Bleeding gums, gum disease, periodontal disease, the whole story…

Bleeding gums:

If you have bleeding gums, chances are you have a local cause for that. something wrong happening with your gums. Indeed it might mean something more sinister, like Leukemia, or other blood disorders, but we need to investigate the local conditions first.

So if your gums bleed, that is not normal. It is the first sign you have problems with your gums.
Gum diseases are collectively called Periodontal diseases. The whole process starts when you eat and produce saliva (all normal), the germs in your mouth start forming a layer on teeth surfaces. This layer is called dental plaque and consists of germs, mucus, food debris, by-products from the germs, and a protein layer.
If this layer of dental plaque is not removed, it will eventually develop into calculus (also called Tartar). The mechanism of forming calculus is not fully understood yet. They are very similar to gall bladder stones, or even kidney stones. We can call them gum stones for simplicity.
The home-care procedures are very important to break this cycle. Unfortunately, it only slows it down, but you will not get rid of the dental plaque between your teeth without having them professionally cleaned at the dentist, at least once every 6 months.

Stages of Periodontal disease:

– Gingivitis, which is simply the inflammation of the gums. It is caused by the dental plaque and calculus on your teeth, which act as scaffolding for germs to attack your gums. This stage is usually easily managed, it just needs dental scaling to remove the calculus build up from your teeth and follow a home-care regime.
As the gums get inflamed, they get engorged with blood, hence they bleed with any provocation, like a tooth brush.
The calculus is simply petrified dental plaque.
Calculus starts getting bigger and thicker. which enables the germs to reach more areas, especially under the gum line. Normally there is a pocket (called Sulcus) between your gum and tooth at the depth of 2-3mm. The germs get access to the sulcus using calculus build up. Germs start producing toxins that break down the attachment of the gum to the tooth surface, and the gums respond with more inflammation and swelling. So the sulcus gets deeper and the gums swell up. The sulcus is known as periodontal pocket, and can reach to 10mm in depths. In the gingivitis stage, a periodontal pocket might be present, and it is called a pseudo-pocket (because the depth of the suclus gets increased by the swelling of the gums only, but not the breakdown of the tooth-gum attachment).
The breakdown of the gum-tooth attachment heralds the second stage of periodontal disease:
– Early Periodontitis:
Periodontitis simply means inflammation of the tissues around the tooth. In this stage it involves the periodontal ligament. The gums seem bigger than usual and bleed more easily.
at this stage deep scaling is needed, where the ultrasonic scaler needs to reach under the gum to remove all te deposits and build up.


– if not treated the condition enters the next stage:
– Advanced Periodontitis. Once the inflammation reaches the bone around the tooth, the bone itself starts to respond by inflammation and breakage, which makes the pockets even deeper. Teeth start to feel loose. Prognosis for the teeth starts to get worse. Treatment will involve surgical cleaning and regular maintenance.
– once bone breakdown starts, the condition is probably not reversible. There are some new products that have promising results. Some target the under-the-gum tartar to dissolve it. Another product is a combination of bone-gum tissue graft, that might help the regeneration process of the lost tissues.


We conclude from this, that Periodontal disease is caused by local factors, but there are other factors that increase the risk for gum disease, and can cause bleeding gums:
– Certain diseases: Heart problems, Diabetes, blood and bleeding disorders.
Uncontrolled Diabetes: this causes delayed healing, unresponsive white blood cells (which are, our immune system). Elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease, tends to be more prevalent, and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.
– Diet: Vitamin C, and Vitamin K deficiencies can cause bleeding gums.
– Medication: high blood pressure medication, Aspirin, anticoagulants.
– Pregnancy. Hormonal changes during pregnancy make the gums react in an exaggerated manner to inflammation, making them bleed easily.
– Misaligned teeth: these makes it easier for germs to attach to tooth surface, and form plaque and calculus. It is also more difficult for the person to clean.
– Dentures: dentures provide more surface for germs to attach to. Partial dentures have clasps that are very inviting for germ to form plaque on the tooth surface.
– Rough fillings. If you have a rough filling, this makes it easier for germs to adhere to the tooth surface.
– Braces: these are another platform for germs to use in forming more plaque on teeth.

Management of periodontal disease:

 – prevention is the key here. Advanced periodontal disease has poor prognosis.
Through out this article, the word pain has never been mentioned. This is important, periodontal disease is often painless, and most people who get diagnosed with even the advanced stages of it, are totally oblivious, and get surprised when told they have a serious problem in their mouth.
– Make sure to brush twice daily and floss at least once.
– use mouth rinses every other day.
– diet rich in vitamins, and proteins. In general healthy diet.
– Fish oil also help eliminate the early stages of gum disease.

Conclusion:

Peirodontal disease is a serious condition if you are serious about keeping your teeth. No one is immune against it. Most important thing to remember is: Prevention, prevention, prevention.