Well, there are quite a number of reasons why you may have bleeding from the gums. Majority of causes are local, meaning within or related to the mouth. In some cases bleeding gums may herald a systemic condition.
- Soft Plaque: Plaque (bacteria plus bacterial food) on one’s teeth may infect the gums and lead to gum inflammation or gingivitis. Gingivitis is the body’s inflammatory response to bacteria in plaque which can be removed effectively by proper teeth cleaning at least 2 times daily. Plaque loves to accumulate on the tooth surface close to the gum level. Special attention should therefore be given to this area during cleaning. In the clinic we are able to see plaque better by staining as shown below.
- Hardened plaque/Calculus: When soft plaque stays on the tooth surface for more than 24hours, it starts to mineralize thanks to the calcium and phosphate ions in saliva. This calculus can be beneath the gum and/or above it and can only be removed by the dental scaler located in the dentist’s office. Calculus makes it easier for plaque to adhere hence causing more gum irritation and bleeding. When calculus remains longer, the result is loose teeth.
- Pregnancy & Puberty: Hormonal changes in these individuals make the gums more susceptible to plaque. Also high estrogen and progesterone levels affect the tiny blood vessels within the gums and make them engorged and friable. This combined effect results in what we term ‘pregnancy gingivitis’, ‘gingivitis of puberty’, or ‘menstrual-cycle associated gingivitis’. Extra dental hygiene is crucial in these life stages.
- Vitamin C deficiency: Vitamin C helps in the formation of collagen which is a major component in our body’s supporting tissues such as blood vessel walls. The vessels become weak in deficiency states of this vitamin and will leak blood easily. Thankfully it’s rare these days.
- Trauma: Sometimes injury to the gums caused by improper technique of tooth-brushing or using a hard-bristled toothbrush may result in bleeding. A gentle but purposeful circular movements of the toothbrush (angulated at 45 degree to the gum) during cleaning is mostly advised.
- Drugs: Just like “hormonal gingivitis”, the use of oral contraceptives may make the gums more susceptible to plaque irritants. Some drugs used as anti-platelets such as aspirin, clopidogrel etc may precipitate gum bleeds especially when used in high doses. Also drugs used for treating several cancers can lead to low platelets.
- Blood disorders: The main players for our initial blood “clot” after injury are the platelet cells. When these are low or inactive we have prolonged bleeding times. Low platelets can result from decreased production in the bone marrow or increased destruction in the blood from a variety of causes. Sometimes the platelet levels are normal but do not work effectively.
By far the main reason for gum bleeding is plaque which can be effectively controlled by twice daily proper tooth-brushing. Bleeding from other causes are classified as systemic causes which means you are likely to bleed from other parts of your body too. Always consult your doctor!
Dr Randy Chance, BSc. Med. Sci, BDS
Korle-Bu Teaching Hospital & Official Doctor at Bisa