Gingivitis can occur without bleeding

Bleeding gums

Brief overview

  • Causes of bleeding gums: often (bacterial) inflammation of the gums or inflammation of the gums (periodontitis), sometimes other diseases (fungal infection, viral infection, diabetes, leukemia, etc.), nutritional deficiencies, mucosal injuries, medication or hormonal influences (e.g. during pregnancy)
  • What to do with bleeding gums Depending on the cause, you can do something against 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.
  • Is bleeding gums dangerous? If periodontitis develops, in which the gums and jawbones recede and there is a risk of tooth loss, then yes.

Bleeding gums: causes and possible diseases

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

Gingivitis

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

Chronic periodontal disease

In periodontitis, the entire tooth supporting structure is inflamed. The gums recede and the jawbone disappears. If left untreated, the affected teeth can loosen and even fall out. Chronic periodontitis is usually bacterial and the result of gingivitis that has not been resolved. If the patient works 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 periodontal disease

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

It is not yet fully understood why particularly aggressive bacteria multiply in the oral cavity of some people. However, often 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 disease begins with a painful inflammation in the space between the teeth, which then quickly spreads to the gums. Heavy bleeding gums, yellow, greasy deposits on the gums, death (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 the NUG is also often observed in people infected with HIV and people in developing countries.

In the case of NUP (nectrotizing 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 or deficiency affecting the whole body. Examples are:

  • Diabetes mellitus: In people with diabetes, not only is the sugar level in the blood increased, but also in the saliva and in the sulcus fluid. Due to the rich food supply, the bacteria multiply in the mouth, which promotes tooth decay and periodontal disease. In addition, the immune system is weakened in diabetics with poorly controlled blood values. This makes it even easier for the bacteria to multiply. In addition, the regenerative capacity of the tooth support system is then reduced.
  • Leukemia: Signs of "blood cancer" can include frequent bleeding gums and nosebleeds. The reason for this is that the excessively produced white blood cells in the patient displace the healthy blood cells - including the blood platelets (thrombocytes). Blood coagulation suffers as a result - the tendency to bleed is increased.
  • Nutritional deficiency: Malnutrition, anorexia or severe alcoholism can lead to a protein or vitamin C deficiency (scurvy). Bleeding gums and receding gums are typical signs.
  • Viral infections: Infections with herpes viruses, the Epstein-Barr virus or cytomegalovirus often lead to changes in the mucous membrane. They are rarely manifested by bleeding gums, especially in children.
  • Fungal infections: The yeast Candida albicans can also affect the gums. Typical for this are white, wipeable deposits on reddened, bleeding gums.
  • HIV: The gums of people infected with HIV often turn red, swell and bleed.
  • Bleeding disorders: Changes in blood coagulation caused by blood-thinning drugs such as heparin or coumarin, but also blood diseases such as haemophilia A or a lack of coagulants, can cause profuse bleeding from the gums.
  • Allergies: Hypersensitivity to dental materials (e.g. for dentures) can locally cause bleeding 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 hormone-related. Fluctuations in the hormonal balance lead to bleeding and swelling of the gums, especially during puberty or pregnancy. The reason is that some hormones loosen the gums, making it easier for bacteria to enter. One differentiates:

  • Pregnancy gingivitis
  • Puberty 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 a lot - especially in the area of ​​the incisors:

  • Anti-epileptic drugs: Phenytoin, a commonly used drug for epilepsy, can lead to gum growth, especially in high doses.
  • Immunosuppressants: Immune-suppressing drugs such as cyclosporine A are given after organ transplants and to treat autoimmune diseases. They can cause bleeding gums as a side effect.
  • Antihypertensive: So-called calcium channel blockers (such as nifedipine or verapamil) can cause gums to grow, which increases the risk of plaque and gingivitis.
  • Hormonal contraceptives: Hormonal birth control products (such as the pill) cause hormonal changes similar to those that occur during pregnancy. The possible consequence can be bleeding gums.

