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Bleeding Gums: When just brushing and flossing is not enough

Published November 24, 2014

OralHealth.CDiep120814ORAL HEALTH SERIES: Issue 1

In this article:

 

INTRODUCTION

According to the American Dental Association, about 100 million Americans did not see a dentist in 2007. Despite recommended semiannual dental checkups, people are often times only concerned with their oral health after they begin to feel pain. In the absence of pain, they tend to neglect other common oral problems, such as bleeding gums.

However, it is still important to go to these regular checkups and keep tabs on our oral health. Infections in the mouth may be associated with heart disease, stroke, and other health problems. In other words, a healthy mouth means a healthy body. Issues such as bleeding gums indicate that things have gone awry, so it is important that we make appropriate changes to our lifestyle to address these problems.

 

BLEEDING GUMS: A SIGN OF INFLAMMATION

Bleeding gums result from inflammation of the oral tissues in and around the gingiva (gums). When we routinely brush and floss our teeth, we remove the bacteria living on the enamel and the supporting dentin underneath. When we neglect to do so, the bacteria in our mouths are able to build up at and below our gum line. The bacteria then weaken our teeth by producing their corrosive and acidic by-products. Ultimately, the gum infection leads to gingivitis (inflammation without bone loss) or periodontitis (inflammation with bone loss and deep gingival pockets).

 

WESTERN MEDICINE PERSPECTIVE

When bleeding gums arise due to poor oral hygiene, the resumption of daily brushing and flossing can slow or even reverse the progression of bleeding. Removing plaque build-up below the gingiva crevices with deep root cleaning and scaling can also arrest the progression of gum diseases. If bleeding gums cannot be effectively managed firstly through these conservative dental procedures and lifestyle changes, more invasive gum surgery and therapies may be used to eliminate the deep pockets due to bone loss in periodontitis.

In other cases, some patients may brush and floss regularly, but their gums will still bleed when stimulated. This may be due to the dynamic equilibrium that exists between the dental plaque bacteria and the host defense system. When the host immune system is weakened by various medical conditions, unhealthy diet, or lifestyle choices gum bleeding could occur or become exacerbated. In the worst case, persistent gum bleeding may also indicate serious medical conditions such as leukemia, hemophilia, lupus, or HIV.

Factors that relate to bleeding gums include:

  • Stress (including physical, metabolic, emotional and psychosocial)
  • Smoking [1]
  • Sleep deprivation [2,3]
  • Hormone imbalances [4]
  • Inflammation-inducing food intake
  • Vitamin deficiency
  • Other health conditions (atherosclerotic vascular disease [5][6], diabetes, lupus, pemphigoid, HIV, leukemia and other blood disorders)
  • Side effects of medications (Fluoxetine (Prozac), calcium channel blocking drugs (Flunarizine), Warfarin (Coumadin) [7], Sertraline (Zoloft), Phenytoin (Dilantin))

 

INTEGRATING EASTERN MEDICINE AND SELF-CARE

Dental disease is one of the most common and costly diseases in United States. Americans spend more than $70 billion each year on dental services. Thus, doing appropriate self-care could help prevent many costly visits to the dentists for you and your family. Many oral health remedies and lifestyle changes that stem from Eastern medicine can also add great value to the current conventional dental treatments.

The incorporation of self-care and exposure to modalities that utilize the fundamental framework of Eastern medicine, particularly traditional Chinese medicine (TCM), can provide a more comprehensive and person-centered approach to help address the gingival inflammation and whole-body imbalance related to bleeding gums, as well as promote oral health.

  • Acupuncture [administered by a licensed professional]:
    • Reduces inflammation by enhancing the sympathetic/parasympathetic nervous systems and promoting release of inflammatory mediators [8, 9]
    • Increases local microcirculation [10], which aids dispersal of swelling
    • Reduces snoring and increases lip closure, which could in turn reducing mouth-breathing gingivitis
    • Provides relief for insomnia [11] and anxiety that could help to balance the inflammation cytokines [12] in both the blood vessels and saliva to reduce gum bleeding
  • Diet:
    • Avoid spicy, grilled, or fried foods
    • Reduce sugar intake
    • Increase vitamin C, D, and co-enzyme Q10 intake to boost immunity
    • Drink water infused with cooling herbs like peppermint and sage
    • Maintain a healthy oral bacteria flora in the mouth to promote a healthy gut, which has been shown to be linked to the brain and may influence emotions and behavior. [13]
  • At-Home & Herbal Remedies:
    • Brush with tea tree oil toothpaste, which has antibiotic properties [14]
    • Use turmeric mouthwash and gel [15, 16]
    • Gargling with warm salt water
    • Blend baking soda and water to make a paste and apply on the inflamed area. Or rinse with this mixture.
    • Mix salt and finely chopped ginger into a paste to compress the bleeding gum several times a day. Or rinse with this mixture.
    • Essential oils (eucalyptus, rosemary, lemon, myrrh, clove, peppermints) are good for oral health. Make a homemade mouthwash to reduce inflammation by diluting these oils with a nonalcoholic solution. (Mouthwash with alcohol can trigger more bleeding and dry mouth.)
    • Ask a certified herbalist or Chinese Medicine clinician about Qing Wei San, a compound of Chinese medicinal herbs, classically used to reduce oral inflammation, restore circulation, and modulate pain [17, 18]
    • Compressing gums with cooling herbs like berberin (Huang Lian) or mint (Bo He) could reduce the oral inflammation (Shang Huo, a TCM condition) [19]
    • Lifestyle:
      • Get massages to relieve jaw muscle tightness and neck pain. This will eliminate the referred pain to gums and cheeks due to latent or active trigger points in muscles.
      • Get sound sleep to boost immunity
      • Do appropriate exercise or mindfulness practices to reduce inflammation and manage stress (i.e. yoga and Tai chi [20])

