Bleeding gums when brushing are usually a sign of gum inflammation caused by plaque, the sticky film of bacteria that builds up along the gumline. This is not normal, but at this early stage the inflammation can be reversed: with regular, thorough and gentle cleaning, gums often settle within a few days (EFP). If the bleeding does not stop or keeps coming back, it is time for a check-up.
Bleeding gums when brushing: why does it happen?
The most common cause is plaque (MedlinePlus). If it is not removed every day, it irritates the gums and they become inflamed: red, swollen and prone to bleeding when you brush, clean between your teeth or bite into something hard, such as an apple (NHS).
This is usually gingivitis, the first stage of gum disease. Over time, plaque hardens into tartar (calculus), which a toothbrush cannot remove; only a professional clean at the dentist can. Plaque then clings even more easily to its rough surface.
Other possible causes of bleeding gums
Sometimes gums bleed because of:
- brushing too hard, or flossing incorrectly
- hormonal changes during pregnancy
- a denture or other dental appliance that does not fit properly
- an infection in a tooth or in the gum
- blood-thinning medicines
- a lack of vitamin C or vitamin K
- rarely, a blood-clotting disorder or a blood condition such as leukaemia
That is why it is a good idea to let a dentist find the cause rather than guess.
Early signs and symptoms of gum disease
Gum disease (periodontal disease) is the umbrella term for conditions affecting the gums and the tissues that hold your teeth in place. Its two main stages are gingivitis and periodontitis. It usually does not hurt until it is advanced, so you can have it without noticing anything unusual (ADA). That makes bleeding an important warning sign.
Look out for these signs:
- gums that bleed when you brush, clean between your teeth or eat
- red, swollen or tender gums
- bad breath or an unpleasant taste in your mouth that will not go away
- receding gums, which make your teeth look longer
- new gaps between your teeth, or teeth that are loose or shifting
- a change in your bite, or in how a partial denture fits
- sensitivity to hot and cold, or pus along the gumline
How can you tell gingivitis from periodontitis? These are the main differences:
| Question | Gingivitis | Periodontitis |
|---|---|---|
| What does it affect? | The gums | The gums, the bone and the ligaments that hold the tooth in place |
| Typical signs | Red, swollen gums that bleed | Gum pockets, receding gums, loose teeth |
| Is it reversible? | Yes, with good cleaning at home and at the dentist | Not fully, but it can be stopped or slowed |
In some people, inflammation that persists spreads deeper. ‘Pockets’ form between the tooth and the gum, bacteria collect in them, and the bone around the tooth is gradually lost. According to the European Federation of Periodontology (EFP), around 40% of people have periodontitis, and it is one of the main causes of tooth loss in adults (EFP).
Lost bone usually does not grow back, so it is worth catching gum disease while it is still gingivitis, and stopping periodontitis as early as possible.
Who is more at risk of gum disease?
- Smokers. Smoking raises the risk of periodontitis, speeds it up and makes treatment less effective. Smokers’ gums may bleed less, so the problem can go unnoticed for longer (EFP).
- People with diabetes, especially if their blood sugar is poorly controlled. Treating the gums may help with blood sugar control, alongside the treatment your doctor prescribes.
- Pregnant women. Hormonal changes make bleeding gums more common in pregnancy. Some women also develop a harmless growth on the gum, which usually disappears after the birth (ADA).
- People with a family history of gum disease.
- People taking certain medicines, such as some blood pressure or epilepsy medicines, steroids or the contraceptive pill. Some of these medicines cause the gums to thicken, which makes cleaning harder.
- People with crooked or overlapping teeth, which are harder to keep clean.
- People living with long-term stress, a poor diet or obesity (BSP).
Inflamed gums: what to do at home
The most important thing is to keep brushing where your gums bleed. Many people avoid those areas because they worry about the bleeding, but then the plaque stays in place and the inflammation gets worse.
- Brush your teeth twice a day, for two minutes each time, with a fluoride toothpaste.
- Use a soft toothbrush and short, gentle strokes, without pressing hard.
- Clean between your teeth every day: use interdental brushes (tiny brushes for the gaps between teeth) where they fit, and floss where the gaps are too tight.
- After brushing, spit out the toothpaste, but do not rinse your mouth with water.
- Do not use mouthwash straight after brushing, and use it regularly only if your dentist recommends it.
- If you smoke, try to stop. Ask your GP (family doctor) for help.
Pharmacies sell ‘gum care’ gels, toothpastes and mouthwashes, but none of them removes tartar. A mouthwash may help with very mild gum inflammation, but it can also mask more serious gum disease (BSP).
