Bleeding gums are one of the first reasons that most people give for not flossing. Gums can bleed at just the beginning stages of infections like gingivitis or be a signal that more serious problems are present. Thankfully, bleeding gums can be reversed fairly easily if care is taken quickly.
What Causes Bleeding Gums
Gums bleed due to the body’s immune system targeting infection or bacteria in the gumline area around the teeth. An increased blood supply in an area of trauma or infection is very common and is often paired with inflammation. Healing simply cannot occur if there is no flow of oxygenated blood to the area where infection is present. Some of the specific causes of gingival bleeding are:
Gingivitis – Initial inflammation due to irritation, plaque buildup, or poor oral hygiene results in gingivitis. The majority of bleeding from flossing or brushing comes from active gingivitis, due to bacteria depositing just under the gums and irregular or improper hygiene. As part of the healing process, bleeding helps cleanse the area and bring a fresh blood supply to the location of the infection so that healing can occur. However, this condition can progress into periodontal disease and irreversible bone loss if it is not treated. With gingivitis, bleeding will usually only occur during brushing or flossing, when the small area of infection is stimulated.
Periodontal Disease – When gingivitis goes untreated, plaque continues to work its way under the gumlines, causing the pockets (sulcus) to become much deeper. Once bacteria have made its way this far, regular oral hygiene usually cannot remove it because it’s impossible to reach. At this point, the gums detach from the surface of the tooth, and bone structure is also permanently lost. Once moderate to severe bone loss has occurred, teeth become mobile and may actually fall out. Unlike gingivitis, periodontal disease can cause bleeding from stimulants other than oral hygiene. Bleeding may occur during chewing, touching the area, or sporadically on its own.
Aggressive Tooth Brushing – Accidental trauma from aggressive brushing can cause injury to localized areas of gum tissue. Healthy gingiva should not ever bleed during proper brushing or flossing, so if generalized bleeding during brushing is a problem, it’s likely there’s an infection. Using medium to stiff bristled toothbrushes can cause enamel abrasion, tissue trauma, and occasional bleeding if the pressure is too firm.
Poor Oral Hygiene – Not removing bacterial plaque on a routine basis will cause an immune response in the body that results in swelling and bleeding. Brushing for too short of a time, and irregular or nonexistent flossing will allow bacteria to secrete byproducts that cause the immune system to target the area where plaque is present. If irregular oral hygiene occurs for several days, bleeding will typically come on fairly easily.
Hormones – Some women find that during hormonal cycles they will experience elevated gum irritation and bleeding. Pregnancy, menopause, or menstrual cycles can bring on gingival bleeding in a small percentage of women. Even women with good oral health may find that their hormone changes affect their gums.
Misaligned Teeth – When teeth are crowded, crooked, have gaps or suffer some other type of misalignment, then they are more difficult to clean around. Misaligned teeth are much more likely to suffer from gum disease, gingivitis, cavities, gum recession, and tartar buildup. There may not be bleeding in any areas of the mouth except those that have misaligned teeth, due to these risk factors.
Iron Deficiency (Anemia) –People that are anemic are more likely to have gums that bleed, even if they floss on a regular basis. This is due to a deficiency of iron, which helps blood platelet formation and restriction of bleeding. When there are not enough platelets in the blood, then bleeding is more evident and harder to stop, even with good oral hygiene. Iron is found in red meats and green leafy vegetables.
Old or Faulty Dental Restorations – Sometimes old fillings can leak or have open margins that allow bacteria or food to congregate around. This creates chronic irritation to nearby gum tissues. Sometimes even healthy restorations like full coverage crowns will harbor more bacteria due to the small margin around the restoration, requiring more dedicated oral hygiene.
Symptoms of Bleeding Gums
Bleeding is an obvious symptom that is hard to miss. It can be seen as well as tasted when the gums bleed. For most people, bleeding gums occur when:
- Flossing is irregular
- There is visible plaque buildup along the margin of the gum tissue
- Brushing is incorrect or aggressive
Other symptoms that may be associated with bleeding gums can include but are not limited to:
- Gum disease
- Receding gums
- Bad breath
- Failing dental restorations
- Visible tartar and plaque buildup
Types of Bleeding
Localized areas of bleeding in one or two areas of the mouth, usually between the teeth when flossing is irregular.
