It is important to follow the instructions from your dentist in order to maintain healthy gums. Improper brushing and flossing technique may actually irritate or traumatize the gum tissue. If gum bleeding persists, it may be a sign of serious medical disorders such as leukemia, bleeding disorders, platelet disorders, or overmedication with anticoagulants ("blood thinners" such as Coumadin).

• Gingivitis from inadequate plaque removal
• Periodontitis (advanced form of gingivitis)
• Anticoagulants such as Coumadin (warfarin) and heparin
• Toothbrush abrasion, improper flossing
• Infection, which can be either tooth or gum related
• Vitamin C deficiency
• Vitamin K deficiency
• Hormonal changes during pregnancy
• Chemical irritants such as aspirin
• Leukemia
• Placement of new dentures can lead to denture sores/irritations
• Idiopathic thrombocytopenic purpura

• Visit the dentist at least once every 6 months for plaque removal. Follow your dentist's home care instructions.
• Brush teeth gently with a soft-bristle toothbrush after every meal. The dentist may recommend rinsing with salt water or hydrogen peroxide and water. Avoid using commercial, alcohol-containing mouthwashes, which aggravate the problem.
• Floss teeth twice a day to keep plaque from building up.
• Eliminate between-meal snacks and reduce carbohydrate intake to help prevent plaque build-up on teeth.
• Use an oral irrigation device on the low setting to massage the gums.
• Maintain a balanced, healthy diet.

• Avoid the use of tobacco, which aggravates bleeding gums.
• Have poorly fitting dentures adjusted and relined by your dentist if they are causing sore spots in gums.
• Avoid aspirin unless your health care provider has recommended that you take it.
• Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water.
• If you have been diagnosed with a vitamin deficiency, take recommended vitamin supplements
• If side effects of medication are irritating, ask your doctor to adjust or substitute another medication. Never change your medication without consulting your doctor.

Consult your health care provider if:

• Your gums continue to bleed even after treatment
• The bleeding is severe or chronic
• Other unexplained symptoms are associated with the bleeding

Your dentist will examine your teeth and gums, and ask questions such as:

• Are the gums bleeding a large amount?
• Did the bleeding begin recently?
• Do the gums bleed frequently or only occasionally?
• Have you had gum problems before?
• How often do you brush?
• How often do you floss?
• Do you use a soft or hard bristled toothbrush?
• How vigorously do you brush?
• What other home care aids do you use (toothpicks or other)?
• When was the last time you had your teeth cleaned at the dentist?
• Have you changed your diet?
• Do you eat adequate amounts of fruits and vegetables?
• Do you take supplemental vitamins?
• Do you have a high carbohydrate diet (pasta)?
• What medications do you take? Do you take anticonvulsants, anticoagulants (such as Coumadin, heparin), or aspirin?
• Are you pregnant?
• Have you changed mouthwash or tooth paste recently?
• What other symptoms do you have? (e.g., sore throat)

Diagnostic tests that may be performed include:

• Blood studies such as a CBC or blood differential)
• X-rays of the teeth and jawbone