Dental Myth Buster series: Bleeding gums (or How I learned to stop worrying and love the hygienist)

Continuing my theme of addressing common misconceptions in dentistry, this week I’m going to talk about bleeding gums aka ‘gingivitis’: what causes it, how to prevent it and what happens if it gets ignored…..

One of the most common questions a dentist gets asked is ‘Doc, my gums are bleeding, am I brushing them too hard?’ followed by ‘So I’ve been brushing them much more gently but the problem isn’t going away’. This is perfectly logical until you realise that understanding the cause of bleeding gums is counter-intuitive…

Now if scientific-speak turns you off you may want to skip a few paragraphs and cut to the chase! For those who are still with me I feel that knowing a bit about the biology behind bleeding gums helps to provide the understanding we need to fix the problem. So here goes:

Bacteria in the mouth (plaque) sticks to the sides of the teeth just above the gum (at the junction between the tooth and the gum). If it doesn’t get removed (by brushing the gum line and flossing) after about 24 hours it causes a local inflammatory response in the gum around the tooth. (Inflamed gums).

An inflammatory response is the body’s way of trying to remove infection (ie bacteria) which could be harmful. The body is trying to deliver immune cells to the infected area (ie the side of the tooth) via the blood stream to fight infection – and this is the keyin order to deliver these cells the inflamed site produces extra blood vessels in the area which make the gum spongy, swollen and fragile: one touch with a toothbrush and it starts to bleed.

It gets worse: the swelling of the gum traps that plaque under the gum and hides the true cause from the patient. And because the plaque is on the tooth surface it is beyond reach of the immune system so the situation becomes worse and worse unless the plaque is physically removed.

The final nail in the coffin is that the patient thinks they are harming the gums by brushing too hard and stops brushing the area altogether – which is the exact opposite of what needs to be done to fix the problem! (I warned you this was counter-intuitive!)

How to prevent it

Correct brushing technique and the use of floss is the answer -both of which your friendly neighbourhood hygienist should be helping you with (if you have to ask your hygienist how to do this then find a new one). If you have bleeding gums and you don’t see a hygienist regularly, find one (I know this great hygienist in Harold Wood, Essex…….)

What happens if bleeding gums get ignored

This is really a subject for another post. But to cut a long story short: the gingivitis progressively worsens (more bleeding, more swelling) and turns into ‘periodontitis’ aka gum disease: the bone holding the teeth in place starts to get eroded by the long term infection, the teeth become loose, the breath starts to smell, and eventually teeth just fall out…..But, hey! Your hygienist can prevent all this (phew, always try to end on a high note)!

Comments

  1. Thank you for this information, but as I was reading it an advert on the TV for a well known brand of mouthwash claims to eliminate bacteria that cause gum disease. Is this correct?

  2. Hello Jo:
    to claim that a mouthwash ‘eliminates’ bacteria that cause gum disease is hogwash – assuming that the definition of ‘eliminate’ is ‘to remove 100% of’.
    And how is a mouthwash meant to penetrate underneath the gum where the real problem is?…killing some of the bacteria on the tongue or on the outside of the gum won’t help…

    Mouthwashes play a useful role as an ‘adjunct’ to Hygiene Therapy in certain cases. On their own they’re hopeless. But you won’t catch them admitting that on a national ad campaign 🙂
    andrew

  3. I have peridontal disease, aggravated I know by smoking and the inability to get to see a dentist for 5 years whilst living in Scotland. It seems to be a ‘done deal’, my teeth are loose and it scares the life out of me…as does all dentistry. I clean/floss manically but I can’t get an appt. with a hygienist for another 5 months. I used mouthwash as instructed but having developed a very sore tongue/mouth my pharmasist now tells me I have an allergy to it’s active ingredient! Any suggestions will giving up smoking make a signifigant difference at this stage), eating is already a problem and I don’t want to lose more teeth! Don’t say ‘dentures’ please! ;o)

    Sorry to barge in here but getting advice from a professional close at hand seems to be impossible for months! :o( Any help would be much appreciated.

  4. Hi there,

    It does sound as if you have periodontal disease. It is not possible to say without clinical examination how far the disease has progressed so I am not able to tell you how serious this is.

    Perio’ disease has a large spectrum from mild gingivitis (bleeding gums) through to teeth which have pus appearing around the gum and are literally falling out on their own.

    There are 3 causes of this disease

    1) Smoking
    2) Inadequate oral hygiene
    3) Genetic predisposition

    Most sufferers have a bit of all 3 in varying proportions.

    My suggestion would be
    1) Find a decent local dentist – if you don’t know anyone who is recommended then look at the website of anyone you are interested in, that will give you ‘an idea’. Once you have found one you like, phone them: if the receptionist is helpful and gives you the time of day, book in for a consultation. This is by no means a given….
    2) Give up smoking now.
    3) Don’t give up on floss/brushing etc but hopefully your new dentist will have an equally decent hygienist who will sort this out for you and show you what to do
    4) Waiting 5 months for a hygiene appointment when you have these problems is unacceptable: See 1).

    A well run Hygiene service is the key to avoiding all the above. At Winning Smiles we monitor our patients very closely for any signs of early Perio’ disease and deal with it before it takes hold.

    Hope this helps!

  5. Thank you, much appreciated and will take your advice. The smoking issue of course is going to be the toughest one but worth it if I can hang onto some teeth! As for how advanced, no teeth fallen out but one removed and four more very ‘wobbly’ though have avoided much in the way of infection thus far. The remainder, very slightly loose, maybe I can hang onto those. Ok, I’m off now to try and find a dentist with a hygienist who has appointments!

    Thanks again.

  6. I gave up smoking nearly four weeks ago, and withing a couple of days my gums started to bleed every time I brush them. They even started to bleed the other morning when I swilled my mouth with mouthwash before brushing. The bleeding doesn’t seem to come from any particular area, but varies. I believe this may be due to better blood circulation around the gums since giving up smoking. Will this settle as I normally have no problems with my gums and teeth.

  7. Hi there,

    bleeding gums is always a sign of gum disease (gingivitis). The nicotine in smoke causes restriction of the blood vessels in the gums and effectively ‘masks’ the true problem here.

    Long term gingivitis can lead to periodontitis which is destruction of the bone holding the teeth in.

    My advice would be to see your hygienist or dentist sooner rather than later and get them to do a proper gum assessment and decide what treatment is necessary.

    Hope this helps.

    Regards

    Dr Andrew Fennell BDS (Lond)

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