Causes of Gum disease

List of causes of Gum disease

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Gum disease) that could possibly cause Gum disease includes:

• Pregnancy gingivitis (type of Dental conditions)

Longer list of causes of Gum symptoms: see full list of causes for Gum symptoms

Gum disease as a symptom:

Conditions listing Gum disease as a symptom may also be potential underlying causes of Gum disease. Our database lists the following as having Gum disease as a symptom of that condition:

• Alveolar Bone Loss
• Chronic Granulomatous Disease
• Congenital disorder of glycosylation type X - Bombay blood group phenotype
• Leukocyte Adhesion Defect
• Leukocyte adhesion deficiency type 1
• Progeria short stature pigmented nevi

What causes Gum disease?

Article excerpts about the causes of Gum disease:
Gum diseases are also caused by dental plaque. The bacteria in plaque causes the gums to become inflamed and bleed easily. If left untreated, the disease gets worse as pockets of infection form between the teeth and gums. This causes receding gums and loss of supporting bone. You may lose enough bone to cause your teeth to become loose and fall out. (Source: excerpt from Taking Care of Your Teeth and Mouth - Age Page - Health Information: NIA)

Medical news summaries relating to Gum disease:

The following medical news items are relevant to causes of Gum disease:

• Dental authority highlights the link between oral health and smoking
• Oral health and overall wellbeing
• Smoken' campaign
• More news »

Related information on causes of Gum disease:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Gum disease may be found in:

• Risk factors for Gum disease
• Hidden causes of Gum disease

Causes of Gum disease: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Gum disease.

Gum bleeding [Gingival bleeding]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Agranulocytosis

Spontaneous gum bleeding and other systemic hemorrhages may occur in agranulocytosis, which typically causes progressive fatigue and weakness, followed by signs of infection, such as a fever and chills. Inspection may reveal oral and perianal lesions, which are usually rough edged with a gray or black membrane.

Aplastic anemia

In aplastic anemia, profuse or scant gum bleeding may follow trauma. Other signs of bleeding, such as epistaxis and ecchymoses, are also characteristic. The patient exhibits progressive weakness and fatigue, shortness of breath, a headache, pallor and, possibly, a fever. Eventually, tachycardia and signs of heart failure, such as jugular vein distention and dyspnea, also develop.

Ehlers-Danlos syndrome

In Ehlers-Danlos syndrome, gums bleed easily after toothbrushing. Easy bruising and other signs of abnormal bleeding are also typical. The skin is fragile and hyperelastic; joints are hyperextendible.

Gingivitis

Reddened and edematous gums are characteristic of gingivitis. The gingivae between the teeth become bulbous and bleed easily with slight trauma. However, with acute necrotizing ulcerative gingivitis, bleeding is spontaneous and the gums become so painful that the patient may be unable to eat. A characteristic grayish yellow pseudomembrane develops over punched-out gum erosions. Offensive halitosis is typical and may be accompanied by a headache, malaise, fever, and cervical adenopathy.

Hemophilia

Hemorrhage occurs from many sites in the oral cavity, especially the gums. Mild hemophilia causes easy bruising, hematomas, epistaxis, bleeding gums, and prolonged bleeding during even minor surgery and up to 8 days afterward. Moderate hemophilia produces more frequent episodes of abnormal bleeding and occasional bleeding into the joints, which may cause swelling and pain. Severe hemophilia causes spontaneous or severe bleeding after minor trauma, possibly resulting in large subcutaneous and intramuscular hematomas. Bleeding into joints and muscles causes pain, swelling, extreme tenderness and, possibly, permanent deformity. Bleeding near peripheral nerves causes peripheral neuropathies, pain, paresthesia, and muscle atrophy. Signs of anemia and a fever may follow bleeding. Severe blood loss may lead to shock and death.

Hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia is characterized by red to violet spiderlike hemorrhagic areas on the gums, which blanch on pressure and bleed spontaneously. These telangiectases may also occur on the lips, buccal mucosa, and palate; on the face, ears, scalp, hands, arms, and feet; and under the nails. Epistaxis commonly occurs early and is difficult to control. Hemoptysis and signs of GI bleeding may develop.

