Perhaps one of the most common conversations I have had with my patients over the last 20 years is about bleeding gums. There is a lot of misunderstanding around this fairly common problem, and I hope to dispel a few myths with this blog article.
What is gum bleeding
Gum bleeding is also known as gingivitis which is the body’s normal defensive response to the threat of bacteria. The body naturally wants to stop bacteria and other bugs from getting inside and the first layer of defence is the skin. However, the teeth and gums are the only place in the entire body where the skin layer is permanently breached so there will naturally be a lot of defence activity going on.
What does gingivitis look like?
Within our blood system are the body’s defence cells, which circulate around and get to areas where the skin is breached. When the body senses bacteria invading, it wants to draw more blood to the area to fight the threat and this is called inflammation. With more blood in the area of the threat, an inflamed tissue becomes:
- Enlarged with more blood
- red
- hot
- painful to touch as the pain fibres in the tissue are stretched, and
- fragile
If we think about the times when we cut our finger, if the cut was not cleaned well, the cut would get red, hot, sore to touch and would bleed easily if contacted. The gums are the same so do need some regular TLC to prevent inflammation.
Why do my gums bleed?
On our skin, and inside our mouth are millions of bacteria and we can’t get rid of them completely. In fact, these bacteria are introduced within seconds of birth and mostly don’t cause us any issue.
Bacteria in the mouth eat the same foods as we do and are particularly fond of sugars such as those in sweets and confectionary, sugary drinks, chocolate, and biscuits. The bacteria consume these sugars and multiply rapidly, forming a sticky layer on the teeth called plaque. This plaque is the white cheesy layer, which is easily scraped off the teeth with a toothbrush or fingernail. However, if the plaque is not removed entirely from the teeth, particularly at the gum line, it starts to trigger the body’s inflammation pathway and causes the gums to swell up with blood.
Often, patients will tell me that their gums bleed when they clean them, so they stop cleaning them. In fact, this is generally the opposite of what should be done. The reason the gums bleed is because they are fragile from inflammation, because of missing the same areas each time. By cleaning these areas more thoroughly and regularly, patients can remove plaque more effectively and the body will recognise the gums as healthy, reduce the blood levels, and the gums will stop bleeding. However, it will generally take a couple of weeks of thorough cleaning, which will be sore and there will likely be a fair amount of bleeding, but persisting through this will help reverse the problem.
Tips and tricks
As creatures of habit, we clean our teeth the same way every day, and when pressed for time, we are usually not as effective as we could be. Many patients tell me they do a 2-minute general scrub with no particular technique, so here are some tips I give to my patients which I have found work well.
- Forget cleaning the teeth, clean the gums instead. By cleaning the teeth, we will probably miss the gum line. However, by thinking of cleaning the gums, we will naturally clean the crevice between the gum and the tooth, which is where the bacteria are difficult to remove. I advise a 45-degree angle so that the tips of the bristles work their way under the gum line.
- Use floss or some form of cleaning between the teeth. No toothbrush, however good it is, will get the plaque out from between the teeth where they touch. Stagnating bacteria between the teeth can lead to gingivitis or tooth decay, so stirring them up will help to prevent nasty bacteria colonies from forming.
- Use an electric toothbrush. The electric toothbrush can deliver 10-20,000 movements per minute, way more than a human could ever do. Just remember to let the electric toothbrush do the work (don’t try to scrub like a manual brush), angle the brush into the gums and let it work the bristles under the gum line on each tooth in turn.
- Spend 30 seconds per sector. Many newer electric toothbrushes give an indication when to change sectors. I advise to move from the upper teeth cheek side gums to the upper teeth palate side gums, then the lower teeth cheek side gums and finally the lower teeth tongue side gums. Once the gums are clean, brush the tops of all the back teeth and then the tongue.
- Mouthwash can help but is not a substitute for mechanical cleaning. Think about when we clean a car – we cannot remove dirt from the wheels by throwing a bucket of water on the dirt. To clean effectively, we would need to use a small wheel brush to get in all the nooks and crannies, which lifts the dirt of the wheel, before then hosing it down or rinsing the dirt off. The teeth are the same – we need to lift the plaque off the tooth, before rinsing the dirt away. Mouthwash without prior mechanical cleaning just swishes the plaque from side to side as it is stuck (weakly) to the tooth surface.
At the practice, we have looked after the teeth and gums of many patients over the years and are happy to discuss any specific concerns you may have. Our dental hygienist can suggest and demonstrate products for you to help reduce the risk of gingivitis, gum disease and tooth decay, such as floss, interdental brushes, and electric toothbrushes. Why not bring in your oral hygiene aids into your hygienist appointment to receive tailored advice and feedback on your technique?
Richard Staincliffe, BDS, MSc, Dip.FFGDP (UK) RCS Eng, Dip.MILM, PgCME
Richard is a partner at Duston Dental Practice, graduating from Sheffield University in 2003, and has worked in UK General Dental Practice since. He has a distinction in his Master’s in Advanced General Dental Practice from Birmingham University, and has been teaching undergraduate and postgraduate dentists since 2008.