Allergies: Hypersensitivity to dental materials (e.g. for prostheses) can cause local bleeding of the gums. It subsides again when the dentist removes the material in question.
  • Injuries: These include chemical burns to the mucous membrane.

Hormonal influences

Bleeding gums are also often hormonal. Fluctuations in the hormonal balance lead to gum bleeding and gum swelling, especially during puberty or pregnancy. The reason is that some hormones loosen the gums, making it easier for bacteria to enter. One distinguishes:

  • pregnancy gingivitis
  • pubertal gingivitis
  • Bleeding gums during the menstrual cycle or when taking the pill

Bleeding gums from medication

Various medications can also cause the gums to swell and bleed – especially in the area of ​​the incisors:

  • Antiepileptic drugs: Phenytoin , a commonly used antiepileptic drug , can cause gum proliferation, especially in high doses .
  • Immunosuppressants: Drugs that suppress the immune system, such as cyclosporine A, are given after organ transplants and to treat autoimmune diseases. They can cause bleeding gums as a side effect.
  • Antihypertensives: So-called calcium antagonists (such as nifedipine or verapamil) can cause the gums to grow, which increases the risk of plaque and gingivitis.
  • Hormonal contraceptives: Hormonal contraceptives (such as the pill) cause hormone changes similar to those found during pregnancy. Bleeding gums can result.

What to do if gums bleed?

Depending on the cause of the bleeding gums, either you and/or your (dentist) doctor can do something about it.

Bleeding Gums: You Can Do It Yourself

If the bleeding gums are caused by bacteria, you can and must take action yourself:

  • Proper brushing: Let the dentist show you the correct tooth brushing technique. Most often, experts recommend the so-called bass technique (vibration method), which is suitable for both healthy and diseased gums. It is best to use a soft toothbrush. It thoroughly removes plaque without further irritating the gums.
  • Interdental cleaning : With dental floss you can remove plaque from the areas between the teeth that you cannot reach with a toothbrush. The dentist will show you how to do this and what type of dental floss is suitable. As an alternative to dental floss, you can use interdental brushes in different sizes, for example.
  • Don’t stop if it bleeds: It can easily start bleeding, especially if you “thread” the dental floss correctly. Many are put off by this and henceforth refrain from cleaning the interdental spaces. The bleeding here is usually the sign of inflamed gums – and only goes away in the long term when “everything is clean” in the mouth again.
  • Quitting smoking: Tobacco consumption has been proven to be one of the biggest causes of bleeding gums. Not only do smokers have more tartar and plaque, they also have an increased risk of severe periodontitis. The only thing that helps here is stop smoking.
  • Professional teeth cleaning: You should have your teeth professionally cleaned at least twice a year. The dentist removes tartar and plaque that cannot be removed by brushing your teeth. This means that bacteria no longer have any other surface to attack.
  • Eat sugar-free: Sugar encourages the growth of bacteria that not only cause tooth decay but also bleeding gums. Above all, avoid a lot of small sugary snacks – or always keep a dental care chewing gum at hand.
  • Disinfectant mouthwashes: Chlorhexidine is a tried and tested remedy against germs and is contained in many mouthwash solutions. You can also disinfect your oral cavity in a natural way – with sage tea or myrrh tinctures (in addition to daily oral hygiene).

Bleeding gums: That’s what the doctor does

The first point of contact for bleeding gums is your dentist. In the patient interview (anamnesis) he asks, among other things:

  • whether you have a general illness such as diabetes mellitus, bleeding disorders, heart disease or osteoporosis .
  • whether and which medications you are currently using.
  • since when you have bleeding gums, in what form it occurs (e.g. only sporadically or frequently, lightly or severely) and whether you are in pain.
  • what your lifestyle looks like (e.g. current stress levels, eating habits).
  • whether and how much you smoke.
  • (for women:) whether you are pregnant or when you had your last period.

This is followed by an examination of the teeth and oral cavity : the dentist carefully examines each individual tooth for caries and loosening and takes a close look at existing fillings, crowns or dentures . Because crooked teeth, protruding tooth fillings or tooth position errors create niches that are difficult to clean. This can lead to increased bleeding gums.

The dentist can assess the health of the gums by means of a few special examinations. It is often easy to see whether the gums are swollen, reddened or bleeding. The dentist also uses the probe to measure whether there is receding gums and whether the gap between the tooth and gums (sulcus) is deepened. If bleeding occurs during this examination, this is often a sign of inflammation.

In the case of chronic or aggressive forms of bleeding gums, the doctor will take x-rays of the jaw. They show a possible reduction in the jawbone. Regular X-rays are also useful for monitoring the course of long-term therapy.

If the periodontitis does not respond to dental therapy, the dentist can also take a smear of the pathogen in the gap between the gums and the tooth (sulcus). Taking antibiotics can often stop further gum and bone loss.

Further examinations (by other specialists) are useful if general physical illnesses such as diabetes are the cause of bleeding gums. In such cases, appropriate therapy is initiated.

treatment of periodontitis

If the dentist determines periodontitis as the cause of bleeding gums, special treatment makes sense. Here, bacteria have settled so deep in the gap between the gums and the tooth that they can no longer be removed even by thorough brushing of the teeth. That’s why the dentist has to go. This applies all the more to the rare, aggressive form of periodontitis, which affects young people in particular and can quickly lead to tooth loss.

Bleeding gums: when do you need to see a doctor?

Healthy gums don’t bleed! Since poor oral hygiene is often the reason for bleeding gums and if you have no diagnosed diseases or the symptom appeared after taking certain medications, first try to clean your teeth better and talk to your dentist about bleeding gums at the latest at the next check-up appointment . Regular professional tooth cleaning and the right cleaning technique at home can often help here.

In the following cases, however, you should see your dentist/doctor immediately:

  • Bleeding gums last a particularly long time or are very severe.
  • The gums are swollen, very red or visibly changed.
  • You have severe gum pain, possibly accompanied by yellow plaque on the gums, bad breath and fever.
  • In addition to bleeding gums, you have general symptoms such as fever, unusual tiredness and/or increased susceptibility to infections .

Are bleeding gums dangerous?

Bleeding gums are dangerous in that it is always a sign that something is wrong. The gums are basically quite robust in order not to be injured when chewing hard food. If the gums still occasionally bleed, this is often due to inflammation of the gums (gingivitis), which you can usually heal yourself with thorough oral hygiene.

Bleeding gums as a result of inflammation of the entire periodontium (periodontitis) are more serious: the teeth can fall out due to the breakdown of bone tissue in the jaw. So always take bleeding gums seriously and visit the dentist once too often rather than risk permanent damage.

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