Bleeding Gums & Gum Disease — Causes, Treatment & the Gut Connection

Gum disease is inflammation of the tissues that surround and support the teeth. It is very common, often painless, and easy to ignore: blood in the sink after brushing can become background noise. Bleeding gums are rarely an emergency, but they are almost never nothing. They are an early warning with a window in which the situation is fully reversible.

Gingivitis and periodontitis

Gingivitis is inflammation of the gum only. The bone holding the teeth is untouched. Gums look red and puffy and bleed easily. With professional cleaning and better daily care, gingivitis usually settles within a few weeks.

Periodontitis is what untreated gingivitis can become. Bacteria move below the gum line, and the body's own inflammatory response gradually breaks down the supporting bone. Pockets form between tooth and gum, and teeth can loosen or drift. Progression can be stopped, but lost bone does not grow back on its own. How quickly someone moves from one stage to the other varies with genetics, smoking, diabetes control and general health.

Signs and symptoms

• Bleeding when brushing, flossing or eating
• Red, swollen or tender gums
• Persistent bad breath or a bad taste
• Gums that are shrinking back, so teeth look longer (see gum recession)
• Sensitivity to cold along the gum line (see sensitive teeth)
• Pus between the teeth and gums
• Teeth that feel loose, have moved, or bite together differently

Smoking deserves a note: it reduces blood flow to the gums and can hide the bleeding while the disease continues underneath. Bleeding that appears after someone stops smoking is often a sign of recovery rather than deterioration.

The bleeding comes from inflammation; the trigger varies. By a wide margin the most common trigger is plaque, a soft film of bacteria that forms on the teeth continuously and irritates the gum when it is not removed thoroughly each day. Most other factors either amplify the gum's response to plaque or, less often, mimic it.

How it develops

Plaque begins to re-form within hours of cleaning. Left undisturbed for a day or two, it becomes more inflammatory. Over the following days it can harden into tartar (calculus), which brushing and flossing cannot remove and which gathers yet more plaque. The redness and bleeding you see are the body's response. Importantly, it is largely that inflammatory response, rather than the bacteria directly, that damages bone over time. This is why two people with similar cleaning habits can have very different outcomes.

Risk factors

• Hormonal change during puberty, pregnancy, the menstrual cycle and the menopause makes gums more reactive to plaque.
• Some medicines increase bleeding tendency or cause gum overgrowth that traps plaque. Please always tell us what you take.
• Diabetes, particularly when blood sugar is not well controlled, raises the risk of gum disease, and gum inflammation can in turn make diabetes harder to control.
• Smoking accelerates the damage while masking the warning signs.
• Stress and poor sleep affect immune function and saliva, and are often present when gums do not settle despite good cleaning. See chronic stress and burnout.
• Diet. A low intake of vitamin C weakens gum tissue, and a high-sugar diet feeds the bacteria involved. See our guide to gut health.
• Family history. Susceptibility to periodontitis has a genetic component, so a family history means closer monitoring.
• Heavy brushing or a new flossing routine. Hard brushing causes local trauma, and gums often bleed for a week or two when flossing is first started. Bleeding beyond that is usually gingivitis rather than a reason to stop.

Rarely, bleeding gums are linked to a general medical condition. Persistent unexplained bleeding alongside tiredness, easy bruising or feeling unwell should be discussed with your GP as well as your dentist.