CHALLENGES related to oral health are still causing anxiety, unhappiness and restlessness to many.
Brushing teeth once a simple act of hygiene, becomes difficult, smiling feels like a risk and biting into an apple has a distant memory because of one common factor — “bleeding gums”.
Initially, your gums were bleeding due to a stimulus from brushing or eating, but now they just bleed spontaneously.
Probably you have visited the dental office for a professional cleaning since dentists always advice it every six months, incorporated flossing in your routine, as well as changing your toothpaste to no avail, the problem still persists.
Hence this realisation sparked some questions: What really is causing the bleeding gums? What am I really doing wrong.
Did you know that bleeding gums are not always dental related, or plaque-induced?
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A professional cleaning expecting spontaneous changes is inevitable, but the purpose of a cleaning is to clean away the leftover or hardened plaque, reduce bacterial load, help you to clean the hard-to-reach areas.
Plaque-induced gum bleeding can stop immediately after this procedure because gum inflammation has been reduced, which is the reason of increased blood flow to the gums to help to fight the bacterial toxins being produced by the oral bacteria.
However, if perhaps your gums are not inflamed and you do not have left-over plaque and you brush your teeth thoroughly as directed by the dentists, that entails that the problem is not dental at all.
Bleeding gums can be dental or non-dental, which are due to systemic causes.
There are many conditions that affect our system as a whole, including the mouth as the mouth is not an isolated ecosystem, but an integral part of the human body.
Bleeding gums, in this context, are not the disease, but a symptom of an underlying issue.
What are these conditions?
- Haematological (Blood) disorders:
Bleeding gums are a result of the connection between the blood in your body and the gums.
Hence the conditions that affect your blood could indirectly also affect your gums.
Conditions affecting the clotting system or the health of your blood vessels could result in spontaneous bleeding.
Vitamin deficiency — The deficiency of Vitamin C (scurvy) or K raises suspicion.
Vitamin C is necessary for the production of collagen, a protein that helps to strengthen your gum tissue and blood. Without it, gums become spongy, swollen and bleed profusely.
Vitamin K, on the other hand, is responsible for the liver to produce certain proteins that are required for blood clotting.
Vitamin K deficiency — either by malnutrition, malabsorption issues or certain medications — can result in a general tendency to bleed.
Thrombocytopenia — a condition that is characterised by a low number of platelets in the blood resulting in easy bruising and bleeding.
Leukaemia — In some forms of blood cancer, the overproduction of abnormal white blood cells can crowd out the platelet-producing cells in the bone marrow, leading to thrombocytopenia and, consequently, bleeding gums.
This is often one of the early warning signs.
- Hormonal fluctuations —Hormones have a profound effect on the gum tissues, altering their response to plaque.
Pregnancy: “Pregnancy gingivitis” is a well-documented phenomenon. Increased levels of progesterone cause heightened blood flow to the gum tissues, making them more sensitive, swollen and reactive to even small amounts of plaque, leading to easy bleeding.
Menopause and menstrual cycle: Hormonal changes during these periods can also make gums more vulnerable to inflammation and bleeding, a condition sometimes referred to as menstruation gingivitis.
- Medications
A surprising number of common medications list bleeding gums as a side effect.
Blood thinners: Drugs like warfarin, heparin and the newer direct oral anticoagulants (like apixaban, rivaroxaban) are designed to prevent dangerous blood clots for patients who are at risk of developing severe clots due to the dysfunction of the clotting system.
However, these drugs meant to reduce the body’s overall ability to form clots can cause gum tissue to become very delicate making it a common site for bleeding.
Additionally, certain anti-epileptic drugs, immunosuppressants, and some blood pressure medications can cause gum overgrowth (gingival hyperplasia).
This creates deeper pockets where plaque can accumulate, making the gums more prone to inflammation and bleeding.
- Chronic systemic diseases
Several major diseases have a bidirectional relationship with oral health.
Diabetes: Uncontrolled diabetes impairs white blood cell function and reduces the body's ability to fight bacteria, including those in the mouth.
This makes people with diabetes more susceptible to severe and persistent gum disease (periodontitis).
The bleeding gums are only a sign of this heightened inflammatory response.
This is not to say that everyone who has bleeding gums also has diabetes.
Bleeding gums are only a smaller fraction of the symptoms for diabetes mellitus.
Cardiovascular disease: Gum disease does not only potentially increase the risk of cardiovascular disease, but the presence of a cardiovascular disease can also exacerbate oral health problems.
The idea is that any form of reduced blood flow and compromised circulation associated with atherosclerosis (which is the build up of fats in the arterial wall) can weaken the gum tissue’s ability to heal and fight infection, creating a perfect environment for gum disease to flourish.
Liver disease: The liver produces most of the body’s clotting factors.
Conditions like cirrhosis can impair this function, leading to a bleeding tendency that manifests in the gums, as also the liver is responsible for producing blood clotting factors.
If your bleeding gums persist despite excellent oral care, it is time to broaden your investigation and find out more about the causative factors.
Always remember that your yearly dental visits are very crucial, never miss any.
However, you must initiate a conversation with your physician to get to the bottom of the issue.
By recognising your mouth as a mirror reflecting your overall health, you can move beyond temporary fixes and address the root of the problem, ensuring not just a healthy smile, but a healthy you.