Leukemia

Easy gum bleeding, which is an early sign of acute monocytic, lymphocytic, or myelocytic leukemia, is accompanied by gum swelling, necrosis, and petechiae. The soft, tender gums appear glossy and bluish. Acute leukemia causes severe prostration marked by a high fever and bleeding tendencies, such as epistaxis and prolonged menses. It may also cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Later effects may include confusion, headaches, vomiting, seizures, papilledema, and nuchal rigidity.

Chronic leukemia usually develops insidiously, producing less-severe bleeding tendencies. Other effects may include anorexia, weight loss, a low-grade fever, chills, skin eruptions, and an enlarged spleen, tonsils, and lymph nodes. Signs of anemia, such as fatigue and pallor, may occur.

Pemphigoid (benign mucosal)

Most common in women between ages 40 and 50, pemphigoid typically causes thick-walled gum lesions that rupture, desquamate, and then bleed easily. Extensive scars form with healing, and the gums remain red for months. Lesions may also develop on other parts of the oral mucosa, conjunctiva and, less commonly, the skin. Secondary fibrous bands may lead to dysphagia, hoarseness, or blindness.

Periodontal disease

Gum bleeding typically occurs after chewing, toothbrushing, or gum probing, but may also occur spontaneously. As gingivae separate from the bone, pus-filled pockets develop around the teeth; occasionally, pus can be expressed. Other findings include an unpleasant taste with halitosis, facial pain, loose teeth, and dental calculi and plaque.

Polycythemia vera

In polycythemia vera, engorged gums ooze blood after even slight trauma. This disorder usually turns the oral mucosa — especially the gums and tongue — a deep red-violet. Among associated findings are a headache, dyspnea, dizziness, fatigue, paresthesia, tinnitus, double or blurred vision, aquagenic pruritus, epigastric distress, weight loss, increased blood pressure, ruddy cyanosis, ecchymosis, and hepatosplenomegaly.

Thrombocytopenia

Blood usually oozes between the teeth and gums; however, severe bleeding may follow minor trauma. Associated signs of hemorrhage include large blood-filled bullae in the mouth, petechiae, ecchymosis, epistaxis, and hematuria. Malaise, fatigue, weakness, and lethargy eventually develop.

Thrombocytopenic purpura (idiopathic)

Profuse gum bleeding occurs in idiopathetic thrombocytopenic purpura. Its classic feature, however, is spontaneous hemorrhagic skin lesions that range from pinpoint petechiae to massive hemorrhages. The patient has a tendency to bruise easily, develops petechiae on the oral mucosa, and may exhibit melena, epistaxis, or hematuria.

Vitamin K deficiency

The first sign of vitamin K deficiency is usually gums that bleed when the teeth are brushed. Other signs of abnormal bleeding, such as ecchymosis, epistaxis, and hematuria, may also occur. GI bleeding may produce hematemesis and melena; intracranial bleeding may cause a decreased level of consciousness and focal neurologic deficits.

Other causes

Drugs

Warfarin and heparin interfere with blood clotting and may cause prolonged gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelets, producing bleeding gums. Localized gum bleeding may also occur with mucosal “aspirin burn” caused by dissolving aspirin near an aching tooth.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Gum bleeding [Gingival bleeding]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Agranulocytosis

Spontaneous gum bleeding and other systemic hemorrhages may occur in this hematologic disorder, which typically causes progressive fatigue and weakness, followed by signs of infection, such as fever and chills. Inspection may reveal oral and perianal lesions, which are usually rough edged with a gray or black membrane.

Aplastic anemia

In this disorder, profuse or scant gum bleeding may follow trauma. Other signs of bleeding, such as epistaxis and ecchymosis, are also characteristic. The patient exhibits progressive weakness and fatigue, shortness of breath, headache, pallor and, possibly, fever. Eventually, tachycardia and signs of heart failure, such as jugular vein distention and dyspnea, also develop.

Cirrhosis

A late sign of cirrhosis, gum bleeding occurs with epistaxis and other bleeding tendencies. Other late effects include ascites, hepatomegaly, pruritus, and jaundice.

