What causes gums to bleed?

Bleeding gums are caused by inflammation of the gum tissue. Inflammation occurs in the gums as a result of a bacterial infection. The bacteria accumulate in the plaque and tartar on the teeth and it is the waste products of these bacteria which irritate the gum tissues to the point where they become unhealthy and start to bleed. It is very similar to an infected wound which is not healing properly. This unhealthy condition is called Gum Disease, and is sub-divided into Gingivitis and Periodontitis. Gingivitis is the presence of inflammation in the gums without any loss of bone around the teeth; Periodontitis is a more advanced stage of gum disease in which the bacterial infection has progressed to the point where bone loss has occurred around the teeth making them unstable and prone to being lost. As the bacterial populations increase, their increased waste products begin to break down the bone and collagen fibers which hold your teeth in place. The important thing to remember about these two types of Gum Disease is that Gingivitis is reversible, while bone loss from Periodontitis is non-reversible. Once bone has been lost to Periodontitis, it is gone forever. There are some cases where we can replace lost bone by doing a bone graft, but it requires certain conditions which are not always available. Prevention of bone loss is the best treatment when treating Periodontitis.

We diagnose Gum Disease by periodontal probing and phase contrast microscopy. Probing is a way for us to measure how much inflammation and bone loss is present around your teeth. We perio probe all of our new patients, and at least once a year for our existing patients. To the right is a picture of a periodontal probe. The probe slides into the space in between the tooth and the gums, called the periodontal pocket, and stops at the bone. We then use the markings on the probe to measure in millimeters how deep the probe goes. We measure from the bottom of the pocket to the top of the gums. In general, 1-3mm pockets are healthy, 4-6mm are unhealthy and 6+mm are very bad. The pictures below show how bone loss affects the probing depths, you can see how the probe dips deeper in the bottom two pictures where significant bone loss has occurred. What is also important to notice is that in the top two pictures the bone levels are the same but there are deeper pockets shown in the Gingivitis picture; the deeper pockets are from the inflammation of the gums. Since no bone has been lost yet, returning the gum tissue to health will get the patient back to a healthy state. The teeth shown in the bottom right picture showing advanced Periodontitis will need to be removed; there just is not enough bone left to support them anymore. In addition to probing, we also look at the appearance of the gums and whether they bleed when we probe. Healthy gums are firm, pink and do not bleed when probed or flossed. Unhealthy gums are swollen, spongy, red and bleed easily. Many people think that it is normal for their gums to bleed when flossing or having them cleaned and they are wrong. Remember, healthy gums do not bleed- period!

Phase Contrast Microscopy

In our office we have another powerful tool used in diagnosing periodontal disease, phase contrast microscopy. This is a high powered microscope which enables us to actually see the types and amounts of bacteria present in a person's gums. All it requires is small plaque sample from below the gums which can be taken quickly an painlessly. The great thing about this type of exam is that it enable us to identify patients who have gum disease causing bacteria present, but have not yet developed the disease and the associated loss of bone and tissue around their teeth. Periodontal probing is an excellent way to determine that periodontal disease had occurred and measures how much damage has been done, but it is incapable of identifying patients who have disease causing bacteria present. Bone and tissue which has been destroyed by periodontal disease is gone forever, so it is very important that the disease is identified and treated before the damage occurs.

Bacterial Testing- PCR DNA analysis

Once a person has been diagnosed with periodontal disease, we will recommend testing of the bacteria to determine which species of bacteria the gums are infected with. This is a relatively new development which has become available to the dental profession. Periodontal disease bacteria are very specialized and can only live in a living human host, they are very difficult to grow in a culture as is done for other types of infectious bacteria (strep, staph and other respiratory infections). The bacterial samples we take from the gums die within an hour or so of being removed from the host. Thanks to the development of DNA analysis, these dead samples can still be analyzed by identifying the genetic sequence of the bacteria; the amounts of the bacteria present are also revealed through this process.

Identification of the bacteria is the key to treating periosontal disease. With this information we can prescribe an apporpriate antibiotic which has been proven to be effective against the identified bacteria. Simply put, you can't properly treat an infection if you don't know exactly what is causing it.

Periodontal disease is common in people 30 and over...

Studies show that at least thirty five percent of U.S. adults over the age of 30 have Periodontitis to some degree. Of those thirty five percent, about a quarter have advanced periodontal disease and will not get to keep their teeth for the duration of their lifetime. As we learned earlier, once bone is lost it is gone for good, so your best defense against periodontal disease is preventing it from happening. We do not cure Periodontitis, we can only manage it and keep it under control. This is done by scaling and root planing (deep cleaning), laser sterilization of pockets, and regular hygiene visits. Sometimes we refer patients out to a Periodontist- a dentist who specializes in treating the gums. Our job as dentists is to educate people about gum disease and to prevent the onset of this destructive disease process.

A common response we get from patients when we inform them that they have Gum Disease is that nothing is hurting and they are not overly concerned. Gum Disease is generally painless- mostly because it is a slow process which can take a few years to lead to the loss of a person's teeth. It is very important to monitor the pocket depths closely because even if you are only losing a half millimeter of bone each year or two, you will have lost so much bone in five to ten years that many teeth will be lost.

Gum Disease has been linked to to other, serious health conditions...

In the last few years researchers have found that people with Gum Disease are at higher risk of heart disease as well. Diseased gums release significantly higher levels of bacterial inflammatory compounds into the bloodstream of patients with periodontal disease compared to healthy patients. As a result, these harmful bacterial compounds in the blood travel to other organs in the body, such as the heart, and cause harm.

Another interesting discovery by researchers is that the same type of bacteria found in the gums of people with periodontal disease were also present in the atherosclerotic plaque build-up of coronary (heart) blood vessels. These plaques are responsible for causing blockages in the coronary blood vessels which can lead to heart attack and stroke. Bleeding gums should be regarded as an open sore which is not healing, and are providing bacteria and other harmful organisms an open door to your bloodstream. If you had an open sore anywhere else on your body that was not healing, you would seek out medical attention- having bleeding gums is no different and they need to be treated as such.

How do we treat Gum Disease?

First, we need to determine if a patient has Gingivitis or Periodontitis. We then decide what type of tooth cleaning they require. In general, we treat Gingivitis with a routine cleaning (called a prophylaxis) and we treat Periodontitis with scaling and root planing (also known as a deep cleaning). "Scaling" describes the removal of tartar from teeth while "root planing" describes the removal of tartar from the root surfaces with subsequent smoothing of the rough surfaces. The main difference between these two procedures is how deep below the gums we are using our instruments. Since scaling and root planing occurs several millimeters below the gums, it is always done using local anesthetics to keep the patient comfortable. In cases where people have severe Gingivitis we will often recommend scaling and root planing since gums which are severely inflamed are extremely sensitive and need to be numbed. In our office we also use our soft tissue laser to remove unhealthy tissue and kill bacteria in the pockets around the teeth. We monitor our patient's gums at each hygiene visit and continue to use the laser in unhealthy areas until the pockets are less than 3mm and do not bleed. If you have bleeding gums, or questions about gum disease, Dr. Diercks and Dr. Sawyer are always here to help. Call us today at (408) 402-0900 for an appointment.

Here is a link to the patient education section of our website which you may find helpful. There is a lot of information there for you to browse through and to answer any questions you may have, and was designed by a dental education company whose tools are used in our office to help our patients understand their treatment options. Some of the information there may be a bit outdated because the dental field is always evolving, but the general concepts of dentistry are nicely described and illustrated.

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