Introduction
Gum bleeding is one of the most common and noticeable symptoms in dentistry. On average, every third patient over 40 suffers from occasional gum bleeding. And the trend is rising. The causes of such bleeding of the gums can be many and varied, but the therapy is initially the same for almost all reasons. Only the prevention (prophylaxis) of a recurrence of bleeding gums differs from trigger to trigger.
What causes gum bleeding?
As with most diseases within the oral cavity, gum bleeding is also caused by a long-term lack of and/or inadequate oral hygiene. In most cases, bleeding of the gums (lat. Gingiva) itself is not so much a disease but rather a symptom of gingivitis.
Gingivitis is a severe inflammation of the gums, which is mainly caused by pathogens. In a large number of cases, these pathogens are germs of bacterial origin. Similar to caries of the teeth, the formation of plaque plays a decisive role in the development of gingivitis with bleeding gums.
The term plaque describes a tough bio-film that consists of both bacterial metabolic end products and food residues that have not been carefully removed. This soft dental plaque can even penetrate to below the gum line and accumulate there if oral hygiene is poor and/or inadequate. In these areas it can then accumulate at and around the root of the tooth and create deep gum pockets.
This creates the ideal breeding ground for bacteria and other germs. Within the gum pockets, both the soft plaque and immigrating pathogens cause extensive inflammatory processes to develop. As a result, the characteristic bleeding of the gums occurs afterwards.
In addition, bleeding of the gums can occur in the course of a disease of the periodontium (known as periodontosis, but actually the disease is called periodontitis, which means bleeding of the gums. While gingivitis is an “isolated” inflammation of the gums, the inflammatory processes in periodontitis also penetrate into other structures of the periodontium. However, since such periodontitis usually results from an untreated gingivitis with bleeding gums, the two diseases cannot be completely separated from each other.
Therefore, the causes of gingivitis and periodontitis are almost the same. To this day, inadequate and/or inadequate oral hygiene is still considered the main cause of gum bleeding. However, long-term studies on the occurrence of such symptoms within the family show that genetic factors must also be considered as a cause.
Other causes of gum bleeding include tobacco use, increased oral respiration, untreated decayed teeth and the presence of gingivitis in the partner. The latter fact can be explained by the fact that an “infection” with the relevant germs can occur particularly quickly in these cases. Also the presence of a general weakness of the immune system (specialist term: immune deficiency) in the course of an infection or an HIV disease can be the cause of bleeding in the area of the gums.
Gum bleeding can also be caused by strong mechanical pressure. Too much pressure when brushing or a brush that is too hard damages the gums, resulting in tiny bleeding injuries to the tissue. In addition to triggering bleeding of the gums, this can even lead to pressure-induced gingival recession.
A large number of affected patients notice the bleeding of the gums during or immediately after brushing their teeth. This fact does not exclude a bacterial cause, but it should be considered if it is not bleeding due to injury. When choosing a suitable toothbrush, it is therefore important to choose a medium strength brush to protect the gums.
Too soft toothbrushes are usually not able to remove plaque efficiently, too hard toothbrushes sometimes put too much pressure on the gums. Another important cause of gum bleeding is the hormonal changes that occur in the body during pregnancy.Excess hormones can trigger strong inflammatory processes and thus lead to gum inflammation and bleeding. Gingivitis can be recognized by swelling and reddening of the gums.
In addition, bleeding occurs more frequently, especially when brushing the teeth. A distinction is made between inflammation of the gums close to the teeth (gingiva), which is caused by plaque and can recede if the plaque is removed from the periodontitis (colloquially called periodontosis), in which the entire periodontal apparatus is affected. The latter is associated with specific germs that infect the gum pockets and also lead to bone resorption.
Periodontitis can have various causes. First, a so-called “pellicle” forms on the tooth enamel. This is an initial biofilm of proteins from saliva.
It protects the tooth and controls the mineralization processes that take place between the enamel and the oral cavity. If this layer of proteins is now colonized by bacteria (typical coccus, rods and spirochetes) it is called plaque. It adheres firmly to the tooth enamel, but can be removed by brushing the teeth thoroughly.