Ehlers-Danlos syndrome

In this congenital syndrome, gums bleed easily after toothbrushing. Easy bruising and other signs of abnormal bleeding are also typical. Skin is fragile and hyperelastic; joints are hyperextendible.

Giant cell epulis

This pedunculated granuloma, which occurs on the gums or alveolar process in front of the molars, is dark red and vascular, resembling a surface ulcer. Gums bleed easily with slight trauma.

Gingivitis

Reddened and edematous gums are characteristic of this disorder. The gingivae between the teeth become bulbous and bleed easily with slight trauma. However, with acute necrotizing ulcerative gingivitis, bleeding is spontaneous and the gums become so painful that the patient may be unable to eat. A characteristic grayish yellow pseudomembrane develops over punched-out gum erosions. Halitosis is typical and may be accompanied by headache, malaise, fever, and cervical adenopathy.

Hemophilia

Hemorrhage occurs from many sites in the oral cavity, especially the gums. Mild hemophilia causes easy bruising, hematomas, epistaxis, bleeding gums, and prolonged bleeding during even minor surgery and for up to 8 days afterward. Moderate hemophilia produces more frequent episodes of abnormal bleeding and occasional bleeding into the joints, which may cause swelling and pain. Severe hemophilia causes spontaneous or severe bleeding after minor trauma, possibly resulting in large subcutaneous and intramuscular hematomas. Bleeding into joints and muscles causes pain, swelling, extreme tenderness and, possibly, permanent deformity. Bleeding near peripheral nerves causes peripheral neuropathies, pain, paresthesia, and muscle atrophy. Signs of anemia and fever may follow bleeding. Severe blood loss may lead to shock and death.

Hereditary hemorrhagic telangiectasia

This disorder is characterized by red to violet spiderlike hemorrhagic areas on the gums, which blanch on pressure and bleed spontaneously. These telangiectases may also occur on the lips, buccal mucosa, and palate; on the face, ears, scalp, hands, arms, and feet; and under the nails. Epistaxis commonly occurs early and is difficult to control. Hemoptysis and signs of GI bleeding may develop.

Hypofibrinogenemia

In this rare disorder, the patient has frequent, spontaneous episodes of severe gum bleeding. Hematomas, ecchymosis, and epistaxis are also common. Signs of GI bleeding (such as hematemesis) and of CNS bleeding (such as focal neurologic deficits) may also occur.

Leukemia

An early sign of acute monocytic, lymphocytic, or myelocytic leukemia, easy gum bleeding is accompanied by gum swelling, necrosis, and petechiae. The soft, tender gums appear glossy and bluish. Acute leukemia causes severe prostration marked by high fever and bleeding tendencies, such as epistaxis and prolonged menses. It may also cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Later effects may include confusion, headaches, vomiting, seizures, papilledema, and nuchal rigidity.

Chronic leukemia usually develops insidiously, producing less severe bleeding tendencies. Other effects may include anorexia, weight loss, low-grade fever, chills, skin eruptions, and enlarged spleen, tonsils, and lymph nodes. Signs of anemia, such as fatigue and pallor, may occur.

Pemphigoid (benign mucosal)

Most common in women between ages 40 and 50, this autoimmune disorder typically causes thick-walled gum lesions that rupture, desquamate, and then bleed easily. Extensive scars form with healing, and the gums remain red for months. Lesions may also develop on other parts of the oral mucosa, the conjunctivae and, less often, the skin. Secondary fibrous bands may lead to dysphagia, hoarseness, or blindness.

Periodontal disease

Gum bleeding typically occurs after chewing, toothbrushing, or gum probing but may also occur spontaneously. As gingivae separate from the bone, pus-filled pockets develop around the teeth; occasionally, pus can be expressed. Other findings include unpleasant taste with halitosis, facial pain, loose teeth, and dental calculi and plaque.

Pernicious anemia

Gum bleeding and a sore tongue can make eating painful in this disorder whose other cardinal symptoms are weakness and paresthesia. The patient’s lips, gums, and tongue appear markedly pale, and his sclerae and skin are jaundiced. Other features are typically widespread, affecting the GI, cardiovascular, and central nervous systems, and include altered bowel and bladder habits, personality changes, ataxia, tinnitus, dyspnea, and tachycardia.

