Why do gums bleed, and when should it be taken seriously?

Healthy gums do not bleed when brushed. Bleeding is the first sign of inflammation in response to bacterial plaque collecting at the gum margin. It is usually painless and therefore ignored — yet at this early stage it is completely reversible.

Commonest causes

• Inadequate or incorrect brushing; not flossing
• Calculus (tartar) build-up
• Hormonal periods such as pregnancy and puberty
• Certain medicines (blood thinners, some blood-pressure and epilepsy drugs)
• Smoking (can mask bleeding while the disease progresses)
• Diabetes, vitamin C deficiency, some blood disorders
• Overhanging fillings and ill-fitting crown margins

Gingivitis or periodontitis?

Gingivitis: redness, swelling and bleeding; no periodontal pocket, the bone is intact. It heals within 1–2 weeks with cleaning and regular care. Periodontitis: the inflammation has reached the fibres and bone holding the tooth; gum recession, mobility, gaps opening between the teeth and bad breath are added. Lost bone does not come back, but treatment halts progression.

What can you do at home?

1. Brush twice a day for 2 minutes with a soft brush, angled at 45° to the gum margin. Don't avoid the bleeding area; clean it gently.
2. Use floss or an interdental brush every day.
3. Cut down on smoking; keep diabetes under control.
4. If bleeding has not eased within 2 weeks, book an examination.

Signs that need an examination

• Spontaneous bleeding (without brushing)
• Gum recession, teeth looking longer
• A loose tooth, a change in the bite
• A gum abscess, discharge
• Persistent bad breath

What happens at the examination?

Pocket depths are measured and, if needed, bone levels are assessed on an X-ray. For gingivitis, scaling and brushing instruction are enough; for periodontitis, root planing and a regular maintenance programme are planned.

Should bleeding gums be brushed?

Yes — and more carefully. Stopping brushing when you see blood is the commonest mistake: plaque remains, inflammation and bleeding increase. Gentle circular strokes with a soft brush at 45° to the gum margin plus daily flossing, kept up for 7–14 days, reduce bleeding markedly. A hard brush and horizontal scrubbing, on the other hand, injure the gum.

Hormones and medicines

• Pregnancy and puberty: Hormones heighten the gum's response to plaque; pregnancy gingivitis peaks in the second trimester. See Dental health during pregnancy.
• Blood thinners: Bleeding lasts longer; the drug is not stopped, the dentist is informed.
• Some blood-pressure, epilepsy and immunosuppressant drugs: Cause gum overgrowth (hyperplasia); plaque control and, if needed, gum recontouring.

Bleeding gums and general health

Bleeding gums are a doorway through which bacteria can enter the bloodstream. Untreated periodontitis has been linked with diabetes control, cardiovascular disease and pregnancy outcomes. Gum health therefore concerns not just the mouth but general health. See Diabetes and gum health, Smoking and oral health.

Products used at home

• Antiseptic mouthwash (chlorhexidine): Effective short term (1–2 weeks); long use stains the teeth and alters taste. Not a substitute for brushing.
• Gum toothpastes: Stannous-fluoride pastes reduce inflammation; herbal "bleeding-stopper" products have limited effect.
• Water flosser: Helpful between the teeth; alongside floss, not instead of it.

Staying healthy after treatment

Gingivitis is fully reversible; in periodontitis, bone loss is permanent and the disease is "kept under control". Maintenance visits every 3–4 months, stopping smoking and daily interdental cleaning prevent recurrence. More: Gum treatment · Is scaling harmful?