Bleeding gums and gingivitis: catching it early

A pink streak when you spit out your toothpaste: many people put it down to brushing too hard and ignore it. In fact healthy gums do not bleed when brushed properly. Bleeding gums are almost always a sign that the gums are inflamed by plaque and tartar. The good news is that at this stage gingivitis is fully reversible with proper cleaning and scaling. Left alone, the inflammation spreads to the bone and becomes periodontitis, and that damage does not reverse.

Signs of gingivitis

• Gums that are dark red instead of pale pink, shiny and swollen, having lost their natural stippling.
• Bleeding when brushing or flossing, sometimes when eating.
• Persistent bad breath or an unpleasant taste.
• The gums may be slightly tender, but gingivitis is usually not very painful, which is why it is easy to ignore.

Gingivitis versus periodontitis

• Gingivitis: inflammation confined to the gum, not yet affecting the bone. It resolves once plaque and tartar are removed.
• Periodontitis: the inflammation has destroyed the ligament and bone that support the teeth. Signs: receding gums, teeth that look longer, widening gaps between teeth, loose teeth, pus from the gums, teeth drifting, severe bad breath. Lost bone does not grow back; treatment aims to keep what is left.

Periodontitis progresses silently over years and is often noticed only when teeth are loose. Catching it at the gingivitis stage is the chance to reverse it completely.

Who is more at risk

Smokers (whose gums bleed less, hiding the sign), people with diabetes, pregnant women (hormonal changes make gums more reactive), people with braces (patients treated at Asahii Dental Clinic have a guide to cleaning around brackets in the clinic's Zalo Mini App), people with crowded teeth that are hard to clean, people on certain medicines, and people whose relatives have had severe gum disease.

Cleaning properly so the gums recover

• Brush twice a day for two minutes with a soft brush, tilted 45 degrees towards the gum line, with short vibrating strokes then a sweep towards the biting surface. The gum line is exactly where the plaque that causes inflammation sits.
• Clean between the teeth every day with floss or interdental brushes. A toothbrush does not reach there.
• Do not stop brushing where it bleeds. Many people avoid the bleeding spot out of fear; plaque builds up and the inflammation gets worse. Brush gently but thoroughly, and the bleeding usually stops within one to two weeks.
• Antibacterial mouthwash is a short-term aid when prescribed, not a replacement for brushing and flossing.
• Do not smoke.

See Brushing, flossing and water flossers: how to do it right.

Examination and scaling

Tartar is plaque that has hardened, bonded firmly to the teeth above and below the gum line; brushing cannot remove it. The dentist uses an ultrasonic scaler and hand instruments to remove tartar above and below the gum, then polishes the teeth so plaque has a harder time sticking again. Periodontitis needs deeper cleaning under the gum, area by area, possibly over several visits, and closer follow-up. At Asahii the pocket measurements and X-rays from each visit are entered in your record to compare with the next, and the dentist tells you how many visits are needed and what they cost before starting. See Regular scaling.

After scaling the gums may bleed slightly and feel sensitive for a few days; that is the time to brush more carefully, not to stop.

When to see a dentist

• Bleeding gums for more than two weeks despite brushing and flossing properly.
• Very red, swollen gums, pus, severe bad breath.
• Loose teeth, gaps opening up, obvious gum recession.
• Bleeding gums while pregnant, diabetic or smoking.
• Gums that bleed spontaneously without brushing, or with bruising or bleeding elsewhere on the body: see a general doctor as well.

When to see us straight away

• Greatly swollen, very painful gums with pus, or fever.
• Very loose teeth, or pain on biting.
• Heavy gum bleeding that does not stop.

Whether it is gingivitis or already periodontitis can only be told by an examination, with pocket measurements and X-rays. See our preventive dentistry page or book an examination and scaling by hotline 0928 888 121, Zalo or the Mini App; the clinic is open every day of the week, 08:30 to 19:00.