Polycythemia vera

In this disorder, engorged gums ooze blood after even a slight trauma. Polycythemia vera usually turns the oral mucosa—especially the gums and tongue—a deep red-violet. Associated findings include headache, dyspnea, dizziness, fatigue, paresthesia, tinnitus, diplopia or blurred vision, aquagenic pruritus, epigastric distress, weight loss, increased blood pressure, ruddy cyanosis, ecchymosis, and hepatosplenomegaly.

Pyogenic granuloma

Commonly affecting the gums, lips, tongue, and buccal mucosa, this granuloma may ulcerate and bleed spontaneously or with slight trauma. The lesion is pedunculated with a smooth or warty surface.

Thrombasthenia (familial)

This hereditary blood platelet disorder causes spontaneous bleeding from the oral cavity, especially the gums. The patient commonly displays purpura, epistaxis, hemarthrosis, and signs of GI bleeding, such as hematemesis and melena.

Thrombocytopenia

In this disorder, blood usually oozes between the teeth and gums; however, severe bleeding may follow minor trauma. Associated signs of hemorrhage include large blood-filled bullae in the mouth, petechiae, ecchymosis, epistaxis, and hematuria. Malaise, fatigue, weakness, and lethargy eventually develop.

Thrombocytopenic purpura (idiopathic)

Profuse gum bleeding occurs in this disorder. Its classic feature, though, is spontaneous hemorrhagic skin lesions that range from pinpoint petechiae to massive hemorrhages. The patient has a tendency to bruise easily, develops petechiae on the oral mucosa, and may exhibit melena, epistaxis, or hematuria.

Vitamin C deficiency (scurvy)

This deficiency causes swollen, spongy, tender gums that bleed easily. The gums between the teeth are red or purple. The teeth themselves become loose and may be surrounded by pockets filled with clotted blood. Other findings include muscle and joint pain, petechiae, ecchymosis, splinter hemorrhages in the nail beds, and ocular hemorrhages. Associated effects are anorexia, dry mouth, pallor, weakness, lethargy, insomnia, scaly skin, and psychological disturbances, such as depression or hysteria.

Vitamin K deficiency

The first sign of this deficiency is usually gums that bleed when the teeth are brushed. Other signs of abnormal bleeding, such as ecchymosis, epistaxis, and hematuria, may also occur. GI bleeding may produce hematemesis and melena; intracranial bleeding may cause decreased level of consciousness and focal neurologic deficits.

Other causes

Chemical irritants

Occupational exposure to benzene may irritate the gums, resulting in bleeding. Other signs of abnormal bleeding may accompany limb weakness and sensory changes.

Drugs

Warfarin and heparin interfere with blood clotting and may cause prolonged gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelets, producing bleeding gums. Localized gum bleeding may also occur with mucosal “aspirin burn” caused by dissolving aspirin near an aching tooth.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Gum swelling: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Crohn’s disease

Granular or cobblestone gum swelling occurs in this disorder, which is characterized by cramping abdominal pain and diarrhea. In acute Crohn’s disease, the patient may also have nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, and abdominal distention. Chronic effects include anorexia, weight loss, a palpable lower quadrant mass, perianal lesions, skin lesions (erythema nodosum), arthritis, and occasionally constipation.

Fibrous hyperplasia (idiopathic)

In this disorder, the gums become diffusely enlarged and may even cover the teeth. Large, firm, painless masses of fibrous tissue that form on the gums may prevent tooth eruption and cause lip protrusion and difficulty chewing.

Leukemia

Gum swelling is commonly an early sign, especially in acute monocytic, lymphocytic, or myelocytic leukemia. Usually, the swelling is localized and accompanied by necrosis. The tender gums appear blue and glossy and bleed easily.

Acute leukemia also causes severe prostration, high fever, and signs of abnormal bleeding, such as ecchymosis and prolonged menses. Sometimes it produces dyspnea, tachycardia, palpitations, and abdominal or bone pain. Late effects may include confusion, headache, vomiting, seizures, papilledema, and nuchal rigidity. In chronic leukemia, signs and symptoms develop insidiously and may include malaise, pallor, low-grade fever, chills, minor bleeding tendencies, and enlarged tonsils, lymph nodes, and spleen.

