Bleeding Gums and Gingivitis

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Most of the time bleeding gums, typically the result of gingivitis, are simply a wake up call that we had take better care of our mouths by brushing and flossing more effectively. When we see blood in the sink while brushing or flossing, a few adjustments in our daily dental care routine are all that is usually needed. This is generally true, especially in this country where we are blessed to have adequate oral care and, for the most part, a fairly nutritious diet. However, bleeding gums can also be an indicator of more serious health problems, so it is a good idea never to take them for granted.

What Are Bleeding Gums-Gingivitis?

Bleeding gums are most often the result of a gum disorder known as gingivitis (inflammation of the “gingival”), but they can occur for other reasons as well. If you suffer from bleeding gums or gingivitis you are not alone. It is estimated that up to 80% of American adults will suffer from some degree of inflamed, bleeding gums at some point in their lives. The problem is even worse in many other parts of the world where dental hygiene is poor, and malnutrition is common.

Gum disease or bleeding gums is not generally a serious problem in its early stages. However, if left untreated it can worsen into a significant infectious situation that can lead to tooth and bone loss, as well as systemic, body wide infections that can be dangerous and even fatal in rare cases. Bleeding gums can also indicate certain cancers or other serious illnesses. The good news is that gum disease is almost totally preventable, and can be successfully treated in almost all cases.

What Causes Gingivitis?

Since gingivitis is the most common reason for bleeding gums, we’ll take an in depth look at it. By far the most common cause of gingivitis is “plaque” which is the result of poor dental hygiene. Plaque is an invisible, sticky film that is a combination of food particles and bacteria that form on your teeth. Plaque is formed by a chemical reaction between bacteria in the mouth and starches and sugars from foods you eat. Plaque is normally removed by sufficiently brushing your teeth, but if you slack in this area and plaque is allowed to remain on the teeth for longer than 24 hours, it will begin to harden into a substance called tartar or calculus, which cannot be removed through simple brushing or flossing. It must be taken care of via a professional cleaning by your dentist. Calculus is an irritant to the “gingival,” the part of your gums that are found at the base of your teeth. Calculus also acts as a “reservoir” for bacteria, so unless the tartar is removed, the gums continue to deteriorate and become red, swollen, and will bleed easily.

The good news is that this primary cause of gingivitis and the resulting sore, bleeding gums is preventable through sensible, consistent brushing, flossing, and regular cleanings by your dentist. A diet that avoids excessive sugar and simple carbohydrates will go a long ways towards improving your oral health as well. So this condition is totally avoidable by making lifestyle choices that lead to wellness and not disease. Prevention is truly the best medicine.

Besides plaque, there are other conditions that can result in gingivitis and/or bleeding gums. Some of the more common ones include:

