Bleeding gums: what's normal and when to worry

The most common reason is plaque, the soft, sticky film of bacteria that builds up along the gumline every day. When it sits there, the gum next to it gets inflamed. Inflamed gum tissue is puffy and full of tiny blood vessels, so it bleeds with even light pressure from a toothbrush or floss. That early stage is called gingivitis.

Other things can make bleeding more likely or more noticeable:

• Starting to floss again after a break (this usually settles in a week or two)
• Brushing hard, or using a firm-bristled brush
• Hormone changes, including pregnancy
• Some medications, including blood thinners
• Diabetes, especially when blood sugar runs high
• A new partial denture or appliance rubbing the gum

Smoking is a special case. It can hide bleeding by reducing blood flow to the gums, so smokers can have gum disease with less warning.

Occasional light bleeding that stops quickly, especially after flossing a spot you usually skip, is common. If you brush twice a day and floss daily for a week or two and it fades, that was probably early gingivitis, and your home care is fixing it.

It's time to book an exam if:

• Your gums still bleed after two weeks of steady brushing and flossing
• Your gums look red, swollen or shiny instead of pink and firm
• Your gums seem to be pulling back and your teeth look longer
• You notice bad breath or a bad taste that doesn't go away
• Teeth feel loose, or your bite feels different
• You see pus between a tooth and the gum

Gingivitis is inflammation of the gum only. It's reversible. Remove the plaque consistently and the gum heals.

Periodontitis is what happens when it goes on long enough. Plaque hardens into tartar below the gumline, where a toothbrush can't reach. The gum starts to separate from the tooth and forms a pocket, and bacteria in that pocket damage the bone that holds the tooth in. Lost bone doesn't grow back on its own, so the goal becomes stopping it.

Untreated periodontitis is one of the leading causes of tooth loss in adults. It usually doesn't hurt until late, which is why so many people are surprised by it.

At an exam we gently measure the space between each tooth and the gum with a small ruler. Healthy gums fit snugly, with shallow spaces. Deeper pockets, bleeding when we measure, and gum recession tell us how far things have gone. X-rays show the bone level around each tooth.

The pocket measurements are quick and usually painless. If your gums are inflamed, they may be a little tender, and you may see some bleeding while we measure. That bleeding is information, not a problem.

At our Mesquite office you'll see those numbers and images with us, so a recommendation makes sense instead of sounding like a sales pitch. If your gums are healthy, we'll tell you that too. New patients start with the $80 exam and x-rays.

Gingivitis is usually handled with a regular cleaning and better daily habits. We'll show you where plaque is collecting and how to reach it.

Periodontitis usually needs a deep cleaning, called scaling and root planing. We numb the area, remove tartar and bacteria from below the gumline, and smooth the root surfaces so the gum can heal closer to the tooth. It's usually done in sections over one or two visits. Your gums may feel tender for a few days, and most people notice less bleeding within a couple of weeks.

After that, cleanings are often scheduled more often than every six months for a while, to keep the pockets from filling back up. We recheck the measurements and show you the change.

Insurance usually treats deep cleanings as basic care, not preventive, so the deductible may apply. We check your plan and put the cost in writing first. See how dental insurance works for the details.

• Brush twice a day for two minutes with a soft brush, angled toward the gumline
• Floss or use small interdental brushes once a day, gently, following the curve of each tooth
• Don't stop flossing because it bleeds. That inflamed spot is the one that needs it most.
• If you smoke, quitting is one of the best things you can do for your gums
• If you have diabetes, keeping blood sugar steady helps your gums heal
• Keep your checkups. Tartar can only be removed with dental instruments.

An electric toothbrush with a pressure sensor can help if you tend to scrub. Ask us what fits your mouth.

Gums can get inflamed around dental work too. Plaque collects at the edge of a crown and under a bridge, where it's easy to miss with a brush. Floss threaders, small interdental brushes or a water flosser help reach those spots.

Implants need the same care. An implant can't get a cavity, but the gum and bone around it can get infected, a condition called peri-implantitis. Bleeding, swelling, a bad taste or a sore spot around an implant are worth an exam soon, whether the implant was placed here or somewhere else. Caught early, it's usually easier to manage.

Researchers have found links between gum disease and other conditions, including diabetes and heart disease. The relationship is still being studied, and gum disease hasn't been proven to cause them. What's well established is that diabetes and gum disease affect each other: each can make the other harder to control. It's one more reason not to ignore gums that bleed.

If you're pregnant, hormone changes make gums more prone to swelling and bleeding. Dental cleanings are generally considered safe during pregnancy. Tell us when you book.