Vitamin C deficiency (scurvy)

In this deficiency, the gums are spongy, tender, and edematous, and the papillae appear red or purple. The gums bleed easily, and inspection may reveal pockets filled with clotted blood around loose teeth. Associated findings include anorexia, pallor, dry mouth, scaly dermatitis, weakness, lethargy, insomnia, and signs of abnormal bleeding, such as myalgia and arthralgia (possibly with swelling), from hemorrhage into joints and muscles. Occasionally, psychological changes, such as depression and hysteria, occur.

Other causes

Drugs

Gum swelling is a common side effect of the anticonvulsant phenytoin. Cyclosporine, a drug used to prevent rejection of transplanted organs, also produces this sign in about 15% of patients.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Gum bleeding: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Agranulocytosis

Spontaneous gum bleeding and other systemic hemorrhages may occur in agranulocytosis, a hematologic disorder that typically causes progressive fatigue and weakness. Bleeding may be followed by signs of infection, such as fever and chills. Inspection may reveal oral and perianal lesions, which are usually rough edged with a gray or black membrane.

Aplastic anemia

In aplastic anemia, profuse or scant gum bleeding may follow trauma. Other signs of bleeding, such as epistaxis and ecchymoses, are also characteristic. The patient exhibits progressive weakness and fatigue, shortness of breath, headache, pallor and, possibly, fever. Eventually, tachycardia and signs of heart failure, such as jugular vein distention and dyspnea, also develop.

Cirrhosis

A late sign of cirrhosis, gum bleeding occurs with epistaxis and other bleeding tendencies. Additional late effects include ascites, hepatomegaly, pruritus, and jaundice. Other signs and symptoms include abdominal pain, anorexia, fatigue, nausea, vomiting, and weakness.

Gingivitis

Reddened and edematous gums are characteristic of gingivitis. The gingivae between the teeth become bulbous and bleed easily with slight trauma. However, with acute necrotizing ulcerative gingivitis, bleeding is spontaneous and the gums become so painful that the patient may be unable to eat. A characteristic grayish yellow pseudomembrane develops over punched-out gum erosions. Offensive halitosis is typical and may be accompanied by headache, malaise, fever, and cervical adenopathy.

Hemophilia

In hemophilia, hemorrhage occurs from many sites in the oral cavity, especially the gums. Mild hemophilia causes easy bruising, hematomas, epistaxis, bleeding gums, and prolonged bleeding during even minor surgery and up to 8 days afterward. Moderate hemophilia produces more frequent episodes of abnormal bleeding and occasional bleeding into the joints, which may cause swelling and pain. Severe hemophilia causes spontaneous or severe bleeding after minor trauma, possibly resulting in large subcutaneous and intramuscular hematomas. Bleeding into joints and muscles causes pain, swelling, and extreme tenderness and may cause permanent deformity. Bleeding near peripheral nerves causes peripheral neuropathies, pain, paresthesia, and muscle atrophy. Signs of anemia and fever may follow bleeding. Severe blood loss may lead to shock and death.

Leukemia

Easy gum bleeding is an early sign of acute monocytic, lymphocytic, or myelocytic leukemia that’s accompanied by gum swelling, necrosis, and petechiae. The soft, tender gums appear glossy and bluish. Acute leukemia causes severe prostration marked by high fever and bleeding tendencies, such as epistaxis and prolonged menses. It may also cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Later effects may include confusion, headaches, vomiting, seizures, papilledema, and nuchal rigidity.

Chronic leukemia usually develops insidiously, producing less-severe bleeding tendencies. Other effects may include anorexia, weight loss, low-grade fever, chills, skin eruptions, and enlarged spleen, tonsils, and lymph nodes. Signs of anemia, such as fatigue and pallor, may also occur.

Periodontal disease

Gum bleeding typically occurs after chewing, toothbrushing, or gum probing but may also occur spontaneously. As gingivae separate from the bone, pus-filled pockets develop around the teeth; occasionally, pus can be expressed. Other findings include unpleasant taste with halitosis, facial pain, loose teeth, and dental calculi and plaque.

