Bleeding gums: causes and signs of periodontitis

What healthy gums look like

Healthy gums surround your teeth and hold them in place. This helps to protect against tooth loss. Pain is not a good guide, because inflamed gums often do not hurt either. Look out for these signs instead:

• They are pink, not dark red.
• They are firm, not swollen.
• They fit closely around each tooth and fill the gaps between the teeth.
• They do not bleed when you brush or eat.

Common causes of bleeding gums

Often several causes come together. An examination shows which ones apply to you.

Plaque at the gum line

The most common cause is a film of bacteria on the teeth called plaque. It collects mainly where the tooth meets the gum. If it stays there, the gums can become inflamed within just a few days. Later it hardens into tartar, which can only be removed at a dental practice.

Brushing too hard or starting to floss

Hard bristles and a lot of pressure can injure the gums. If you have just started to floss, your gums will often bleed for the first few days. That is no reason to stop. It usually settles after about a week.

Pregnancy, hormones and medication

During pregnancy and puberty, hormones make the gums more prone to inflammation. Some medicines, for example for high blood pressure, can cause the gums to overgrow. Blood thinners can make bleeding gums more likely. Never stop taking a medicine on your own, though. Speak to your doctor instead.

Smoking and conditions such as diabetes

Smoking markedly increases the risk of periodontitis. Nicotine also narrows the blood vessels in the gums. This is why smokers' gums often barely bleed, even when they are inflamed. Diabetes and stress also make inflammation more likely. In rare cases, a blood clotting disorder is behind it.

Crowded teeth, overhanging fillings and wisdom teeth

Where teeth are crowded, plaque is more likely to stay behind. For more, see treatment for crowded teeth. Fillings or crowns with overhanging edges also trap plaque. The gum can swell at the very back of your mouth. A wisdom tooth that has not fully come through may be the cause. Read more about an inflamed wisdom tooth.

The difference between gingivitis and periodontitis

Gingivitis and periodontitis are often confused. Both are forms of gum disease. The difference matters, because only gingivitis can clear up completely.

Gingivitis affects only the gums

In gingivitis, the inflammation is limited to the gums. They are red and swollen and bleed easily. If plaque is removed regularly, gingivitis usually clears up. Otherwise it can spread.

Periodontitis damages what holds the tooth in place

In periodontitis, the inflammation spreads to the tissues that hold the tooth in place. Gum pockets form, and bacteria collect in them. The bone around the teeth breaks down, and teeth can become loose. Periodontitis does not heal on its own. When gingivitis is spotted early, it is less likely to turn into periodontitis.

Why periodontitis often causes no pain

Periodontitis usually develops slowly and does not hurt. Pain often starts only when pus forms or teeth become loose. So pay attention to warning signs, even when nothing hurts.

Signs and symptoms of gum disease

The symptoms of periodontitis come on slowly and at first resemble those of gingivitis. These two lists can help you assess your situation. They do not replace an examination.

Early warning signs

• Your gums bleed when you brush, floss or eat.
• Your gums are red or swollen.
• Bad breath or a bad taste in your mouth does not go away. This can point to plaque below the gum line.

Later warning signs

• Your gums recede, so your teeth look longer.
• Your teeth are sensitive near the gum line, for example to cold.
• Pus comes out at the gum line.
• Teeth become loose or shift.
• New gaps appear between your teeth.
• Chewing hurts.

Receding gums

When gums recede, parts of the tooth root are exposed. The teeth look longer. Near the gum line, they often react to cold, sweet foods or touch.

Possible causes of receding gums

• periodontitis
• scrubbing hard or using a hard brush
• highly abrasive toothpastes, for example for whitening
• naturally thin, delicate gums
• lip or tongue piercings
• injuries and ageing

What can be done

Gums that have receded do not grow back on their own. The first step is to stop the cause, such as periodontitis or brushing too hard. At the examination, we check whether the exposed root surfaces can be protected or covered.

What to do if your gums bleed when brushing

Above all, thorough, gentle brushing helps with bleeding gums. The gums can only heal once plaque has gone. In short:

1. Brush gently twice a day with a soft brush.
2. Clean between your teeth once a day.
3. If you use mouthwash, use it only as an extra.
4. If you smoke, stop.

Keep brushing, but gently

Keep brushing, even if your gums bleed. Use fluoride toothpaste and press only lightly. Place the bristles at an angle against the gum line and move them gently.

Clean between your teeth every day

A toothbrush can hardly reach the plaque between your teeth. Use interdental brushes where there is some space, and floss where there is not.

What mouthwash can and cannot do

Mouthwash does not replace a toothbrush or floss. Chlorhexidine mouthwashes are only meant for short-term use. Over a longer period they can stain your teeth. Only use them after speaking to us or a pharmacist.