Bleeding gums: causes and what to do

A little blood on your toothbrush or in the sink is easy to ignore, and hard to stop wondering about. Are you brushing wrongly, or is something wrong? Only a dentist can tell you what is behind it in your own mouth.

Why do gums bleed?

The Oral Health Foundation says gums bleed when they are irritated and inflamed, which it does not consider normal, and puts the inflammation down to plaque left on the teeth. Plaque is a film of bacteria that builds up on teeth. According to the NHS, it irritates your gums if brushing and cleaning in between your teeth do not remove it. The foundation adds that, left long enough, plaque can harden into tartar, which needs professional scaling by a dentist or hygienist to remove.

Dentists call this inflammation gingivitis. The government toolkit for dental teams (from the Department of Health and Social Care and NHS England) describes it as inflammation that stays within the gum and can be reversed by reducing plaque at and below the gumline. Not everyone with gingivitis goes on to develop periodontitis, but gingivitis is a risk factor for it. Periodontitis damages the tissues that support the teeth. The toolkit calls it irreversible, and says it will recur and worsen without good plaque control.

The NHS lists bleeding when you brush, floss or eat hard foods among the symptoms of gum disease, alongside gums that are swollen, red and sore. Gum disease is very common, it adds, but it is important to have it checked by a dentist. It can lead to bad breath, shrinking gums, loose teeth or teeth falling out, and a dental abscess. The toolkit notes that the early stages may cause no symptoms, and the NHS advises regular check-ups with a dentist and hygienist even when you have no problems, especially if you are pregnant or have type 2 diabetes.

What else can make gums bleed?

Plaque is the cause the sources point to, but other things can make gums react more strongly, bleed more readily or hide a problem.

Factor	What the sources say, and who to ask
Pregnancy	Hormone changes can make gums react more strongly to plaque, so they may be red, swollen or tender, and bleed when you brush (Oral Health Foundation). Ask your dentist or midwife.
Blood-thinning medicine	Anticoagulants can make you more prone to bleeding if you are injured, and the NHS suggests a soft toothbrush. Ask your GP, anticoagulant clinic or pharmacist.
Smoking, or stopping	Smoking is a risk factor for gum disease (government toolkit). It can also hide a gum problem, so gums may start to bleed after you stop (Oral Health Foundation). Ask your dentist.
Diabetes	The government toolkit says to assume a higher risk of gum disease for anyone with diabetes. Ask your dentist.

If you are pregnant, routine dental care, including gum treatment and professional cleaning, is safe, according to the foundation. It asks you to tell your dental team you are pregnant and how far along you are, and to tell your dentist or midwife if your gums bleed often.

Blood-thinning medicines

Anticoagulants, sometimes called blood-thinning medicines, reduce the ability of your blood to clot. The NHS advises anyone taking one to tell their dentist before a dental procedure such as having a tooth taken out, and to stop the medicine only on the advice of a GP or another healthcare professional. If you have bleeding you cannot stop, or severe or recurring bleeding, it says to seek medical attention straight away, by calling 111 or going to A&E. If your gums bleed often while you take one, tell your dentist, and mention it to your GP or anticoagulant clinic.

Other medicines can affect the gums too. The toolkit gives dry mouth and swollen gum tissue as examples, and stresses a full and up-to-date medical history. If you think a medicine is involved, ask your pharmacist or GP.

Stopping smoking

This can seem backwards. The Oral Health Foundation says smoking restricts blood flow to the mouth and can cover up a gum problem. When someone gives up, the gums get better circulation and can start to bleed. A small 2003 study by researchers at a London dental school followed 27 people on a quit-smoking programme for 4 to 6 weeks. More of the sites checked bled by the end, even though the group’s oral hygiene had improved. The authors took it as further evidence that smoking affects the gums’ inflammatory response and that these changes are reversible on quitting. Because smoking can hide gum disease, bleeding after you stop may also show a problem that was already there, so it is worth a check. Stopping is still the right thing for your gums.

If you notice this, tell your dentist and keep brushing and cleaning between your teeth. The NHS advises against smoking as part of preventing gum disease, and our guide to smoking and your mouth has more.

Diabetes and other health conditions are covered in our guides to diabetes and your mouth and health conditions and your teeth.

What can you do at home?

Home care is aimed at the plaque. The UK guidance comes down to a few habits.

• Brush for about 2 minutes, last thing at night and once more during the day, with fluoride toothpaste. Clean every surface of every tooth, including where tooth meets gum.
• Clean between your teeth every day with interdental brushes or floss.
• Spit out after brushing rather than rinsing, and avoid mouthwash straight afterwards, as the NHS advises.
• Use a small-headed brush. The toolkit suggests medium bristles for most people, and the foundation adds that a softer brush may help while your gums are inflamed.

Keep brushing even if your gums bleed. Plaque left behind makes the inflammation worse, the foundation explains, and after a few days of thorough cleaning your gums should stop bleeding. If they do not, ask your dental team, because you may need a professional clean.

For powered toothbrushes, the toolkit rates the evidence as moderate certainty that they reduce plaque and gingivitis more than manual ones. It calls the practical importance unclear and says either kind can clean teeth effectively. For cleaning between teeth, it says interdental brushes may work better than floss, with evidence of low to very low certainty.

What does a dentist check?

One well-known way of screening the gums is the Basic Periodontal Examination, which the toolkit describes as quick and suitable for all adults with teeth. A probe checks whether the gums bleed, whether anything such as tartar or an overhanging filling is trapping plaque, and whether there are pockets between tooth and gum. The toolkit stresses that this is a screening check, not a diagnosis.

What happens next depends on what is found. According to the NHS, a dentist in the early stages will give advice on keeping your teeth clean, for example with interdental brushes. They will also advise you to stop smoking if you smoke, and to get your teeth cleaned by a hygienist. If gum disease is serious, you may need deep cleaning under your gums, antibiotics, some teeth removed or gum surgery.

When to see a dentist or your GP

The NHS advises seeing a dentist if your gums bleed when you brush or eat hard foods, and booking a check-up if you have not had one for 2 years (1 year if you are under 18).

In an emergency or out of hours, call your dentist first: if they are closed, an answerphone message may tell you what to do. The NHS says to call 111 if you do not have a dentist or cannot get an emergency appointment.

What we would do

A new patient exam is the first step. We examine your teeth, gums and soft tissues, carry out an oral cancer screening and take small X-rays where needed, then explain any options in plain language. Tell us about any medicines you take and any health conditions, including pregnancy: the exam gives us a full picture of your oral health, with your medical history in mind.

If there is plaque or tartar to remove, a dental hygiene appointment starts with an assessment of your gum health, followed by a clean and scale and a polish. It also includes advice on your own brushing and flossing routine.

If your gums bleed when you brush, or are still bleeding after a few days of careful cleaning, book an appointment and we can take a look.

Want us to take a look?

Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.

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