Bleeding and swollen gums

Gums that bleed when you brush or floss are inflamed. Healthy gums do not bleed with normal cleaning — in the same way that healthy skin does not bleed when you wash it.

This is the single most commonly dismissed sign in dentistry, usually put down to brushing too hard. Occasionally that is the cause. Far more often it is the earliest visible sign of gum disease, at the stage when it is still completely reversible.

What bleeding gums are telling you

Plaque collecting along the gumline provokes an immune response. The tissue becomes inflamed, engorged with blood and fragile, so light contact makes it bleed. That stage is gingivitis, and with proper cleaning it resolves fully with no lasting damage.

If plaque is left, it hardens into calculus — which cannot be brushed off — and the inflammation can extend deeper, to the bone and fibres holding the tooth in place. That is periodontitis, and the bone lost at that stage does not come back.

The distinction between something entirely reversible and something permanent is often just a matter of time.

The counter-intuitive part

Many people notice bleeding and respond by cleaning that area more gently, or avoiding it altogether. This makes it worse. Plaque accumulates faster in the area being avoided, the inflammation deepens, and the bleeding increases.

With thorough, gentle cleaning of the area — including flossing, especially where it bleeds — bleeding usually reduces markedly within one to two weeks. If it has not settled after two weeks of genuinely consistent cleaning, book an appointment. That points to calculus below the gumline that has to be removed professionally.

The two-week test

This is genuinely diagnostic, costs nothing, and tells you what you are dealing with.

1. Brush twice daily for two full minutes with a soft brush, angled at 45 degrees into the gumline
2. Clean between every tooth, every day — floss or interdental brushes, including the gaps that bleed
3. Do it for fourteen days without missing one
4. On day fifteen, floss and watch

Bleeding has stopped or nearly stopped: it was gingivitis, and you have treated it. Keep going, and keep your recall appointment.

Bleeding is unchanged, or worse in specific spots: there is calculus below the gumline that no brush can reach, and it needs a professional clean. Book.

Bleeding may increase for the first few days as inflamed tissue is disturbed. That is expected, and it is not a reason to stop.

Getting between the teeth properly

This is where almost all gum disease begins, and where almost all of the cleaning effort goes missing.

• Floss suits tight contacts. Curve it into a C against one tooth, slide gently just under the gum, sweep up, then repeat against the neighbouring tooth. Snapping it straight down is what makes people sore
• Interdental brushes are more effective wherever a gap exists, and are far easier to do well. We will size them for you — too small does nothing, too large is uncomfortable
• Water flossers help around bridges, implants and braces, and for people with limited dexterity. They complement rather than replace physical cleaning
• Once a day, thoroughly, is better than three rushed attempts. Most people find bedtime works

Other things that cause gums to bleed or swell

Hormonal change. Pregnancy, puberty and the menstrual cycle all exaggerate the gum response to the same amount of plaque. Pregnancy gingivitis is common and usually settles after birth, but it should still be managed during pregnancy — tell us if you are pregnant.

Medications. Blood thinners increase bleeding. Some blood pressure medications, anti-epileptics and immunosuppressants can cause gum overgrowth. Bring an up-to-date list of what you take.

Smoking. Smokers' gums often bleed less despite worse disease, because nicotine constricts the blood vessels. The absence of bleeding in a smoker is not reassuring.

Medical conditions. Diabetes, particularly when poorly controlled, and some blood disorders and vitamin deficiencies affect gum health. Gum disease and diabetes influence each other in both directions.

A new toothbrush or new flossing habit. Genuine short-term bleeding for a few days as inflamed tissue is disturbed — which then settles. It should settle.

Something stuck. A popcorn husk or a fragment of food lodged under the gum can cause localised swelling and bleeding in one spot. If it is one tooth only, mention that.

Pregnancy

Worth its own note. Raised hormone levels make gum tissue respond more strongly to the same plaque, so gums that were fine can become swollen and bleed readily from the second trimester onward. Occasionally a localised overgrowth appears on the gum — harmless, and it usually resolves after birth.

What to do: keep cleaning gently and thoroughly rather than backing off, keep your check-ups through the pregnancy, and tell us you are pregnant when you book. Untreated gum inflammation is not something to wait out, and dental care during pregnancy is appropriate rather than something to defer.

Gum health and the rest of you

Periodontitis is associated with several general health conditions — diabetes, cardiovascular disease, rheumatoid arthritis and adverse pregnancy outcomes among them. The relationships are genuine and well documented, though association is not the same as proof that one causes the other, and we would not claim more than the evidence supports.

The clearest of them is diabetes, where the influence runs in both directions: poorly controlled blood glucose makes gum disease worse, and active gum inflammation makes glucose harder to control. If you have diabetes, treating your gums is worth doing for reasons beyond your teeth, and it is worth telling your GP that you are having it treated.

When to be seen sooner

Book promptly, rather than waiting, if you have:

• Bleeding that continues beyond two weeks of good cleaning
• Swelling localised to one tooth, or a lump on the gum
• Pus, or a persistent bad taste
• Gums pulling away from the teeth
• Teeth that feel loose or have moved
• Pain, rather than just bleeding

Facial swelling, fever, or difficulty swallowing or breathing needs urgent care — see face and cheek swelling.

Also worth telling us: bleeding that occurs spontaneously without brushing, or bleeding elsewhere in your body such as frequent nosebleeds or easy bruising. That warrants a conversation with your GP as well as us.

What we do about it

We assess before we treat. That means a full examination, periodontal charting — measuring the depth of the crevice around each tooth and recording exactly where bleeding occurs — and radiographs to check the bone level, which is the only way to distinguish gingivitis from established periodontitis.

Treatment is thorough removal of plaque and calculus from above and below the gumline, with local anaesthetic where pockets are deep, followed by a review to re-measure the same points and confirm the tissue has responded.

The full detail is on our gum care and periodontics page.

The numbers being called out

During charting you will hear a series of numbers. They are the depth in millimetres of the crevice between gum and tooth, measured at six points around each tooth.

• 1–3mm with no bleeding — healthy
• 1–3mm with bleeding — gingivitis: inflammation without bone loss, and reversible
• 4–5mm — a pocket forming; beyond what a toothbrush reaches
• 6mm and above — established periodontitis; needs treatment and close monitoring

Ask to be told your numbers. Recording them means the next visit can answer the only question that matters: better, the same, or worse.

What treatment is like, and afterwards

A deep clean below the gumline is done under local anaesthetic where pockets are deep, usually over one or two longer appointments. Afterwards expect tenderness for a few days, some sensitivity to cold, and gums that look as though they have shrunk — which is inflammation resolving rather than anything going wrong. Teeth can feel slightly longer and gaps can appear between them, for the same reason.

A review four to eight weeks later re-measures the same points. Sites that have responded need maintenance; sites that have not may need further treatment or referral to a registered periodontist. We are a general dental practice and hold no specialist registration.

Maintenance intervals for treated periodontitis are usually shorter than the standard six months — commonly three or four — because the pockets that remain refill with bacteria faster than healthy sites do.

What to do at home in the meantime

• Brush twice daily for two minutes with a soft-bristled brush, angled into the gumline. Soft, not medium or hard.
• Clean between the teeth daily. Brushing reaches about three of the five surfaces of a tooth; the areas that bleed most are usually the ones being missed.
• Be thorough but gentle. Pressure is not what removes plaque — contact and technique are.
• Rinse with warm salty water to ease soreness.
• If you smoke, stopping does more for your gums than any product available.

Book an appointment

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145

Phone (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · closed weekends and public holidays

Book online at any hour.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.