More generalized bleeding throughout the mouth. Most areas bleed when flossed.
Quick evidence of bleeding when the gumlines are brushed. Bleeding is heavy and takes several minutes to stop.
It is important to note that while bleeding is a primary symptom of gingivitis and gum disease, using tobacco products like cigarettes can prevent bleeding from occurring. This can mask the presence of even severe gum disease and bone loss.
How to Treat Bleeding Gums
Depending on the severity of oral infection, bleeding may be something that can easily be reversed in as little as 2 weeks. If severe infection is the cause, then more aggressive treatments will be needed.
Proper Brushing – When gingivitis and early periodontitis is the cause of bleeding, then thorough oral hygiene should reverse all signs of bleeding within 2 weeks. A soft toothbrush that is angled toward the gums, making short back and forth strokes just 2 teeth at a time is adequate to remove marginal plaque as well as provide oxygen to the area which can help destroy anaerobic bacteria.
Brush the teeth twice a day for at least 2 minutes each time. Studies also show that electric toothbrushes will remove more bacteria from the mouth, as there are more strokes achieved per second in an electric brush than in someone using a manual toothbrush.
Change your toothbrush head out when you’ve experienced an illness, the bristles appear splayed, or at least every 3 or 4 months.
Interproximal Cleaning – Cleaning between the teeth is just as important. Brushing alone will not keep bleeding gums at bay. Most dentists recommend flossing once a day. Wrap the floss in a “C” shape around each tooth and slide it up and down under the gums several times. Come all the way up before crossing to the adjacent tooth. Flossing daily for 2 weeks is usually adequate to reverse most cases of bleeding gums caused by gingivitis. For people that cannot or do not like to floss, a water flosser or flossing aid can be used.
Many studies now also suggest that using a water flosser to clean the areas under the gumlines and between the teeth is more effective than thorough flossing. That’s because of deep pockets that can be present in people with gum disease, as well as concavities around the natural structure of the teeth. Even the best brushing cannot clean between the teeth, so it’s important to find a method of interproximal cleaning that is effective for each person.
- Nutritional Supplements – Certain nutritional supplements and diet aids can help decrease bleeding and inflammation in the body. If a person is anemic, then increasing the amount of iron in their diet can be achieved through dietary counseling or supplements. Certain essential oils can also decrease bleeding. Foods that are rich in Omega-3 fatty acids like nuts and fish oil can reduce gum swelling, promote healing, and also be beneficial to other health conditions. Fibrous foods like fresh vegetables help stimulate the gums and boost the immune system.
- Orthodontic Therapy – If bleeding gums are associated with crooked or misaligned teeth, then orthodontic therapy is a wise choice to help improve the health and longevity of a person’s smile. Many patients find clear alignment-tray styles of braces to be comfortable to wear and easy to care for, as you simply take them out for daily oral hygiene practices. Most people complete their orthodontic treatment within 12-24 months. Braces are considered part of a preventive or comprehensive care plan for many patients with active periodontal diseases.
- Replacement of Old Dental Restorations – Dental x-rays and a clinical examination can determine whether or not a filling or crown needs to be replaced. If visible open margins are present, then even good oral hygiene will not keep the area from constantly suffering from gum irritation, as bacteria will congregate in the area. Just like a patch in a tire, fillings wear out over time as well. All restorations require eventual replacement, so having your dentist monitor them and replace them as necessary will help eliminate bleeding as well as recurrent tooth decay.
- Manage Systemic Diseases – Uncontrolled systemic diseases like diabetes, high blood pressure, anemia, and cardiovascular diseases can make it more difficult for a person to fight off oral infections that cause gingival bleeding. The better managed the systemic health condition is, the more likely their oral health is to be.
Why crowns are more likely to have to bleed around them than other restorations?
Crowns are placed subgingivally (just under the gumlines), while fillings are always above the gumlines. Subgingival edges of the crown are likely to harbor plaque when oral hygiene isn’t thorough every single day.