Bleeding gums: why they bleed and what to do about it

Healthy gums do not normally bleed. When plaque, the sticky layer of bacteria, builds up along the gumline, the gums become irritated, red, swollen and sore and bleed easily when brushed. The Oral Health Foundation describes gum disease as very common and often painless at first, with bleeding when you brush or clean between your teeth as an early warning sign.

The NHS lists bleeding when brushing, flossing or eating hard foods such as apples, and gums that are swollen, red and sore, as the main symptoms of gum disease. Left untreated, it says gum disease can lead to bad breath and a bad taste in the mouth, shrinking gums, loose or lost teeth and a dental abscess.

The Oral Health Foundation explains two main types of gum disease. Gingivitis is the early stage, with red or swollen gums, bleeding when brushing or eating, bad breath and a bad taste. It says gingivitis can be reversed with good daily cleaning and advice from your dental team.

If gingivitis is not treated it can develop into periodontal disease, also called periodontitis. This damages the bone and tissues that hold teeth in place, can cause the gums to pull away from the teeth and may lead to loose teeth or tooth loss. It cannot be reversed but, according to the Oral Health Foundation, it can be controlled with the right care.

The NHS recommends brushing teeth with fluoride toothpaste at least twice a day, spitting after brushing rather than rinsing, cleaning between the teeth every day with floss or interdental brushes, and seeing a dentist and dental hygienist for regular check-ups, especially if you are pregnant or have type 2 diabetes. It also advises not using mouthwash straight after brushing and not smoking.

The Oral Health Foundation gives a similar routine: brush for 2 minutes last thing at night and once more during the day with fluoride toothpaste, clean between your teeth once a day with interdental brushes or floss, and keep up regular dental visits. It warns that ignoring bleeding gums can lead to pain, infection and tooth loss. If bleeding does not settle once you are cleaning well, mention it to the dentist.

The NHS says the dentist will check your teeth and gums and may refer you to a specialist for further tests and treatment. In the early stages the dentist will give advice on keeping your teeth clean, such as using interdental brushes, advise you to stop smoking if you smoke, and may suggest a clean by a hygienist. If gum disease is serious you may need deep cleaning under the gums, antibiotics, removal of some teeth or gum surgery.

The Oral Health Foundation says the dentist or hygienist will thoroughly clean your teeth to remove plaque and tartar, show you how to clean at home and recommend suitable tools. It adds that you may need several appointments if gum disease is more advanced.

The NHS advises asking for an urgent dentist appointment if you or your child has gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip. If you cannot get an emergency appointment, it suggests calling 111. The NHS mouth cancer page separately lists a red or white patch, a lump in the mouth or on the lip, and a mouth ulcer lasting more than 3 weeks among its symptoms, so these should not simply be put down to gum disease.

The NHS lists gum disease among the long-term complications of diabetes and advises regular dental check-ups for people with type 2 diabetes.