Bleeding is not normal
A healthy gum is pink, firm and hugs the tooth like a well-fitted collar. It does not hurt and it does not bleed when you touch it, whether with a brush or with floss. If you see blood repeatedly there is inflammation, and inflammation always has a cause: nearly always plaque sitting right at the gum margin or just below it.
The other common mistake is brushing the bleeding area less for fear of causing damage. It works the other way round: it bleeds because plaque is there, and leaving it alone makes the bleeding worse. Clean it properly, with the right technique and without hesitation, and come and have it looked at if it is still bleeding a fortnight later.
Gingivitis and periodontitis: where the line is
Both start in the same way, with plaque at the gum margin, but the outlook is nothing alike. The difference is whether the disease has stayed in the soft tissue or has already reached the bone that supports the tooth.
- Gingivitis: inflammation confined to the gum. It bleeds and looks red and puffy, but the bone is intact and it is fully reversible.
- Periodontitis: the inflammation has destroyed part of the bone and ligament. Pockets form between tooth and gum, and lost bone does not come back on its own.
- Signs of periodontitis: persistent bad breath, receding gums, teeth that look longer, feel loose or have drifted apart.
- A bite that suddenly feels different, or a denture that stops fitting, can also be a warning.
What makes gums inflamed
Plaque is always the starting point: once it has sat there for a few hours undisturbed, the bacteria irritate the gum. Left for days it hardens into calculus, which a toothbrush can no longer shift. That said, certain factors mean the same amount of plaque does far more damage in some people than in others.
- Smoking, by far the most decisive: it masks the bleeding, reduces blood flow to the gum and worsens the response to treatment.
- Poorly controlled diabetes, which works both ways: it worsens the gums, and inflamed gums make blood sugar harder to control.
- Family history, since some forms of periodontitis clearly run in families.
- The hormonal changes of pregnancy, which make the gums far more reactive.
- Certain medicines — anti-epileptics, immunosuppressants, some blood pressure tablets — that cause gum overgrowth.
- Crowded teeth and overhanging fillings, which create corners you simply cannot clean.
How it is treated
First we need to know where you stand. Using a millimetre probe we work around each tooth and record the depth at every point, and an X-ray shows us the bone level. That chart tells us whether this is gingivitis or periodontitis and, if so, how advanced. For gingivitis, one or two hygiene appointments and a change to your routine at home are usually enough for the bleeding to stop.
If there are pockets and bone loss, we carry out root surface debridement: we clean the root below the gum, quadrant by quadrant and under local anaesthetic, so you feel nothing during the appointment. Six to eight weeks later we probe again to see how each area has responded. Most improve considerably; pockets that remain deep can be treated surgically to gain proper access.
Maintenance is what holds the result
Treated periodontitis is not cured for good: it is controlled. Bacteria recolonise the pockets within a few months, which is why maintenance appointments every three, four or six months — depending on your risk — are what really holds the result together. It is also the part people are most likely to drop, and it explains most relapses.
Left untreated, the course is predictable: the bone continues to recede, teeth loosen, drift and eventually either fall out or have to be taken out. It is one of the commonest causes of tooth loss in adults and, at the same time, one of the most avoidable when it is caught in time.
Booking an appointment
If you have been seeing blood on the brush for weeks, do not wait for it to sort itself out. Call us on 972 30 65 64 or write through the contact form. At the first appointment we chart your gums, check the bone level and explain exactly where you stand and what needs doing, with a clear plan and timescale.
Questions about this topic
Is it normal for gums to bleed when brushing?
No. Bleeding always means inflammation, even when it does not hurt. If it happens occasionally after a few days without flossing it may settle by itself; if it lasts more than a week or two, you need a check-up to see whether it is gingivitis or already periodontitis.
Does deep cleaning of the roots hurt?
It is done under local anaesthetic, so you will feel no pain during the appointment. Over the following days there may be sensitivity to cold and the gums can feel tender; an ordinary painkiller is enough and it usually settles within a few days.
Will treatment bring back the bone I have lost?
Generally no. The aim is to stop further loss and keep your teeth. In certain defects, regenerative techniques can recover part of the bone, but the rule is to stabilise the situation rather than return to the starting point.
Would you like us to take a look? Call us on 972 30 65 64 or write to us using the contact form.