Bleeding Gums

Why are my gums bleeding, and does it matter?

Swollen, red and bleeding gums are classic signs of gum disease. Healthy gums do not bleed when you brush or floss, so bleeding is a symptom rather than a normal event.

Whether it matters depends on which of two conditions you have — and they sit at opposite ends of a spectrum:

• Gingivitis is mild and reversible.
• Periodontitis is chronic, irreversible, and requires ongoing treatment and maintenance.

The difference is not a matter of degree in the way it sounds. One resolves with better cleaning; the other destroys the structures holding your teeth in place. What Is Gum Disease? covers the same ground in shorter form.

Smile Solutions is at Level 1, 220 Collins Street, Manchester Unity Building, Melbourne CBD — see Location.

Gingivitis — reversible

Gingivitis is inflammation of the gums caused by plaque buildup at the gumline due to poor dental hygiene.

Most people have some gingivitis. It is easily treated and reversed with improved home care — brushing, flossing, and regular professional cleans.

Other causes include:

• certain medications
• chronic conditions such as diabetes
• poor nutrition
• viral or fungal infections

Symptoms vary with severity, with bleeding gums the most common sign.

The smoker's trap

Bleeding may be masked in smokers. Smoking constricts the blood vessels in the gums, so the disease can progress without producing the one symptom most people rely on to notice it.

A smoker with no bleeding does not have healthier gums than a non-smoker who bleeds. It is the opposite: smoking both increases susceptibility to gum disease and hides its main warning sign.

Periodontitis — irreversible

Periodontitis, sometimes called “destructive gum disease”, involves irreversible damage to the ligaments and bone supporting your teeth. It is described in more detail in Periodontal (gum) disease.

The warning signs:

• bad breath
• gum recession creating dark triangles between the teeth
• a “long in the tooth” appearance as gums recede
• teeth loosening or shifting position

If untreated, periodontitis can eventually result in tooth loss — and replacing a lost tooth with a bridge, a denture or an implant costs far more than keeping it.

It cannot be reversed. Its progression can often be stabilised with excellent home care and ongoing professional maintenance — but the bone already lost does not come back. That is why the gingivitis stage is the one worth acting on.

How well it stabilises varies between people, and it depends heavily on factors outside the dental chair: smoking, diabetes control, genetics, and how consistent home care is between appointments. Periodontal treatment is a long-term partnership rather than a course of treatment that finishes.

Who is more susceptible

• Genetics — susceptibility runs in families
• Smoking
• Chronic conditions such as diabetes — see Diabetes and oral health

What the examination actually measures

A gum assessment is mostly measurement, and knowing what the numbers mean makes the appointment far less opaque. A fine probe is walked around each tooth at six points, and the clinician records:

• Pocket depth, in millimetres, from the gum margin to the base of the crevice. 1 to 3 mm is the healthy range. 4 mm and above is a pocket — a space you cannot clean at home and bacteria can.
• Bleeding on probing. Recorded as a percentage of sites. This is the most sensitive sign of active inflammation, and it is what should fall after treatment.
• Recession, how far the gum has moved down the root.
• Attachment loss — pocket depth plus recession, which is the truest measure of what has actually been lost.
• Mobility, whether a tooth moves.
• Furcation involvement, whether bone loss has reached the split between the roots of a molar. This matters a great deal for prognosis.

Radiographs then show the bone level directly, which probing can only infer — How safe are dental x-rays answers the question people usually have about that.

Ask for your numbers. A periodontal chart is an objective record, it is yours, and comparing this year's to last year's tells you whether things are stable far more reliably than how your gums feel.

How gum disease is classified now

Since 2018 periodontitis has been described in two dimensions rather than as “mild, moderate, severe”, and you may see both on a treatment plan:

• Stage I to IV — how much has already been lost, and how complex it will be to treat. Stage I is early; Stage IV involves severe bone loss, tooth loss and bite collapse.
• Grade A, B or C — how fast it is progressing, and how likely it is to keep progressing. Grade C is rapid, and smoking and poorly controlled diabetes both push a case toward it.

