Gums, bleeding

• oral trauma, for example bristles of a toothbrush that are too hard or if gums are poked with a toothpick
• periodontitis from tartar build up
• infection
• gingivitis
• effect of medication (such as an anticoagulant)
• vitamin C deficiency
• vitamin K deficiency
• pregnancy
• atmospheric pressure changes
• chemical irritants
• drugs such as Coumadin, heparin, aspirin
• leukemia
• idiopathic thrombocytopenic purpura

Note: There may be other causes of bleeding gums. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for bleeding gums, occurring alone or in combination with other problems.

Home Care:
Home care depends on the cause. Follow your health care provider's recommendations.

• For infection, treatment by the dentist is recommended.
• For effects of medication, prescribed adjustments of dose or use of substitute drugs is recommended. NEVER CHANGE YOUR MEDICATION WITHOUT CONSULTING YOUR HEALTH CARE PROVIDER.
• For vitamin deficiency, proper diet or vitamin supplements are recommended.
• Sore and bleeding gums can be aggravated by citrus fruits and juices, rough or spicy food, alcohol, and tobacco. Take vitamin C supplements if citrus fruits and juices cannot be taken.
• If dentures make gums bleed, wear them only during meals.
• Avoid toothpick use. This may cause gum injury and infection.
• Use an oral irrigation device on the low pressure setting to massage gums.
• Avoid aspirin unless your health care provider has asked you to take it for a specific reason.
• Gum bleeding can be controlled by applying pressure with a gauze pad soaked in ice water directly to the bleeding gums.
• Eliminate between-meal snacks and reduce carbohydrate intake to help prevent plaque build-up on teeth.
• Visit the dentist at least once every 6 months for plaque removal.
• Brush teeth gently (with a soft-bristle toothbrush) after every meal. The dentist may recommend rinsing with salt water or hydrogen peroxide and water. Avoid using commercial, alcohol-containing mouthwashes, which aggravate the problem.
• Floss teeth daily to remove plaque (unless the dentist says not to).

Call Your Healthcare Provider If:

• the gums continue to bleed even after changing to a softer brush and following home care recommendations.
• the problem is severe or chronic or if other unexplained symptoms are associated with the bleeding.

What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting bleeding gums in detail may include:

• quality
  • Are the gums bleeding a large amount (massive hemorrhage)?
  • Can you control the bleeding?

• time pattern
  • Did the bleeding begin recently?
  • Do the gums bleed frequently; or does it occur repeatedly (recurrent)?
  • Has gum bleeding been present lifelong?
  • Does it only occur occasionally?
  • Have you had gum problems before?

• oral hygiene habits
  • How often do you brush?
  • How often do you floss?
  • How hard of a toothbrush is used?
  • How vigorously do you brush?
  • What are other habits (use of toothpicks or other)?
  • When was the last time you had your teeth professionally cleaned (at the dentists)?

• eating habits
  • Have you changed your diet?
  • Do you eat adequate amounts of fruits and vegetables?
  • Do you take supplemental vitamins ?

• medications
  • What medications are being taken? Especially, do you take:
    • anticonvulsants
    • anticoagulants (such as Coumadin, heparin)
    • aspirin

• other
  • Are you pregnant ?
  • Have you changed mouthwash or tooth paste recently?
  • What other symptoms are also present? Is there:
    • breath odor
    • redness of the gums
    • abnormal color of the teeth
    • sore throat

The physical examination will include a detailed examination of the mouth and gums.

Diagnostic tests that may be performed include:

• blood studies (such as a CBC or blood differential )
• X-rays of the jaw and mouth
• dental X-rays

After seeing your health care provider:
If a diagnosis was made by your health care provider related to bleeding gums, you may want to note that diagnosis in your personal medical record.


A cross section illustration of the tooth. The gums are shown in pink and the bone is yellow.