Do not self-medicate with antibiotics: they are not a routine treatment for gum disease (EFP).
For more on brushing technique, read our article on how to brush your teeth properly and clean between them.
When to see a dentist about bleeding gums
Book a check-up if:
- your gums bleed when you brush or eat, especially if it keeps happening
- your gums are sore, swollen or receding
- you have bad breath that does not go away despite good oral hygiene
- your teeth are shifting, or new gaps have appeared between them
Even if you have no symptoms, the EFP recommends a check-up at least once a year (EFP). This is especially important if you smoke, have diabetes or are pregnant.
Do not wait for a routine appointment if your gums are very sore and swollen, a tooth has become loose or is falling out, you have ulcers or red patches in your mouth, a lump in your mouth or on your lip, or pus around a tooth. Phone and ask to be seen as soon as possible.
If you have swelling of the face or neck with a high temperature, or find it hard to swallow or breathe, call 194 (ambulance) or 112 (European emergency number), or go to hospital straight away. These are the numbers in North Macedonia; elsewhere, call your local emergency number. See also what to do about toothache.
To find out how to ask for a same-day appointment (during opening hours, when a slot is available) and where to go when the practice is closed, see our page on toothache or a broken tooth.
See your GP as well if the bleeding is heavy or long-lasting, if it continues after dental treatment, or if you also have other unexplained symptoms (MedlinePlus). If you take blood-thinning medicines, do not stop taking them on your own; talk to the doctor who prescribed them.
What happens at a gum check-up?
The dentist asks about your general health, any medicines you take and whether you smoke, and then examines your gums. Using a thin probe, they measure the depth of the space between each tooth and the gum: up to about 3 mm in healthy gums, and 4 mm or more with periodontitis (EFP). If needed, an X-ray shows whether any bone has been lost.
For gingivitis, a professional scale and polish (teeth cleaning) and better care at home are usually enough. Periodontitis is treated in steps: deep cleaning below the gumline, a reassessment a few weeks later and, only where deep pockets remain, further treatment, sometimes including surgery. This is followed by regular maintenance check-ups every 3 to 12 months, depending on your risk (EFP).
Periodontitis cannot be fully cured, but treatment and regular care can stop or slow it. The outcome depends on your daily cleaning, regular check-ups and whether you smoke. In advanced disease, it is sometimes not possible to save every tooth. All the steps and possible risks are explained on our gum disease treatment page.
Our practice’s motto is ‘Save the tooth’: keeping your natural teeth comes first, and healthy gums are the foundation for that. Before each step, we will explain what we have found and what your options are, so that we can decide together.
Bleeding gums: frequently asked questions
Is it normal for gums to bleed during pregnancy?
It is common, but it should not be ignored. Pregnancy hormones make gingivitis more likely. Check-ups, professional cleaning and local anaesthetic are considered safe during pregnancy (ADA). Please tell us if you are pregnant: in a high-risk pregnancy, some treatments may be postponed on the advice of your dentist, doctor or midwife. Read more in Dental care in pregnancy.
Do receding gums grow back?
Usually not. Treating the inflammation can help stop or slow gum recession. As the swelling goes down, the healed gums may shrink a little, so your teeth can look longer and gaps may appear between them (BSP). In some cases, gum graft surgery can cover part of the exposed root.
Can gum disease cause bad breath?
Yes. The bacteria behind gum inflammation can also cause bad breath (EFP). If it does not go away despite good oral hygiene, it is worth having your gums checked.
Is there a home remedy for gum disease?
No home remedy can replace cleaning. A gel, toothpaste or mouthwash cannot remove tartar from the pockets between your teeth and gums. Your dentist may sometimes recommend a chlorhexidine mouthwash, but only for up to two weeks, because of side effects such as tooth staining and a change in taste (EFP).
If your gums bleed, do not wait until it hurts. Book a check-up and we will work out together what your gums need.
Sources
- NHS – Gum disease
- EFP – Gum diseases: FAQs for patients
- EFP – What is periodontitis?
- EFP – Treatment of stage I–III periodontitis: the EFP S3-level clinical practice guideline (infographics)
- ADA MouthHealthy – Gum disease
- ADA MouthHealthy – Pregnancy dental concerns
- MedlinePlus (U.S. National Library of Medicine) – Bleeding gums
- British Society of Periodontology patient leaflet, in Greater Manchester LDN – Periodontal Management in Primary Dental Care (2nd ed., 2019)