Bleeding Gums Are Not Normal — And They Are Not Only About Your Mouth

Bleeding is information, not clumsiness

The most common explanation people offer for bleeding gums is that they brushed too hard. It is almost never the reason. Skin on your arm does not bleed when you rub it with a soft brush, and neither does healthy gum tissue.

What bleeding usually indicates is gingivitis: bacterial plaque sitting along the gum line long enough that the tissue becomes inflamed, and inflamed tissue is fragile and full of blood vessels close to the surface. The irony is that people who notice bleeding often brush that area less, which allows more plaque to accumulate, which produces more bleeding.

The line between reversible and not

Gingivitis affects the gum only. Remove the plaque and calculus properly, keep the area clean, and the tissue returns to health within a couple of weeks. Nothing has been lost.

Periodontitis is different. The inflammation has reached the bone that holds the tooth in its socket, and that bone recedes. Bone does not grow back on its own. Treatment can arrest the process and keep the tooth stable for decades, but it cannot rewind it, which is why the distinction between the two matters more than almost anything else in gum treatment.

• Gingivitis: bleeding, redness, puffiness. No bone loss. Fully reversible.
• Early periodontitis: deeper pockets between gum and tooth, some bone loss visible on X-ray. Stabilisable.
• Advanced periodontitis: recession, sensitivity, drifting or loosening teeth, sometimes bad breath that does not respond to brushing.

Periodontitis is largely painless until it is advanced, which is the reason it is so often found at a routine examination rather than reported by the patient.

What the evidence says about the rest of the body

This is an area where careful language matters, because it is also an area where a great deal is oversold.

The association between periodontal disease and cardiovascular disease is well documented across large populations. What is less settled is causation — the two conditions share risk factors, smoking and diabetes among them, and separating the contribution of each is difficult. It would be wrong for anyone to tell you that treating your gums will prevent a heart attack.

The relationship with diabetes is better characterised and runs in both directions. Poorly controlled blood sugar makes periodontal disease more likely and more severe; periodontal inflammation appears to make blood sugar harder to control. Studies of periodontal treatment in people with type 2 diabetes have shown measurable improvement in glycaemic control following treatment. That is a real finding, and a reasonable thing to act on.

There is also good evidence linking periodontal disease in pregnancy with adverse outcomes such as pre-term birth and low birth weight, which is why a gum assessment is worth having if you are pregnant or planning to be.

What we will not tell you

We will not tell you that treating your gums cures an unrelated illness, or that we can diagnose systemic disease by looking in your mouth. What we will say is that chronic inflammation anywhere in the body is worth removing when removing it is straightforward — and in the gums, it usually is. This is the practical end of holistic dentistry: treating the mouth in the context of the person it belongs to.

When to have it looked at

• Bleeding when you brush or floss, more than very occasionally.
• Gums that look red or swollen along the tooth margin.
• Persistent bad breath or a bad taste that brushing does not fix.
• Teeth that feel loose, or have drifted or spaced out over time.
• Receding gums, or teeth that have become sensitive at the neck.

An assessment involves measuring the pocket depth around each tooth and comparing it against X-rays, which takes about half an hour and tells you exactly which of the three stages above you are in. See gum treatment for what happens next, and our published fees for what it costs.

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