Bleeding gums: Causes (Hint: it’s not just gum disease) and when to seek help

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Have you noticed blood in the sink when brushing or flossing your teeth? Buildup of dental plaque (AKA biofilm) can lead to an early form of gum disease, referred to as gingivitis. Irritation and swelling of the gums causes them to bleed. However, when it comes to bleeding gums causes, gum disease is not the only culprit. 

Causes of bleeding gums can be simple, such as brushing technique, or more serious—this includes disease and infection. Understanding what causes bleeding gums can help you to find the right solution. Here’s a look at 7 gum bleeding causes and the symptoms to watch out for.

1. Lichen planus

Lichen planus is a chronic, inflammatory autoimmune disease. The cause of oral lichen planus is unclear, but it’s believed to be linked to the immune system. It affects the skin, oral mucosa, genital mucosa, scalp, and nails. When it appears in the mouth it is called 'oral lichen planus'. The condition is quite rare, affecting up to 2% of the population. It typically presents in adulthood, from middle age onwards and is slightly more common in females. 

What are the symptoms? 

Symptoms or oral lichen planus include:

  • Burning or stinging sensation in the mouth when eating or drinking (spicy foods, citrus fruits and alcohol may be particularly troublesome)
  • White patches on the inside of the mouth (cheeks, tongue and gums)
  • Redness or ulcers
  • Tender, bleeding gums, due to inflammation

Diagnosis and treatment

If the cause of bleeding gums is thought to be oral lichen planus, a biopsy will usually be taken for diagnosis. Typically, oral lichen planus only needs treatment when the symptoms are painful. This usually involves applying corticosteroid cream to the affected area.  

2. Mucous membrane pemphigold

It’s a bit of a mouthful to say but as the name suggests, this autoimmune disease affects the mucous membranes. This includes the oral mucosa (that’s the lining of the mouth) and the conjunctiva (the mucous membrane that covers the inner surface of the eyelids and the outer surface of the eye). 

Most often occurring in late adulthood (around the age of 70), mucous membrane pemphigold is twice as common in women as in men

What are the symptoms? 

The symptoms of oral mucous membrane pemphigold include:

  • Painful blisters on the gums (May also affect the roof of the mouth and inner cheeks.)
  • Red, swollen, bleeding gums

Diagnosis and treatment

Treatment may include dental hygiene measures and corticosteroid ointments. If the mouth is sore, an analgesic mouthwash used before meals may be helpful.

3. Pemphigus vulgaris 

Like mucous membrane pemphigold, pemphigus vulgaris is an autoimmune disease. It tends to cause blistering in the oral mucosa (the lining of the mouth) and may involve other areas of the body (such as the skin) as the disease progresses. In comparison, skin involvement is less common in people with mucous membrane pemphigold, occurring in only 25-30% of cases.

What are the symptoms? 

The symptoms of oral pemphigus vulgaris include:

  • Blisters which can turn into painful mouth sores
  • Blisters may appear on other areas of the body 
  • Red, tender, bleeding gums (less common but may occur)

Diagnosis and treatment

Good oral hygiene, rest and reduced stress are important for treating pemphigus vulgaris. Your dentist or hygienist may suggest a soft-food diet to avoid trauma to the fragile skin of the mouth. Corticosteroid therapy with paste, ointments or mouthwash may also be prescribed. 

Old man applying his lower denture.
Caused by a fungal infection, denture stomatitis can affect between 15% to 70% (or more) of denture wearers. Symptoms can include bleeding and swelling in the affected area and a burning sensation, among others.

4. Denture stomatitis 

As the name might suggest, denture stomatitis is linked to denture wearing. It is a common condition which often goes unnoticed by patients. This is partly because some people can have the condition without any symptoms.

Caused by a fungal infection, denture stomatitis can affect between 15% to 70% (or more) of denture wearers. People with medicine-induced dry mouth, diabetes or those with immune suppression are at higher risk of denture stomatitis. 

Common causes of denture stomatitis are:

  • Rough denture surface
  • Ill-fitting dentures
  • Poor denture hygiene
  • Poor brushing habits
  • Constant denture wear  

What are the symptoms? 