The practical value is that stage tells you where you are, grade tells you where you are heading. Two people at the same stage can need very different intensity of maintenance depending on grade.

What treatment involves

For gingivitis: a professional clean to remove plaque and calculus, plus a genuine change in home care. It resolves in weeks.

For periodontitis, the first phase is non-surgical:

• Root surface debridement — cleaning the root surfaces inside the pockets, below the gum, where a toothbrush cannot reach. Often called deep cleaning, and it is not the same as a routine scale and polish.
• Usually done under local anaesthetic, over one to four appointments, commonly by quadrant.
• Expect some tenderness and sensitivity for a few days afterwards, and some gum shrinkage as the inflammation settles — which can leave gaps between teeth that were previously hidden by swelling. That is healing, not damage, though it can be an unwelcome surprise if nobody warns you.
• Re-assessment at six to eight weeks, re-measuring every site to see what responded.

Where deep pockets persist after that, options include further debridement, flap surgery to gain access, or in selected defects regenerative procedures. Those are periodontist territory. See Specialist Periodontists and, for how a staged plan is costed, Understanding Your Treatment.

Why maintenance intervals shorten

After treatment for periodontitis, most people are placed on three-monthly maintenance rather than the usual six.

The reason is specific: the bacterial biofilm in a treated pocket re-establishes itself over roughly three months. The interval is set to interrupt that, not to sell more appointments. Where a case is stable over a long period the interval is sometimes extended, and where it is not, it may shorten. How often should I go to the dentist? sets out the general rule this is an exception to.

Maintenance is the part that determines the long-term outcome. Non-surgical treatment followed by lapsed maintenance tends to return to where it started. See Dental Cleans & Hygienists.

Home care that actually changes the numbers

• Clean between the teeth daily. Brushing reaches about three of the five surfaces of a tooth. The two it misses are where gum disease starts — see Is flossing really that important?.
• Interdental brushes beat floss where they fit. For anything but very tight contacts, a correctly sized interdental brush removes more plaque. Ask to be sized — a brush too small does nothing and one too large damages the gum.
• Angle the toothbrush into the gumline at about 45 degrees, with short movements. The gumline is the target, not the middle of the tooth.
• An electric brush with a pressure sensor is easier to use well, particularly for people brushing too hard — Which toothbrushes do dentists recommend? covers the choice.
• Brushing harder is not brushing better. Hard brushing causes recession and does not remove more plaque; Over brushing: What can it do to my teeth? explains what the damage looks like.
• Stopping smoking does more for gum prognosis than any product, and the improvement begins within months.

Mouthwash is an adjunct, not a substitute — The truth and myths about mouthwashes. Chlorhexidine is effective short-term but stains with prolonged use and is normally prescribed for defined periods rather than indefinitely.

The links with general health

This area is often overstated, so stated carefully:

• Diabetes and periodontitis run in both directions. Poorly controlled diabetes makes gum disease worse and harder to treat, and severe gum inflammation makes blood glucose harder to control. This relationship is well established, and it is the one worth acting on.
• Associations have been reported between periodontitis and cardiovascular disease, rheumatoid arthritis and adverse pregnancy outcomes. Association is not proof of cause, and treating gum disease has not been shown to prevent those conditions. It is a reason to take gum health seriously, not a reason to claim more than the evidence supports. Health problems linked to poor oral hygiene sets out what is and is not established.
• Pregnancy gingivitis is common and hormonal — gums respond more strongly to the same amount of plaque. It usually settles after birth, and dental care during pregnancy is safe and encouraged; see Is it safe to visit the dentist during pregnancy?.
• Some medications cause gum overgrowth, including certain anticonvulsants, calcium channel blockers and immunosuppressants. Tell your clinician everything you take.

