What causes bleeding gums? 

bleeding gums

Bleeding gums is a primary symptom of gum disease. The other systems are redness, swelling (loss of orange peel appearance of healthy gums) pain, bad breath, metallic taste and difficulty in chewing. 

There are numerous causes of bleeding gums. The bleeding gums can occur as a result of bad oral hygiene or secondary to systemic disease. In some cases, episodes of long-term gum bleeding appear as a symptom of systemic disease.  

Causes of bleeding gums

Bad oral hygiene (Plaque buildup)

Plaque build-up at and below the gum line is the leading cause of gum bleeding. Plaque buildup irritates the gum tissue, resulting in inflammation of the gums called gingivitis (gingiva is another name for gums). Gingivitis presents with redness, swelling, pain and gum bleeding on tooth brushing. 

If the bacterial plaque is not removed, the inflammation may involve the deeper tissues supporting the teeth and may lead to loss of tooth attachment apparatus. This advanced infection is known as periodontitis.

It appears as bleeding gums, bluish-purple gums, receding gum lines, loose teeth and/or tooth loss. 

Bleeding gums appear earlier than a change in colour or any other visual signs of inflammation.

Bleeding may occur on teeth with no gum recession or teeth with attachment loss that is stable and not progressing. 

Drug-induced bleeding gums

Drugs such as anti-platelet medications (e.g. Aspirin) or blood thinning medications (e.g. Warfarin) that are prescribed for certain medical conditions also increase the bleeding tendencies of gum tissues. 

Women taking oral contraceptives are relatively more prone to gingivitis and therefore to bleeding gums.

Diabetes 

Diabetic Mellitus is a metabolic disorder characterized by a deficiency of Insulin. In diabetics, gum bleeding occurs due to the increased blood sugar level. 

The impact of glycosylation of membrane protein basement membranes thickens and it will cause thickening of blood capillaries leading to defect in oxygen diffusion to gingival. Free oxygen radicals lead to tissue destruction and an increase in gum inflammation. 

The high blood glucose level in GCF (Gingival crevicular fluid) alters the plaque microbial flora and increases the gingival bleeding.

Pregnancy

Bleeding gums at the time of pregnancy occurs due to fluctuating hormones such as estrogen and progesterone. These hormone levels begin to affect the gums at puberty.

Gum bleeding in pregnancy is characterized by mild to severe bleeding along with the inflammation, pain and overgrowth of gum tissue.

Mostly it resolves on its own after delivery when the hormonal levels return to normal.

Vitamin K deficiency

Vitamin K is required for the production of proteins responsible for blood clotting. The deficiency of vitamin K leads to a lack of active prothrombin in the circulation, a protein essential for blood clotting.

Vitamin K deficiency can lead to gum and nose bleeding and increased clotting time.

Vitamin C deficiency (scurvy)

Vitamin C is required for collagen production and wound healing. Collagen is the main protein of connective tissue that makes up bones, skin and gums. Low consumption of fresh fruits and vegetables in the diet leads to vitamin C deficiency.

Gingivitis and periodontitis are plaque-induced disorders but vitamin C deficiency inhibits the healing and repair of diseased tissue. 

Symptoms of a severe vitamin C deficiency or scurvy include bleeding gums, spongy or sore gums, loose teeth, nausea, fatigue, eventual wound re-opening, infections, fractures and haemorrhages.

Vitamin C deficiency is more common in smokers, the elderly and people of lower socioeconomic status, potentially putting these groups at increased risk of gum disease.

 Leukemia

Leukemia is a cancer of the blood stem cells found in the bone marrow. Undifferentiated (less specialized) stem cells in the bone marrow differentiate (mature) into different blood cell types such as red cells, white cells and platelets. The mature cells then enter the blood circulation. 

Cancer mutations can occur at any stage of blood cell development and can involve one or more blood cell types based on the level at which mutations occurred.

Leukemia is characterized by diffused replacement of the bone marrow by rapidly multiplying cancer cells. The abnormal leukemic cells distribute in blood, so the blood cell count increases. 

The depression of normal bone marrow function leads to anaemia, fever, fatigue and repeated infection (due to defective white cells). Nose or gum bleeding and skin bruises can be seen due to decrease levels of healthy platelets that are responsible for clotting. 

Bleeding gums occurs in response body’s decreased ability to fight infection and defective blood clotting.  

Hereditary blood disorders (Von-Willibrands (VWD) and hemophilia)

Hereditary blood clotting disorders are rare and occur either as a result of a deficiency or defective proteins responsible for blood clottings such as a von-Willebrand’s factor in von-willibrands disease and factors VIII or IX in hemophilia.

Blood clotting is a complex process that involves the activation of several proteins one after the other catalysed by enzymes culminating in the formation of a platelet plug. The platelet plug contains trapped platelets in a thin fibrous mesh. 

Most patients with the bleeding disorder aren’t aware of it until they are adults because bleeding symptoms in these patients are very mild. 

These disorders are characterized by spontaneous bleeding from mucous membranes such as gums and nose, excessive bleeding from wounds, heavy mensural bleeding and prolonged bleeding time. In case of severe deficiency, continuous gum bleeding and postoperative bleeding after tooth removal can occur.

Deposition of iron-rich products from continuous bleeding can stain the teeth and turn them into brown colour. In hemophilic patients (Factor VIII and IX) 64% of bleeding occurs in the gums when compared to other sites in the mouth.

Platelet disorders (thrombocytopenic purpura)

Thrombocytopenic purpura presents with a low platelet count (on blood profile) and a prolonged bleeding time. You may experience spontaneous bleeding into the skin or from mucous membranes (gums and nose bleed). 

Small tiny blood clots and blood-filled blisters may occur in the mouth. Gums show swelling, soft, friable texture and gum bleeding that occur spontaneously. Maintaining good oral hygiene through adequate plaque and tartar removal can reduce the severity of gum bleeding.

Aplastic Anemia

Aplatic amemia is a rare, blood disorder where there are decreased levels of all blood cells i.e, white, red cells and platelets. It is characterized by anemia, recurrent infections and prolonged bleeding. 

Spontaneous episodes of gum bleeding due to decreased platelet level, severe gum disease, pallor, and mouth ulceration are symptoms related to the oral cavity in aplastic anemia.  

Such patients are advised to consult a hematologist before the dental procedure that involves bleeding and make sure to show up for the treatment on the day of platelet infusion.

In patients with uncontrolled bleeding, it is advised to take antifibrinolytics before the procedure to reduce the post-operative bleeding. 

Aplastic anemia is linked to numerous infections and therefore, dental treatment may be postponed until they reach the normal blood cell count. To prevent any complications take the antibiotics as prescribed by your dentist or doctor. 

Summary 

Gum bleeding is a common clinical finding in gum diseases such as gingivitis and periodontitis. Bleeding gums due to the plaque and tartar is widespread.

As discussed earlier, gum bleeding can occur secondary to the systemic disease and manifests as the earliest symptom of all systemic diseases. 

It is important to note that if you experience episodes of bleeding from gums and you have good oral hygiene, get yourself checked by GP or dentist and get it sorted out.

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