Bleeding on probing

Causes

There are many possible causes of gingival bleeding. The main cause of gingival bleeding is the formation and accumulation of plaque at the gum line due to improper brushing and flossing of teeth. The hardened form of plaque is calculus. An advanced form of gingivitis as a result of formation of plaque is periodontitis. Other conditions associated with gingival bleeding include:

• Tooth or gum infection
• Diabetes mellitus
• Hypertension
• Idiopathic thrombocytopenic purpura
• Leukemia
• Malnutrition
• Aspirin and anticoagulants therapy
• Hormonal changes during puberty and pregnancy
• Iron overload

Other less common causes are:

• vitamin C deficiency (scurvy) and vitamin K deficiency
• dengue fever

Diagnosis

An examination by the dentist or dental hygienist should be sufficient to rule out the issues such as malnutrition and puberty. Additional corresponding diagnosis tests to certain potential disease may be required. This includes oral glucose tolerance test for diabetes mellitus, blood studies, human gonadotrophin levels for pregnancy, and X-rays for teeth and jaw bones.

In order to determine the periodontal health of a patient, the dentist or dental hygienist records the sulcular depths of the gingiva and observes any bleeding on probing. This is often accomplished with the use of a periodontal probe. Alternatively, dental floss may also be used to assess the Gingival bleeding index. It is used as an initial evaluation on patient's periodontal health especially to measure gingivitis. The number of bleeding sites is used to calculate the gingival bleeding score.

Peer-reviewed dental literature thoroughly establishes that bleeding on probing is a poor positive predictor of periodontal disease, but conversely lack of bleeding is a very strong negative predictor. The clinical interpretation of this research is that while BOP presence may not indicate periodontal disease, continued absence of BOP is a strong predictor (approximately 98%) of continued periodontal health.Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990 Nov;17(10):714-21.

Treatment

• Corresponding treatments for diagnosed diseases should be taken as first priority.
• Dentist or hygienists should be visited once every three months for plaque removal.
• Soft-bristle toothbrush is recommended for brushing your teeth. Hard-bristled toothbrushes may be softened by leaving under hot running water (very hot) before brushing every time, followed by gentle brushing.
• Flossing twice a day can prevent the building up of plaques.
• Tobacco should be avoided as tobacco can aggravate the bleeding gums.
• A balanced healthy diet should also be taken into account.
• Physiotherapy programme using over-the-counter toothpaste with triclosan should be used with home care.

If there is persistent continuation of inflammation and bleeding, a prescription of antiplaque rinse would be useful.

References

References

1. ''CARRANZA'S CLINICAL PERIODONTOLOGY, 9th edition'', 2002. page 447
2. The blood comes from [[lamina propria]] after the ulceration of the lining.''[http://medical-dictionary.thefreedictionary.com/gingival Gingival bleeding]'' URL assessed on November 21, 2009
3. (February 2020). "Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing". Journal of Clinical Periodontology.
4. ''[https://www.medlineplus.gov/ency/article/003062.htm MedlinePlus: Bleeding gums]'' URL assessed on November 21, 2009
5. 0-7817-3762-1. Google Book Search. Retrieved on November 21, 2009.
6. (2020). "Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing". Journal of Clinical Periodontology.
7. (2020-06-22). "Active gingival inflammation is linked to hypertension". Journal of Hypertension.
8. ''[http://healthguide.howstuffworks.com/bleeding-gums-dictionary.htm Howstuffworks Bleeding gums] {{Webarchive. link. (2017-10-12 '' URL assessed on November 21, 2009)
9. ''Hayes, E. B.; Gubler, D. J. Pediatr. Infect. Dis. J., 1992, 11, 311-317.''
10. ''[http://www.medal.org/visitor/www%5CActive%5Cch9%5Cch9.01%5Cch9.01.04.aspx Gingival Bleeding Index of Carter and Barnes]'' URL assessed on November 21, 2009
11. "Mermaid Clinic-in Gum disease and periodontal disease".