Gum bleeding [Gingival bleeding]
Bleeding gums usually result from dental disorders; less commonly, they may stem from a blood dyscrasia or the effects of certain drugs. Physiologic causes of this common sign include pregnancy, which can produce gum swelling in the first or second trimester (pregnancy epulis); atmospheric pressure changes, which usually affect divers and aviators; and oral trauma. Bleeding ranges from slight oozing to life-threatening hemorrhage. It may be spontaneous or may follow trauma. Occasionally, direct pressure can control it.
Emergency interventions
If you detect profuse, spontaneous bleeding in the oral cavity, quickly check the patient’s airway and look for signs of cardiovascular collapse, such as tachycardia and hypotension. Suction the patient. Apply direct pressure to the bleeding site. Expect to insert an airway, administer I.V. fluids, and collect serum samples for diagnostic evaluation.
History and physical examination
If gum bleeding isn’t an emergency, obtain a history. Find out when the bleeding began. Has it been continuous or intermittent? Does it occur spontaneously or when the patient brushes his teeth or flosses? Have the patient show you the site of the bleeding, if possible.
Find out if the patient or any family members have bleeding tendencies; for example, ask about easy bruising and frequent nosebleeds. How much does the patient bleed after a tooth extraction? Does he have a history of liver or spleen disease? Next, check the patient’s dental history. Find out how often he brushes his teeth, flosses, and goes to the dentist and what kind of toothbrush and floss he uses. Has he seen a dentist recently? To evaluate nutritional status, have the patient describe his normal diet and alcohol intake. Finally, note the prescription and over-the-counter drugs he takes.
Next, perform a complete oral examination. If the patient wears dentures, have him remove them. Examine the gums to determine the site and amount of bleeding. Gums normally appear pink and rippled with their margins snugly against the teeth. Check for inflammation, pockets around the teeth, swelling, retraction, hypertrophy, discoloration, and gum hyperplasia. Note obvious decay, discoloration, foreign material such as food, and absence of teeth.
Medical causes
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.
Special considerations
Prepare the patient for diagnostic tests, such as blood studies or facial X-rays. Prepare him for the possibility of a blood or blood product transfusion, if necessary (platelets or fresh frozen plasma). When providing mouth care, avoid using lemon-glycerin swabs, which may burn or dry the gums.
Pediatric pointers
In neonates, bleeding gums may result from vitamin K deficiency associated with a lack of normal intestinal flora or poor maternal nutrition. In infants who primarily drink cow’s milk and don’t receive vitamin supplements, bleeding gums can result from vitamin C deficiency.
Encourage parents to teach proper oral hygiene early. Daily brushing in the morning and before bedtime should begin with eruption of the first tooth. When the child has all of his baby teeth, he should begin receiving regular dental checkups.
Geriatric pointers
In patients who have no teeth, constant gum trauma and bleeding may result from using a dental prosthesis.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Sore gums
Read excerpts from these other book chapters related to Sore gums:
Medical Books Excerpts
- Gum swelling
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Sore gums
» Next page: Gum bleeding [Gingival bleeding] (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
