Definition
Chronic bleeding from the gums.

Alternative Names
Gingival bleeding; Bleeding gums

Considerations
Bleeding from the gums is due mainly from inadequate plaque removal from the teeth at the gum line. This will lead to a condition called gingivitis, or inflamed gums. If plaque is not removed through regular brushing and maintenance appointments with the dentist, it will harden into what is known as tarter. Ultimately, this will lead to increased bleeding and a more advanced form of gum and jawbone disease known as periodontitis, Improper brushing and flossing technique may actually traumatize the gum tissue leading to irritation. Therefore, it is important to follow the prescribed oral hygiene homecare instructions from your dental professional in order to maintain a healthy oral cavity. If gum bleeding persists, then it may be a sign of serious medical disorders such as leukemia, bleeding disorders, platelet disorders, and/or overmedication with anticoagulants (blood thinners such as Coumadin).

Common Causes
gingivitis
poor oral hygiene
inadequate plaque removal
tarter accumulation
periodontitis (advanced form of gingivitis)
anticoagulants such as coumadin and heparin
self-inflicted oral trauma, such as toothbrush abrasion, improper flossing
infection, which can be either tooth or gum related
Vitamin C deficiency
Vitamin K deficiency
hormonal changes during pregnancy
chemical irritants such as aspirin
leukemia
placement of new dentures can lead to denture sores/irritations
idiopathic thrombocytopenic purpura

Home Care
Home care depends on the cause. Follow your health care provider's recommendations.

For infection, treatment by the dentist is recommended.
For effects of medication, prescribed adjustments of dose or use of substitute drugs is recommended. NEVER CHANGE YOUR MEDICATION WITHOUT CONSULTING YOUR HEALTH CARE PROVIDER.

For vitamin deficiency, proper diet or vitamin supplements are recommended.

Sore and bleeding gums can be aggravated by tobacco.
Poorly fitting dentures will cause sore spots. If dentures hurt or make the gums bleed, they should be adjusted and relined by your dentist.

Use an oral irrigation device on the low setting to massage the gums.
Avoid aspirin unless your health care provider has asked you to take it for a specific reason.

Gum bleeding can be controlled by applying pressure with a gauze pad soaked in ice water directly to the bleeding gums.
Eliminate between-meal snacks and reduce carbohydrate intake to help prevent plaque build-up on teeth.

Visit the dentist at least once every 6 months for plaque removal.
Brush teeth gently (with a soft-bristle toothbrush) after every meal. The dentist may recommend rinsing with salt water or hydrogen peroxide and water. Avoid using commercial, alcohol-containing mouthwashes, which aggravate the problem.

Floss teeth twice a day to keep plaque from building up.

Call your health care provider if
the gums continue to bleed even after following all recommendations.
the problem is severe or chronic or if other unexplained symptoms are associated with the bleeding.

What to expect at your health care provider's office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting bleeding gums in detail may include:

quality
Are the gums bleeding a large amount (massive hemorrhage)?
Can you control the bleeding?

time pattern
Did the bleeding begin recently?
Do the gums bleed frequently
Has gum bleeding been present lifelong?
Does it only occur occasionally?
Have you had gum problems before?

oral hygiene habits
How often do you brush?
Do you brush between meals?
How often do you floss?
Do you use a soft or hard bristled toothbrush?
How vigorously do you brush?
What other home care aids do you use (toothpicks or other)?
When was the last time you had your teeth professionally cleaned at the dentists?

eating habits
Have you changed your diet?
Do you eat adequate amounts of fruits and vegetables?
Do you take supplemental vitamins?
Do you have a high carbohydrate diet (pasta)?

medications
What medications are being taken? Especially, do you take:
anticonvulsants
anticoagulants (such as Coumadin, heparin)
aspirin

other
Are you pregnant?
Have you changed mouthwash or tooth paste recently?
What other symptoms are also present? Is there:
breath odor (halitosis)
redness of the gums
abnormal color of the teeth
sore throat
The physical examination will include a detailed examination of the mouth and gums.

Diagnostic tests that may be performed include:
blood studies (such as a CBC or blood differential)
X-rays of the teeth and jawbone