  • Cancer treatments: Bleeding gums are a common side effect of many chemotherapy and radiation therapies that are often used to treat cancer. They can lead to dry mouth (lack of saliva can cause bleeding gums and lower the mouth’s ability to fight infections), irritated oral tissues including the gums, greater incidence of oral infections, and slower healing of existing issues in the teeth, gums, and other areas of the mouth.
  • Certain medications:  Any drug that dries out the mouth by nature increases the chance of oral issues such as bleeding gums. Saliva is a natural cleanser that helps protect teeth and gums from bacterial infections. Drugs such as antihistamines, some antidepressants, and cold remedies are just some of hundreds of prescription and over-the-counter drugs that can have negative affects on oral health. Other drugs sometimes lead to excessive growth of gum tissues, and may allow for greater irritation by trapping bacteria and plaque more extensively. Examples of these includeimmunosuppressive drugs (often given to organ transplant patients to help reduce the risk of rejection of the organ by the body), calcium channel blockers, and anti-seizure medications.
  • Viral and fungal infections:  The vast majority of oral infections that can cause bleeding gums are of a bacterial nature, but there are also other types of infections that can irritate the gums as well. The herpes virus can trigger an oral condition known as acute herpetic gingivostomatitis that commonly produces painful mouth sores and irritated and bleeding gums. Oral thrush is a fungal infection that causes white lesions to form on the tongue and roof of the mouth, but can also spread to the gums as well. The fungus that causes thrush is normally found in the mouth at much lower levels than those found in folks with thrush infections. Oral thrush is a common condition in many HIV/AIDS patients.
  • Other medical conditions:Leukemia patients will often experience gingivitis and bleeding gums when leukemic cells invade the oral tissues. Leukemia also lowers the immune system function, which can itself result in unhealthy, bleeding gums. Other, more rare, conditions that can attack the gums include a chronic inflammatory disease called oral lichen planus, and autoimmune skin disorders such as pemphigus and pemphigoid. Extreme cases of these diseases can cause the gum tissue to actually peel away in layers.
  • Hormonal changes:When hormonal levels fluctuate, such as during pregnancy or menopause, many women experience uncharacteristic problems with gum disease and bleeding gums. In pregnancy, morning sickness can make the problem even worse due to the irritation caused by frequent vomiting.
  • Nutritional deficiencies:  A diet lacking in certain nutrients can definitely contribute to poor oral health and bleeding gums. Adequate amounts of vitamins B and C, as well as calcium, are particularly of importance. Vitamin C is an excellent antioxidant that can protect the gums and other tissues of the mouth from the destructive effects of free radicals.
  • Diabetes:Diabetics suffer from gingivitis and bleeding gums more readily than the general population because of elevated blood sugar levels. Many diabetics also suffer with a dry mouth, which means less saliva to keep the mouth clean and free from bacterial infections. Diabetes also tends to compromise the immune system, which also contributes to poor dental health.
  • Tobacco use:  Smoking and the use of smokeless tobacco products are a bad idea health wise for a thousand different reasons, but they are particularly hard on oral health. They promote gum decay, oral infections, encourage the growth of harmful bacteria in the mouth and gums, and also lower the effectiveness of the immune system.

What Complications Can Occur From Gingivitis and Bleeding Gums?

Advanced gum disease can escalate from gingivitis to a condition called periodontitis that can lead to much more serious consequences. Possible symptoms include tooth and bone loss, blood poisoning from infections that spread to the circulatory system, and even increased risk for heart attack and stroke. Women with advanced gum disease also have a greater chance of giving birth prematurely.

Another complication from severe gum disease is a condition known as Vincent’s stomatitis or acute necrotizing ulcerative gingivitis (ANUG) that results in painful ulcerations that become infected and bleed excessively. The condition is also called by the slang term trench mouth due to its prevalence during World War I. Soldiers on the front lines had other things to worry about than proper dental and oral care, but this infection became a major medical problem for the allied troops. It is rarely found today in the Western World, but is still a problem in some underdeveloped countries where both dental care and nutrition are poor. Some severe cases have resulted in death due to wide spread infections that invaded crucial organs of the body.

How Are Bleeding Gums/Gingivitis Treated?

Most cases, unless they have reached advanced stages, are easily treated and turned around.

If bacterial infections are significant enough, antibiotics are prescribed that generally will take care of the initial problem. The next step is usually a professional exam and cleaning by a dentist. He or she can remove plaque that has turned into tartar, and allow most patients to be disease free from that point on, providing they practice basic oral care techniques designed to prevent the return of gingivitis and bleeding gums. Sometimes “scaling” is required, which usually takes place over several visits, and is a method of manually removing tartar below the gum line. This can be painful and cause the gums to bleed even more during the procedure, but in the long run it will improve the health of teeth and gums.

Besides proper brushing and flossing techniques, be sure to rinse your mouth after every meal, even if you are not able to brush. Other suggestions that may help preserve your oral health and avoid unhealthy, bleeding gums include:

  • Cranberries:  This amazing fruit has many healthful uses, but one of them appears to be the ability to keep bacteria from adhering to teeth and gums. Be sure to use either cranberry supplement tablets, or a cranberry juice that does not have any added sugar. Extra sugar kind of defeats the purpose when it comes to tooth and gum health.
  • Grapefruit seed extract:  This has proven antibiotic properties that can help prevent bacterial infections in the oral cavity. Try adding a drop to the blob of toothpaste on your brush. It tastes pretty good too!

As we have seen, unhealthy gums that tend to bleed can lead to much more serious consequences if left unattended. Proactive dental care on a daily basis is key to the health of your gums, but one note of caution:  Be careful of commercial toothpastes. Many of them contain toxic chemicals, including fluoride, which can be harmful to your health. You’re better off using plain baking soda and rinsing before bed with diluted hydrogen peroxide.

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