Gum bleeding - part 1

Healthy gingiva is usually pink in color and spongy as a structure. It is also an essential part of oral mucosa as it holds and protects the teeth any circumstances. They have strong bond with the teeth; therefore, they can easily prevent entrance or spreading of any infective materials to the root of the teeth or alveolar bone. Due to pathological condition or aging, gingiva gets weaken and recession occurs. On consequence, there will be every chance of having tooth loss. However, bleeing from the gingiva is majorly occurring due to the infection, injury or inflammation. Such inflamed or infected gingiva are medically signified as gingivitis. It can be detected as the reddish line of blood spreading on the gingival tissues. If bleeding persists for a long time, then it has to be taken seriously as it can be an indication of serious pathological disorders.
Cause of bleeding from the gum or gingiva:
1. Local factors:-
· Chronic marginal gingivitis.
· Chronic adult periodontitis.
· Juvenile periodontitis.
2. Acute cause :-
· Acute necrotizing ulcerative gingivitis.
· Necrotizing ulcerative periodontitis.
· Trauma to the gingiva (e.g; tooth brushing, tooth picks or food impaction or by bitting into solid foods such as apples, flossing, dentures or braces, entry of foreign particles between the teeth etc).
3. Systemic factors :-
· Vascular abnormalities => Vit-C deficiency (e.g; schonlein-Hench purpura)
· Hypo- prothombenemia => Vit- K deficiency
· Platelet disorder => Thrombocytopenic purpura
· Genetic disorders => Haemophilia, Von Willebrand’s disease.
[ There are both genetic disorders where the blood fails to clot due to the deficiency of clotting factors].
· Chistmas disease => coagulation disorder.
· Hormonal changes => Imbalance in hormone level that results in the increase level of fluid in the gum or gingiva making the red and swollen which may eventually result in bleeding.
· Leukaemia.
· Multiple myeloma.
· Smoking and chewing tobacco.
· Dengue fever.
· Chemo therapy and radio therapy can lead to gingival bleeding.
· Hormonal replacement therapy, oral contraceptives cause gingival bleeding.
· Pregnancy and menstrual cycle also cause gingival bleeding.
· Administration of excessive amount of drugs =>
- Anti – depressants.
- Anti – histamines.
- Anti – hypertensive calcium channel blocker.
- Immuno – suppressants.
- Blood thinner such as Heparin
· Auto-immune disorders =>
- Hashimoto’s thyroiditis.
- Rheumatoid arthritis.
- Systemic lupus erythromatosus.
· Systemic disorders =>
- Liver disorder
- Diabetes mellitus.
- Kidney disorder.
- Heart disorder.
[Oral contraceptives => An exaggerate response to local irritants occurs in gingival tissues. Inflammation ranges from mild edema and erythema to severe inflammation with haemmorhagic or hyperplastic gingival tissues. Here, more exudates present in inflamed gingival tissues present of Oral Contraceptice pill users than the pregnant women. Gingival response may be caused by an altered micro vasculature, increased gingival permeability and increase synthesis of prostaglandin. Prostaglandin E is a potent mediator of inflammation appears to rise significantly with increasing levels of sex hormones].
Symptoms of gingival bleeding:
1. Red, tender or swollen marginal and interdental papillae.
2. Bleeding occurs on slightest touch or injury.
3. Bloody taste in mouth due to bleeding gums.
4. Sometimes, pus may also come out through squeezing if gum bleeding present.
5. Bad breath will be one of the major complaints.
6. Gum recession may occur.
7. Teeth may become sensitive.
8. Loose or shaky teeth.
9. Difficulty and discomfort in mastication.
Diagnosis of gingival bleeding:
If persistent gum bleeding occurs, there are several tests can be performed:-
1. X-rays of upper and lower jaw.
2. Oral examination of teeth along with gingiva.
3. Blood analysis.
4. Analysis of bleeding and clotting time.
5. Complete Blood Count => Tc, Dc, ESR, Hb%,
6. Serum creatinine, blood urea, calcium, blood suger.
7. Coagulation factorsm and serum prothrombin time.
In next article, I will discuss on how to prevent gum bleeding in an efficient manner. Stay tuned..