The microorganisms accumulate and release a secretion of proteins and carbohydrates, in which they can settle down and multiply. The plaque grows. Tartar is mineralized plaque.
If plaque is not removed in time, minerals from the saliva are deposited in it, making it a solid tartar. This can no longer be removed with a toothbrush. There is a difference between tartar above the gums and tartar below the gums.
The latter is called “concrement”. These concrements sit even firmer than the tartar above the gum level receive additional minerals from the secretion of the gum pocket. Vitamin deficiency can also lead to gingivitis and thus to increased bleeding of the gums.
Attention here is paid to the vitamin C, the ascorbic acid. One must take this sufficiently with the food to itself, since the body can form no own Vitamin C. The clinical picture which develops, if a drastic Vitamin C lack is present, is called scurvy. The body needs the vitamin C in the collagen synthesis.
Collagen is a fibrous protein that is needed in the structure of all connective tissues in the body. The gums are largely made up of connective tissue and the teeth are fixed in the bone by a fibrous apparatus. If vitamin C is missing for collagen synthesis, the gums weaken and the risk of gum inflammation and bleeding increases.
Periodontitis (often wrongly called periodontosis) is a secondary disease of gingivitis, i.e. the inflammation of the gums near the teeth spreads to the entire periodontium. A distinction is made between chronic and aggressive periodontitis. Chronic pardonontitis is the most frequent.
Mostly the affected persons are older than 30 years (there are also exceptions). Periodontitis is characterized by the formation of pockets and receding gums, and in the advanced stages by bone loss. External factors such as stress, smoking, certain medications and hormones can influence the risk of developing periodontitis.
The aggressive periodontitis often occurs in younger patients, often during puberty. A characteristic here is the good general condition of the patients apart from the parodontitis and the rapid, intermittent progress of the inflammation. Stress has an influence on our immune system.
In case of acute stress the body prepares itself for an emergency situation. The unspecific defence is raised. However, if one suffers from chronic stress and is exposed to stress situations more often, the body can no longer maintain the state of alert.
The immune system is weakened, one becomes ill more quickly. And so inflammation of the gums occurs more quickly, because the immune system can no longer fight the bacteria that settle in the gum pockets as effectively. The thyroid gland is one of the endocrine organs of the human body, which means it can produce hormones.
The gums contain receptors for these hormones, among others. These hormones, when secreted by the thyroid gland, can travel through the bloodstream to the gums, where they dock onto the receptor and take effect. Thyroid hormones influence the body’s metabolism and the mineral balance of the bones.
The calcitonin formed there leads to a reduction of the calcium level in the blood.Its opponent, the parathyroid hormone, is produced by the parathyroid gland. If the parathyroid gland is diseased and produces too much parathormone, the relationship between calcitonin and parathormone is out of balance. The parathormone causes the calcium in the jawbone to be mobilized from the bone.
This causes the bone to lose stability and become porous. If the periodontitis germs are now added, the bone can be broken down more quickly. The risk of periodontitis is therefore increased in the case of parathyroid hyperfunction.
Already in the name “Human Immunodeficiency Virus” hides the reason why people suffering from HIV have an increased risk of getting gingivitis. The immune system has the task to fight bacteria and germs and to keep an associated inflammation in check. If this system no longer functions as it should, the inflammation can spread faster and unhindered.
But not only inflammation in the oral cavity indicates an HIV infection. The immune system is also no longer able to fight specific viruses and fungi. Therefore it is important to examine the mucous membrane in detail for changes, inflammations and bacterial, viral or fungal infestation.
However, an HIV disease does not mean that gum bleeding must necessarily develop and vice versa. The liver plays an important role in blood clotting by forming a large number of so-called clotting factors. These are proteins that ensure that the wound is closed and the bleeding is stopped.
In cases of liver failure or cirrhosis of the liver, there is now a shortage of precisely these hemostatic proteins. If gum bleeding occurs, for example due to mechanical stress when brushing the teeth, blood clotting is disturbed and bleeding is increased and lasts longer than in healthy people. In extreme cases, spontaneous bleeding can also occur in the course of gum inflammation.
