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ULY CLINIC

10 Septemba 2025, 11:56:36

Gum Bleeding (Gingival Bleeding)

Bleeding gums are a common clinical sign that may result from dental disorders, blood dyscrasias, systemic disease, or certain drugs. Less frequently, physiologic or environmental factors contribute, such as pregnancy, atmospheric pressure changes (in divers or aviators), or oral trauma. The bleeding can range from mild oozing to severe, life-threatening hemorrhage and may be spontaneous or trauma-induced.

Emergency interventions

Profuse or spontaneous bleeding: Check airway and cardiovascular status (tachycardia, hypotension).
Immediate actions: Suction oral cavity, apply direct pressure to bleeding site.
Advanced interventions: Airway management, IV fluids, and diagnostic serum studies as needed.

History and Physical Examination

History

Onset, frequency, and triggers (e.g., brushing, flossing).
Previous bleeding episodes in patient or family (easy bruising, epistaxis).
Dental habits (toothbrush type, floss use, dental visits).
Diet, alcohol intake, and medications (prescription or OTC).
History of systemic disease (liver, spleen, or hematologic disorders).

Oral Examination

Remove dentures if present.
Assess site, amount, and color of bleeding.
Check for gum inflammation, swelling, hypertrophy, retraction, or hyperplasia.
Inspect teeth for decay, discoloration, or foreign material.
Record vital signs.

Medical causes of gum bleeding

Cause	Key Features	Additional Findings
Agranulocytosis	Spontaneous gum and systemic bleeding	Fatigue, infection signs (fever, chills), oral and perianal gray-black lesions
Aplastic Anemia	Gum bleeding, easy bruising	Fatigue, pallor, tachycardia, heart failure signs, epistaxis, ecchymoses
Ehlers-Danlos Syndrome	Bleeding after brushing	Fragile, hyperelastic skin; hyperextendible joints
Gingivitis	Red, edematous gums, bleeding on minor trauma	Acute necrotizing ulcerative gingivitis: spontaneous bleeding, gray-yellow pseudomembrane, halitosis, fever
Hemophilia	Spontaneous or prolonged bleeding	Bruising, hematomas, joint bleeding, severe pain, anemia, possible shock
Hereditary Hemorrhagic Telangiectasia	Red-violet spider-like lesions, spontaneous bleeding	Telangiectases on lips, mucosa, extremities; epistaxis, GI bleeding, hemoptysis
Leukemia	Easy gum bleeding, swelling, necrosis	Petechiae, fever, malaise, fatigue, dyspnea, tachycardia, bone pain; chronic leukemia: insidious course
Pemphigoid (Benign Mucosal)	Thick-walled gum lesions, rupture and bleeding	Lesions on oral mucosa, conjunctiva; possible dysphagia, hoarseness
Periodontal Disease	Bleeding with chewing/brushing	Gingival separation from bone, pus-filled pockets, halitosis, loose teeth, dental calculi
Polycythemia Vera	Engorged, deep red-violet gums	Headache, dyspnea, fatigue, tinnitus, visual disturbances, hepatosplenomegaly
Thrombocytopenia	Oozing gums	Petechiae, ecchymosis, hematuria, malaise, weakness
Idiopathic Thrombocytopenic Purpura	Profuse gum bleeding	Spontaneous hemorrhagic skin lesions, petechiae, melena, epistaxis, hematuria
Vitamin K Deficiency	Bleeding on brushing	Ecchymosis, epistaxis, hematuria, GI bleeding, possible intracranial hemorrhage
Drug-Induced	Warfarin, heparin, aspirin, NSAIDs	Platelet dysfunction, localized oral “aspirin burn”

Special considerations

Prepare for blood studies, facial X-rays, or transfusions (platelets or fresh frozen plasma).
Avoid lemon-glycerin swabs, which may irritate gums.
Maintain strict oral hygiene to prevent worsening bleeding.

Patient counseling

Teach proper mouth and gum care.
Demonstrate gentle brushing and flossing techniques.
Discuss reporting of any worsening bleeding.
Review drug interactions that may affect bleeding.

Pediatric pointers

Neonates: consider vitamin K deficiency due to immature intestinal flora or poor maternal nutrition.
Infants: vitamin C deficiency can cause bleeding gums, especially in those drinking only cow’s milk without supplements.
Emphasize early oral hygiene and regular dental visits.

Geriatric pointers

Patients with no teeth may experience gum trauma and bleeding due to poorly fitting dental prostheses.
Monitor for polypharmacy effects on bleeding risk.

References

Epstein JB, Raber-Durlacher JE, Wilkins A, Chavarria MG, Myint H. Advances in hematologic stem cell transplant: An update for oral health care providers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:301–312.
Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, et al. Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer. 2012;20:367–373.