Pernicious anemia

Gum bleeding and a sore tongue make eating painful for patients with pernicious anemia. Among other cardinal symptoms are weakness and paresthesia. The patient’s lips, gums, and tongue appear markedly pale, and his sclera and skin are jaundiced. Other features are typically widespread, affecting the GI, cardiovascular, and central nervous systems, and include altered bowel and bladder habits, personality changes, ataxia, tinnitus, dyspnea, and tachycardia.

Polycythemia vera

In polycythemia vera, engorged gums ooze blood after even slight trauma. Polycythemia vera usually turns the oral mucosa — especially the gums and tongue — a deep red-violet. Among associated findings are headache, dyspnea, dizziness, fatigue, paresthesia, tinnitus, double or blurred vision, aquagenic pruritus, epigastric distress, weight loss, increased blood pressure, ruddy cyanosis, ecchymosis, and hepatosplenomegaly.

Thrombocytopenia

With thrombocytopenia, blood usually oozes between the teeth and gums; however, severe bleeding may follow minor trauma. Associated signs of hemorrhage include large blood-filled bullae in the mouth, petechiae, ecchymosis, epistaxis, and hematuria. Malaise, fatigue, weakness, and lethargy eventually develop.

Thrombocytopenic purpura (idiopathic)

Profuse gum bleeding occurs in idiopathic thrombocytopenic purpura. Its classic feature, though, is spontaneous hemorrhagic skin lesions that range from pinpoint petechiae to massive hemorrhages. The patient has a tendency to bruise easily, develops petechiae on the oral mucosa, and may exhibit melena, epistaxis, or hematuria.

Vitamin K deficiency

The first sign of vitamin K deficiency is usually gums that bleed when the teeth are brushed. Other signs of abnormal bleeding, such as ecchymosis, epistaxis, and hematuria, may also occur. GI bleeding may produce hematemesis and melena; intracranial bleeding may cause decreased level of consciousness and focal neurologic deficits.

Other causes

Chemical irritants

Occupational exposure to benzene may irritate the gums, resulting in bleeding. Other signs of abnormal bleeding may accompany limb weakness and sensory changes.

Drugs

Warfarin and heparin interfere with blood clotting and may cause prolonged gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelets, producing bleeding gums. Localized gum bleeding may also occur with mucosal “aspirin burn” caused by dissolving aspirin near an aching tooth.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Gum bleeding [Gingival bleeding]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Agranulocytosis.Spontaneous gum bleeding and other systemic hemorrhages may occur in agranulocytosis, which typically causes progressive fatigue and weakness, followed by signs of infection, such as a fever and chills. Inspection may reveal oral and perianal lesions, which are usually rough edged with a gray or black membrane.

Aplastic anemia.In aplastic anemia, profuse or scant gum bleeding may follow trauma. Other signs of bleeding, such as epistaxis and ecchymoses, are also characteristic. The patient exhibits progressive weakness and fatigue, shortness of breath, a headache, pallor and, possibly, a fever. Eventually, tachycardia and signs of heart failure, such as jugular vein distention and dyspnea, also develop.

Ehlers-Danlos syndrome.In Ehlers-Danlos syndrome, gums bleed easily after toothbrushing. Easy bruising and other signs of abnormal bleeding are also typical. The skin is fragile and hyperelastic; joints are hyperextendible.

Gingivitis.Reddened and edematous gums are characteristic of gingivitis. The gingivae between the teeth become bulbous and bleed easily with slight trauma. However, with acute necrotizing ulcerative gingivitis, bleeding is spontaneous and the gums become so painful that the patient may be unable to eat. A characteristic grayish yellow pseudomembrane develops over punched-out gum erosions. Offensive halitosis is typical and may be accompanied by a headache, malaise, fever, and cervical adenopathy.