While 30% of people with denture stomatitis experience no symptoms, the remaining 70% may notice:

  • Bad breath
  • Bleeding and swelling in the affected area 
  • Burning sensation
  • Dry mouth
  • Altered sense of taste
  • Pain or discomfort when swallowing
  • Sore throat or mouth
  • White or red patches on the tongue, gums, lips, inner cheeks, or roof of mouth

Diagnosis and treatment

Denture stomatitis is normally picked up during your regular dental check-up. Treatment includes mechanically cleaning the dentures and you may be advised to leave them out of your mouth overnight. In some cases, a topical antifungal medication may be prescribed. 

5. Allergies

Allergens, such as pollen, dust, pet dander, and even toothpaste* (more on this in a moment), trigger an immune response. This causes the common allergy symptoms of sneezing, nasal congestion, runny nose, watery eyes, and itching. But it can also lead to inflammation of the gums. Bleeding can occur as a response to the swelling and irritation. 

*Despite being uncommon, toothpaste allergies happen. Typically, it’s the flavourings in toothpaste that cause the allergy. The most common allergens are spearmint, peppermint and cinnamon.

What are the symptoms? 

The oral symptoms of allergic reaction can include:

  • Itching, tingling, minor swelling of the lips, mouth, tongue and throat
  • Inflammation and bleeding of the gums 
  • Blisters in the mouth

Diagnosis and treatment

Depending on the severity of your allergy symptoms, they may be treated with oral antihistamines and/or intranasal corticosteroids. While there’s no specific treatment for oral symptoms, they should be reduced after taking allergy medication.

Illustration of a man breathing through his mouth while laying down.
Regularly breathing through your mouth, rather than your nose, can dry out your gums and mouth tissue. This changes the natural bacteria in the mouth and may lead to gum disease.

6. Mouth breathing

Believe it or not, mouth breathing can affect your oral health. Regularly breathing through your mouth, rather than your nose, can dry out your gums and mouth tissue. This changes the natural bacteria in the mouth and may lead to gum disease. (It can also lead to headaches, snoring and sleep difficulties, but that’s a whole other blog post.)

What are the symptoms? 

You might be asking yourself “Do I breathe through my mouth?” If you do, you’ll likely notice one or more of the following symptoms:

  • Snoring
  • Dry mouth
  • Bad breath
  • Gum disease symptoms, such as bleeding, inflamed gums
  • Feeling tired on waking

Diagnosis and treatment

Your dentist may suspect mouth breathing based on your oral examination. Alternatively, you may recognise the symptoms yourself. If your mouth breathing is temporary—caused by a cold or seasonal allergies—you have little to worry about. However, if mouth breathing is a lasting, albeit unconscious, habit it’s important to identify and treat the underlying cause. 

Possible causes include:

  • Nasal congestion
  • Enlarged adenoids or tonsils
  • Nasal polyps or benign growths in the nasal cavity
  • The shape of your nose

7. Herpes virus

Herpes simplex is a common virus that can cause inflammation of the gums and lips. Don’t be alarmed when you hear the word herpes; there are two types. Type 1 is mostly spread by oral contact, causing infection in or around the mouth. Type 2 is the sexually transmitted infection. 

What are the symptoms? 

The symptoms of oral herpes include:

  • Cold sores inside or around the mouth
  • Ulcers inside the mouth, including the gums
  • Red, sore, swollen gums that may bleed
  • Bad breath

Diagnosis and treatment

Oral herpes can usually be diagnosed by a medical professional on visual inspection. Treatments include over-the-counter cold sore medication, pain relief, and cold or warm compresses to ease the discomfort and soften blistering.

Final thought…

Bleeding gums can be a symptom of gingivitis (early periodontal disease), but not always. As you can see, there are various causes of bleeding gums in adults. It’s important to keep brushing your teeth with a soft bristle brush or electric toothbrush. Stopping teeth cleaning can make matters worse. Maintaining regular dental check-ups are also essential. Your dentist should be able to identify the underlying cause. If needed, they can refer you to a specialist, such as a periodontist

Device advice to keep your oral health on track

Do you know the difference between dental floss and interdental brushes?

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