Diseases with this symptom

Find out here about the diseases that can cause the symptom:

What to do with bleeding gums

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

Bleeding gums: you can do it yourself

If the bleeding gums are bacterial, you can and must first and foremost take action yourself:

  • Cleaning properly: Let the dentist show you the correct toothbrushing technique. Mostly, 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 removes the plaque thoroughly without irritating the gums.
  • Interdental cleaning: You can use the floss to remove the plaque film from the areas between the teeth that the toothbrush cannot reach. The dentist will show you how to do this and what type of floss is appropriate. As an alternative to flossing, you can use interdental brushes in various sizes, for example.
  • Don't stop if it's bleeding: It can easily start to bleed, especially when “threading” 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 in the mouth is "clean" again.
  • Stop smoking: Tobacco use has been shown to be one of the biggest causes of bleeding gums. Not only do smokers have more tartar and plaque, they are also at an increased risk of severe periodontal disease. The only thing that helps here is to stop smoking.
  • Professional tooth cleaning: You should have your teeth professionally cleaned at least twice a year. The dentist removes tartar and plaque that could not be removed by brushing your teeth. This means that bacteria no longer have any other target.
  • Eat sugar-free: Sugar encourages the growth of bacteria that not only cause tooth decay but also bleeding gums. Above all, avoid lots of small, sugary snacks between meals - or always keep a dental care chewing gum close at hand.
  • Disinfecting mouthwashes: Chlorhexidine is a tried and tested agent against germs and is contained in many mouthwash solutions. You can also disinfect your mouth naturally - with sage tea or myrrh tinctures (in addition to daily oral hygiene).

Bleeding gums: this is what the doctor will do

The first point of contact for bleeding gums is your dentist. in the Patient discussion (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 medication you are currently using.
  • since when you have had bleeding gums, in what form it occurs (e.g. only sporadically or often, lightly or severely) and whether you are in pain.
  • what your lifestyle habits look like (e.g. current stress levels, eating habits.
  • whether and how much you smoke.
  • (for women :) whether you are pregnant or when you last had your period.

This is followed by one Examination of teeth and oral cavity: The dentist carefully checks each individual tooth for tooth decay and loosening and takes a close look at existing fillings, crowns or dentures. Because angled teeth, protruding tooth fillings or tooth positioning errors create niches that are difficult to clean. This can lead to increased bleeding gums.

The dentist can assess the health of the gums with a few special tests. In this way, it can often be seen visually whether the gums are swollen, severely reddened or bleeding. With the probe the dentist also measures whether there is a receding gum and whether the gap between tooth and gum (sulcus) is deepened. If bleeding occurs during this examination, this is often a sign of inflammation.

The doctor prepares these especially for chronic or aggressive forms of bleeding from the gums X-rays of the jaw. A possible receding of the jawbone can be seen on them. 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 provide an additional treatment Pathogen smear in the gap between the gum and the tooth (sulcus). Taking antibiotics can often stop further gum disease and bone receding.

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

Treatment of periodontal disease

If the dentist determines that periodontitis is the cause of the bleeding gums, special treatment is advisable. This is because bacteria have settled so deeply in the crevice between the gum and tooth that they can no longer be removed even by thorough brushing. That's why the dentist has to deal with it. This applies even more to the rare, aggressive form of periodontal disease, which particularly affects young people and can quickly lead to tooth loss.

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

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

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

  • The bleeding gums last a long time or are very violent.
  • The gums are swollen, severely reddened or visibly changed.
  • You have severe gum pain, possibly accompanied by a yellow coating 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.

Is bleeding gums dangerous?

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

Bleeding gums are more serious as a result of inflammation of the entire periodontium (periodontitis): the breakdown of bone tissue in the jaw can cause teeth to fall out. Take Bleeding gums so always seriously and it is better to go to the dentist once too often than to risk permanent damage.

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