Less common causes

Bleeding gums can occasionally be linked to serious medical conditions or to inflammation elsewhere in the body.

There are also reasons unrelated to gum disease: blood-thinning medication, pregnancy, and some blood disorders can all cause gums to bleed more readily. This is one of the reasons an examination matters — the treatment for bleeding caused by plaque is not the treatment for bleeding caused by something systemic.

The only way to fully understand the cause is a dental examination. A simple check can alert your dentist to gum disease, which may then require:

• radiographic analysis of the supporting bone, to measure what has been lost
• referral to a periodontist — a Dental Board–registered gum specialist

We have specialist periodontists practising in-house, so that referral is internal. See Specialist Periodontists and Specialist Care.

Gingivitis or periodontitis?

This table describes the two conditions in general terms. Which one you have — and how far it has progressed — can only be established by examination and, usually, radiographs. Gingivitis does not inevitably become periodontitis; most cases never do.

What to do now

If your gums bleed when you brush or floss, book a dental examination. Do not stop brushing the area — inflamed gums bleed because of the plaque, and cleaning them gently and consistently is part of the treatment, not the cause of the problem.

Be seen sooner rather than at your next routine visit if a tooth has become loose or has shifted, if you have gum swelling with pain or a bad taste, or if bleeding continues for more than a week or two despite good cleaning. Facial swelling with fever, or swelling affecting your eye, swallowing or breathing, is a medical emergency — call 000 or attend a hospital emergency department. See Emergency Dentistry.

Common questions

Should I stop brushing or flossing when my gums bleed?

No. Plaque-related inflammation makes gums bleed, and stopping cleaning allows more plaque to remain. Continue gentle, thorough cleaning and arrange an examination if bleeding persists. A clinician or hygienist can show you how to clean without injuring the tissues.

What is the difference between gingivitis and periodontitis?

Gingivitis is inflammation confined to the gums and can usually be reversed with effective plaque removal. Periodontitis involves loss of the supporting attachment and bone around teeth. That lost support is not restored by ordinary cleaning, although treatment can control the disease and reduce further loss.

Can smoking hide gum disease?

Yes. Smoking can reduce visible bleeding even when disease is present, so a lack of bleeding does not prove the gums are healthy. Pocket measurements, attachment levels, radiographs and other clinical findings matter.

What do pocket-depth measurements mean?

Healthy sites are commonly around one to three millimetres. Deeper readings may indicate swelling or loss of support, but a diagnosis is not made from one number alone. Ask to see the pattern of measurements, bleeding sites and any bone changes on radiographs.

How is gum disease treated?

Treatment usually begins with tailored home care and professional removal of deposits above and below the gum line. The page describes reassessment about six to eight weeks later. More advanced, complex or unresponsive disease may need specialist periodontal care.

Why might I need three-monthly maintenance?

After periodontitis, harmful bacteria and inflammation can return between ordinary six-month visits. A shorter interval may be advised according to disease history, smoking, diabetes, home cleaning and response to treatment. The interval should be reviewed rather than assumed forever.

When are bleeding or swollen gums urgent?

Seek prompt dental care for persistent bleeding, pain, a bad taste, swelling, a loose or shifting tooth, or symptoms that do not improve with good cleaning. Facial swelling with fever, or swelling affecting the eye, swallowing or breathing, needs emergency medical care.

Practical details

Periodontics is one of the thirteen recognised dental specialties in Australia, and specialist registration can be verified free on the AHPRA public register at ahpra.gov.au — see Dentists & Registered Specialists.

General information only — it is not a diagnosis, a treatment plan or a promise of any particular clinical outcome, and it does not replace advice from your treating practitioner. Susceptibility to gum disease, how quickly it progresses and how well it responds to treatment vary considerably between individuals; bleeding gums have several possible causes and need to be examined rather than self-diagnosed from a web page.

Smile Solutions trades under ABN 28 193 514 103.