Why Are My Gums Bleeding?

Healthy gums do not bleed

A little blood on the brush or in the sink can feel minor, and many people stop brushing that area because of it. That is usually the wrong response. Healthy gums are pink, firm and do not bleed with normal brushing. Bleeding is a sign of inflammation, and in most cases the cause is something you can reverse.

The most common cause: plaque and gingivitis

Plaque is a soft, sticky film of bacteria that forms on teeth every day. If it is not removed, the gums around it become red, puffy and tender, and bleed easily. This early stage is called gingivitis. It is common in children, teenagers and adults, and it is reversible.

Plaque that stays for a few days hardens into tartar (calculus), which you cannot brush away. Tartar holds more plaque against the gum. Scaling by a dentist or hygienist removes it.

When it goes further: periodontitis

If gingivitis continues for months or years, the infection can spread below the gum line. Pockets form between the teeth and gums, and the bone that supports the teeth starts to break down. This is periodontitis. Signs include:

• gums that bleed often, or bleed without brushing
• gums that look like they have pulled back, making teeth look longer
• persistent bad breath or a bad taste
• teeth that feel loose or have moved
• pus between the teeth and gums

Periodontitis is not reversible, but it can be controlled with treatment and good home care. Left alone, it is a major cause of tooth loss in adults. See gum diseases for how it is treated.

Other causes

• Brushing too hard or with a hard brush. This can injure the gums. A soft brush and gentle, small circles are enough.
• Starting to floss. Gums that have not been cleaned between the teeth may bleed for the first few days. If you floss gently each day, it should settle in 1 to 2 weeks.
• Hormonal change. Gums can become more sensitive during puberty, pregnancy and menopause.
• Medicines. Blood thinners such as warfarin, aspirin and newer anticoagulants can make gums bleed more. Do not stop any medicine without speaking to your doctor.
• Smoking and tobacco. These can hide bleeding, because the gums get less blood, while making gum disease worse.
• Poorly fitting dentures, braces or rough fillings that irritate the gum.
• Health conditions. Diabetes raises the risk of gum disease. Rare causes include blood disorders, low platelet counts and vitamin C or K deficiency. Bleeding that is heavy, unprovoked or comes with easy bruising needs a medical check.

What you can do at home

1. Brush twice a day for 2 minutes with a soft brush and fluoride toothpaste. Angle the bristles towards the gum line.
2. Clean between your teeth once a day, using floss, tape or interdental brushes.
3. Keep going even if it bleeds. Gentle, regular cleaning is what heals the gums.
4. Replace your brush every 3 months, or sooner if bristles splay.
5. Stop tobacco in all forms.
6. Eat fewer sugary snacks and drinks, and eat fruit and vegetables.

Salt-water rinses can soothe the gums but do not replace cleaning. Antiseptic mouthwash can help for a short time, but it cannot remove plaque on its own.

You should see improvement within 1 to 2 weeks. If you do not, home care alone is not enough.

What the dentist will do

A dentist will check your gums with a small probe, measuring the depth of pockets around each tooth, and may take X-rays to see bone levels. Treatment depends on what they find:

• Gingivitis: scaling and polishing, and advice on cleaning technique
• Periodontitis: deeper cleaning below the gum line (root planing), possibly in several visits, followed by regular maintenance. Some cases need further gum treatment.
• Other causes: adjusting a denture, smoothing a filling, or asking you to see your doctor for a check

Bleeding gums that stay unexplained should never be left. They are one of the earliest signs of a problem that is easy to treat early and harder to treat late. The bleeding gums page lists causes and what to expect from an examination.