Gums That Bleed When You Brush

Healthy gums do not bleed when you brush them, in the same way healthy skin does not bleed when you wash it. Pink in the sink is a sign of inflammation in the gum, and inflammation is almost always a response to bacteria sitting along the gum line.

The good news is that the early stage reverses completely, often within a couple of weeks, with nothing more than better cleaning. The reason to take it seriously is that the later stage does not reverse, and the changeover happens quietly.

Bleeding means inflammation, not that you brushed too hard

The instinct when gums bleed is to back off and brush that area more gently. That is the wrong way round. Plaque left along the gum line irritates the tissue, the body sends more blood to the area to fight it, and the swollen tissue bleeds at the slightest contact. Cleaning less leaves more plaque and makes the bleeding worse.

You can brush too hard, and doing so damages gums over time, but the damage from scrubbing shows up as recession and worn notches at the gum line rather than as bleeding. If your gums bleed in one particular spot every time, that spot is usually being missed rather than over cleaned.

Gingivitis reverses, periodontitis does not

Gingivitis is inflammation confined to the gum. It is extremely common, it causes bleeding, redness and sometimes bad breath, and it leaves no permanent damage. Remove the plaque consistently and the tissue returns to normal.

Periodontitis is what happens when that inflammation continues long enough to involve the bone holding the teeth in. Bone lost to periodontitis does not grow back on its own. The gum detaches from the tooth and forms a pocket, which collects more bacteria in a place a toothbrush cannot reach, and the cycle continues. Treatment can stop it and stabilize things, but it cannot rewind it.

• Gingivitis: bleeding and redness, fully reversible with cleaning
• Periodontitis: pockets, bone loss and eventually loose teeth
• The move from one to the other is usually painless
• Only an examination with measurements and x rays tells you which you have

Two weeks of doing it properly is the test

For simple gingivitis, the fix is mechanical. Brush twice a day for two full minutes with a soft brush angled towards the gum line rather than straight at the tooth, and clean between the teeth once a day with floss or interdental brushes. Interdental brushes clean better where the gaps are big enough for them.

Expect the bleeding to increase slightly for the first few days as you clean areas that have been left alone, then settle. If you do this properly and bleeding has clearly reduced within two weeks, it was gingivitis and you have dealt with it. If it has not, that is the signal to get an examination rather than to try harder for another six months.

The signs that it has gone past cleaning

Some findings suggest the process has already involved the bone. Gums that have pulled back so teeth look longer, teeth that feel loose or have drifted into new positions, gaps opening between front teeth that were not there before, persistent bad breath or a bad taste, and pus at the gum line all point that way. So does bleeding that continues despite genuinely good cleaning.

None of these hurt much, which is exactly the problem. Gum disease usually reaches an advanced stage without pain, and people notice at the point where teeth are moving. A dentist or hygienist measures pocket depths around each tooth and takes x rays to see the bone level, and that is the only way to know where you stand.

• Teeth looking longer as gums pull back
• Loose teeth, drifting teeth or new gaps
• Pus, a persistent bad taste or ongoing bad breath
• Bleeding that carries on despite two weeks of thorough cleaning

Other things that make gums bleed more

Pregnancy hormones make gum tissue react more strongly to the same amount of plaque, so pregnancy gingivitis is common and dental cleaning during pregnancy is safe and recommended. Blood thinners and some other medications increase bleeding once inflammation is present, though they do not cause the inflammation. Diabetes that is not well controlled makes gum disease progress faster, and gum disease in turn makes blood sugar harder to control.

Smoking does the opposite of what you would expect: it constricts blood vessels, so gums bleed less while the disease underneath progresses faster. A smoker with clean looking gums can still have significant bone loss. Tell your dentist about medications, pregnancy, diabetes and smoking, because each one changes how your gums are managed.

Getting it measured is the part you cannot do at home

A gum examination is quick, involves a small probe around each tooth and usually some x rays, and gives you a number rather than an impression. From there the plan may be a regular cleaning and better technique, or scaling and root planing under local anesthetic if pockets have formed, or a referral to a periodontist for advanced cases.

If you have not been seen for a while, our directory searches every dental practice in the United States by town or ZIP code and shows the closest first, free and with no account. Booking a checkup while the only symptom is bleeding is far cheaper than booking one when a tooth has started to move.

Frequently asked

This is general information to help you ask better questions, not a diagnosis. Anything happening in your own mouth needs a dentist who can look at it.