Hemophilia.Hemorrhage occurs from many sites in the oral cavity, especially the gums. Mild hemophilia causes easy bruising, hematomas, epistaxis, bleeding gums, and prolonged bleeding during even minor surgery and up to 8 days afterward. Moderate hemophilia produces more frequent episodes of abnormal bleeding and occasional bleeding into the joints, which may cause swelling and pain. Severe hemophilia causes spontaneous or severe bleeding after minor trauma, possibly resulting in large subcutaneous and intramuscular hematomas. Bleeding into joints and muscles causes pain, swelling, extreme tenderness and, possibly, permanent deformity. Bleeding near peripheral nerves causes peripheral neuropathies, pain, paresthesia, and muscle atrophy. Signs of anemia and a fever may follow bleeding. Severe blood loss may lead to shock and death.

Hereditary hemorrhagic telangiectasia.Hereditary hemorrhagic telangiectasia is characterized by red to violet spiderlike hemorrhagic areas on the gums, which blanch on pressure and bleed spontaneously. These telangiectases may also occur on the lips, buccal mucosa, and palate; on the face, ears, scalp, hands, arms, and feet; and under the nails. Epistaxis commonly occurs early and is difficult to control. Hemoptysis and signs of GI bleeding may develop.

Leukemia.Easy gum bleeding, which is an early sign of acute monocytic, lymphocytic, or myelocytic leukemia, is accompanied by gum swelling, necrosis, and petechiae. The soft, tender gums appear glossy and bluish. Acute leukemia causes severe prostration marked by a high fever and bleeding tendencies, such as epistaxis and prolonged menses. It may also cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Later effects may include confusion, headaches, vomiting, seizures, papilledema, and nuchal rigidity.

Chronic leukemia usually develops insidiously, producing less-severe bleeding tendencies. Other effects may include anorexia, weight loss, a low-grade fever, chills, skin eruptions, and an enlarged spleen, tonsils, and lymph nodes. Signs of anemia, such as fatigue and pallor, may occur.

Pemphigoid (benign mucosal).Pemphigoid typically causes thick-walled gum lesions that rupture, desquamate, and then bleed easily. Extensive scars form with healing, and the gums remain red for months. Lesions may also develop on other parts of the oral mucosa, conjunctiva and, less commonly, the skin. Secondary fibrous bands may lead to dysphagia, hoarseness, or blindness.

Periodontal disease.With periodontal disease, gum bleeding typically occurs after chewing, toothbrushing, or gum probing, but may also occur spontaneously. As gingivae separate from the bone, pus-filled pockets develop around the teeth; occasionally, pus can be expressed. Other findings include an unpleasant taste with halitosis, facial pain, loose teeth, and dental calculi and plaque.

Polycythemia vera.In polycythemia vera, engorged gums ooze blood after even slight trauma. This disorder usually turns the oral mucosa—especially the gums and tongue—a deep red-violet. Among associated findings are a headache, dyspnea, dizziness, fatigue, paresthesia, tinnitus, double or blurred vision, aquagenic pruritus, epigastric distress, weight loss, increased blood pressure, ruddy cyanosis, ecchymosis, and hepatosplenomegaly.

Thrombocytopenia.With thrombocytopenia, blood usually oozes between the teeth and gums; however, severe bleeding may follow minor trauma. Associated signs of hemorrhage include large blood-filled bullae in the mouth, petechiae, ecchymosis, epistaxis, and hematuria. Malaise, fatigue, weakness, and lethargy eventually develop.

Thrombocytopenic purpura (idiopathic).Profuse gum bleeding occurs in idiopathetic thrombocytopenic purpura. Its classic feature, however, is spontaneous hemorrhagic skin lesions that range from pinpoint petechiae to massive hemorrhages. The patient has a tendency to bruise easily, develops petechiae on the oral mucosa, and may exhibit melena, epistaxis, or hematuria.

Vitamin K deficiency.The first sign of vitamin K deficiency is usually gums that bleed when the teeth are brushed. Other signs of abnormal bleeding, such as ecchymosis, epistaxis, and hematuria, may also occur. GI bleeding may produce hematemesis and melena; intracranial bleeding may cause a decreased level of consciousness and focal neurologic deficits.

Other causes

Drugs.Warfarin and heparin interfere with blood clotting and may cause prolonged gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelets, producing bleeding gums. Localized gum bleeding may also occur with mucosal “aspirin burn” caused by dissolving aspirin near an aching tooth.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007