Do you have bleeding gums?

Bleeding gums is a common concern that we see patients present to us for on a regular basis. It should definitely not be ignored. In most cases a little bit of blood here and there while brushing may not be a concern. But it could also be a sign of a more sinister underlying problem and so we recommend you visit your dentist to get it checked out.

What causes the gums to bleed?

Bleeding is a sign of inflammation and a sign that the gums are not happy. This could be due to one or a combination of things such as

- incorrect brushing or flossing technique
- poor dental hygiene
- dry mouth
- smoking
- recreational drugs
- nutrition
- trauma
- certain medications
- gingivitis
- periodontal disease
- dental infections
- cancer (e.g. leukemia)
- other health or autoimmune conditions

By far the 2 most common causes are Gingivitis and Periodontal Disease.

What is Gingivitis?

To put it simply; bleeding gums is usually caused by a build up of plaque along the gum line that is repeatedly missed from oral hygiene. These bacteria then trigger an inflammatory response from the gums and this inflammatory response is called gingivitis - usually identified by red, swollen, puffy, bleedy and sometimes painful gums.

Dirty teeth with lots of tartar, calcium or stain build up on them will help the bacteria grow and attach to the teeth worsening the condition.

Gingivitis can also be first stage of the more serious gum disease (periodontitis or periodontal disease) which can cause irreversible damage to your teeth and gums. To the untrained eye it may be impossible to tell the difference between the two, so please see your dentist for advice if you have bleeding gums.

Fortunately if you only have gingivitis, usually with the correct oral hygiene regime and some professional dental cleaning it can be reversed and managed with no irreversible damage.

What is Periodontal Disease?

Periodontal Disease or Gum Disease is a serious inflammation of the gums, bone and other supporting structures supporting the teeth. There are four stages, the first being gingivitis which was mentioned previously. Then there is slight, moderate and advanced periodontal disease that is irreversible and can relate to major health problems.

Essentially, it is when the calculus and bacteria build up becomes so aggressive and great that the body can no longer fight it. The immune response is for the gums and bone surrounding the tooth to retreat and pull away from the bacteria situated on the teeth and along the gum line. This creates pockets under the gum where inevitably more bacteria and plaque can build up. Eventually the gums and bone can no longer take it and it progresses into advanced gum disease, where unmanaged, the teeth start to shift position, become mobile and then fall out.

What are the symptoms of Gum Disease?

Stage 1: Gingivitis

It begins with the gums looking slightly red, swollen and bleeding while brushing or flossing. You may also start to notice bad breath on occasion.

Stage 2: Slight Periodontal Disease

Physically there is not much change to the human eye, possibly a bit more red and swollen. Bleeding and bad breath however now is when the bone and gum tissue is beginning to damage. A dentist will start to get gum probe readings of 4-5mm pockets.

Stage 3: Moderate Periodontal Disease

Along with the previous symptoms, the dentist will start reaching probing readings of 6-7mm meaning more bacteria is being trapped. The bacteria is now not only attacking your gum and bones but is reaching into your blood stream and affecting your immune system. The gums will be sore and tender to touch and may begin bleeding with even a slight bump. An odour will become more noticeable now and even a funny taste.

Stage 4: Advanced Periodontal Disease

In previous stages, it may not have even occurred to you as anything major going on but by the advanced stage, you will start to see noticeable changes on your end. The gums will be a lot more red and swollen with possible pus oozing from different areas. Usually the teeth start to pan out and create gaps that may have never been noticed before. It may be painful to chew or getting cold sensitivity and most likely there will be many if not most mobile teeth.

How is Periodontal Disease Treated?

The treatment or management strategy changes depending of the severity of the gum disease. In the early stage, gingivitis, it can be managed with:

- the correct brushing technique
- brushing twice a day
- flossing once a day
- introducing occasional mouth washes of Savacol or similar products recommended by your dentist
- regular dental check up and cleans (for most people this will be 6 monthly) to monitor the gum levels and a professional clean
- quitting smoking and/or recreational drugs
- using an electric brush

There is no treatment that will cure the later stages stages of gum disease. Once it has been diagnosed or present in the mouth, it can only be managed with strict oral hygiene and regular dental visits.

Once the pockets have reached 3mm it is impossible to only rely on your at home brushing and flossing techniques to be able to reach all the bacteria. In addition to the previously mentioned strategies, a strict dental visit regime will need to be followed in order to keep on top of things. The dentist will need to use specialised equipment to reach the pockets under the gum.

This could include 3-4 monthly periodontal cleans which generally take a longer than standard cleans as the dentist has a lot more surface area to cover and the utmost care is required.

It may also be recommended to have gum surgery which is done under local anaesthetic and is the process of raising a flap of gum (usually done one quadrant at a time) and meticulous cleaning with specialised equipment. This is only done if deemed necessary and although it is proven successful, is not done regularly as it comes with its own risks.

Another management strategy that will give the best possible outcome is seeing a Periodontist instead or in conjunction with your Dentist/Dental Hygienist. Although a little more costly, it will give you the best management as they are specialists in Periodontal disease and are able to do a exceptional job as that it their niche.

If managed properly, you can improve your oral health significantly and ensure you can keep your smile for the long term.

If you have any questions or concerns, please give our practice a call or book a consult with one of our dentists.