 

WHEN TO SEEK HELP

These tips do not encompass all possible problems that may arise. Contact a physician, dentist, or oral medicine specialist if:

  • You have severe or chronic gum bleeding
  • You have ulcerated lesions on your gingiva
  • You continue to bleed after dental treatment

 

TAKE HOME MESSAGE

Bleeding gums are a warning sign of the imbalances in your body. The key is to restore balance with appropriate rest, sleep, diet, and exercise to manage both physical and emotional stress. The first line of defense is to mechanically remove the bacterial plaque by daily brushing and flossing plus regular 6 month check-ups with your dentist. The integration of TCM self-care and modalities suggested above can help to better preserve the tooth and gingival integrity and could help arrest oral disease before the destruction of dentin and enamel occur.

In other words, a healthy mouth means a health body, and vice versa.

 

REFERENCES

  1. Al-Bayaty FH, Baharuddin N, Abdulla MA, et al. The Influence of cigarette smoking on gingival bleeding and serum concentrations of haptoglobin and alpha 1-antitrypsin. Biomed Res Int.
  2. Yehuda S, Sredni B, Carasso RL, et al. REM sleep deprivation in rats results in inflammation and interleukin-17 elevation. J Interferon Cytokine Res.
  3. Ozcaka O, Buduneli N, Ceyhan BO, et al. Is interleukin-17 involved in the interaction between polycystic ovary syndrome and gingival inflammation? J Periodontol.
  4. Shourie V, Dwarakanath CD, Prashanth GV, et al. The effect of menstrual cycle on periodontal health – a clinical and microbiological study. Oral Health Prev Dent.
  5. Kebschull M, Demmer RT, Papapanou PN. “Gum Bug, Leave My Heart Alone!” – Epidemiologic and Mechanistic Evidence Linking Periodontal Infections and Atherosclerosis. J Dent Rest 89(9):879-902, 2010.
  6. Beck JD, Eke P, Heiss G, et al. Peridontal Disease and Coronary Heart Disease; A Reappraisal of the Exposure. Circulation. 2005;112:19-24.
  7. Kruger T, Floege J. Vitamin k antagonists: beyond bleeding. Semin Dial.
  8. Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.
  9. Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.
  10. Komori M, Takada K, Tomizawa Y, et al. Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg 2009; 108: 635-40.
  11. Autonomic Activation in Insomnia: The Case for Acupuncture Wei Huang, M.D., Ph.D., Nancy Kutner, Ph.D., and Donald L. Bliwise, Ph.D. Journal of clinical sleep medicine. July 15 2011
  12. Oke SL, Tracey KJ. The inflammatory reflex and the role of complementary and alternative medical therapies. Ann N Y Acad Sci 2009;1172:172-80.
  13. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011 Jul 13;12(8):453-66. doi: 10.1038/nrn3071.
  14. Soukoulis S, Hirsch R. The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Aust Dent J.
  15. Asher GN, Spelman K. Clinical Utility of Curcumin Extract. Altern Ther Health Med.
  16. Mali A, Behal R, Gilda S. Comparative evaluation of 0.1% turmeric mouthwash with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: A clinical and microbiological study. J Indian Soc Periodontol.
  17. Meyer-Hamme G, Beckmann K, Radtke J, et al. A survey of Chinese medicinal herbal treatment for chemotherapy-induced oral mucositis. Evid Based Complement Alternat Med
  18. Hu JP, Takahashi N, Yamada T. Coptidis rhizoma inhibit growth and proteases of oral bacteria. Oral Dis.
  19. An Illustration of Chinese Oral Health Beliefs through shang huo, J.M. HOM, Harvard University, Boston, MA, USA (a public health poster)
  20. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment ,M Irwin, J Pike, M Oxman. Evid Based Complement Alternat Med. 2004 December; 1(3): 223–232.

 

ADDITIONAL REFERENCES

  • http://www.ada.org/4504.aspx
  • http://techtransfer.universityofcalifornia.edu/NCD/20195.html
  • http://www.sciencedaily.com/releases/2007/03/070322161040.htm
  • http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/dentistry.html
  • http://aaosh.org/trends-salivary-diagnostics-bacteriologic-genetic-viral-testing/

 

By Cynthia P. Diep, DDS, L.Ac.
UCLA Center for East-West Medicine, Guest Lecturer and Volunteer
UCLA School of Dentistry Orofacial Pain Program

Arthur Diep-Nguyen, Boston College
BS Candidate Class of 2018