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Many people have the misconception that the bleeding of the gums after brushing is caused by too hard and prolonged brushing as well as the use of hard-bristled toothbrushes. Everytime I see my patients and they would complain of gingival bleeding, most of them, if not all, believe that their brushing technique caused the gums to bleed. This is a very big fallacy and I want to correct this so that patients would have a better understanding with regard to their oral health and oral hygiene measures.

The reason why gums bleed after brushing is none other than the fact that a periodontal disease is present in the mouth which may either be gingivitis or periodontitis. There is no use of blaming the bleeding to too harsh brushing techniques because it would never ever be the cause.

PLAQUE AS THE CULPRIT

Plaque is a soft structural deposits that adhere to tooth surfaces. It is composed of bacterial flora that continually multiply and coaggregate. Plaque is the main etiologic factor that causes periodontal disease. As plaque thickens, there is a shift in the bacterial composition from generally aerobic gram (+) bacteria to anaerobic gram (-) bacteria. As the microflora becomes dominated by anaerobic bacteria, they become pathogenic enough to overcome hosts immune response that would then induce gingivitis.

The first line of defense when the gingival tissues are exposed to this pathogenic bacterial microflora is inflammation. The degree of inflammation depends on the severity of the periodontal disease. It may range from slightly rolled to bulbous gingiva or may be slightly blunted to pronounced blunting of the interdental papilla.

WHY THE GUMS BLEED

In the presence of a periodontal disease, there would be inflammation of the gingiva as one of the signs and symptoms. During inflammation, vascular changes would occur including vasodilation, increased blood flow, increased vascular permeability as well as formation of inflammatory exudates in interstitial tissues.

Due to these vascular changes, the gums are susceptible to bleed easily. Dentist use the periodontal probe to determine the severity of the periodontal disease. You would notice that the more plaque and the more inflamed the gingival is, the more bleeding could be seen when a periodontal probe is inserted to the gingival sulcus.

TREATMENT

The treatment is plain and simple proper oral hygiene. A patient who brushes his teeth after every meal does not guarantee that he may not develop gingivitis. Many patients do not

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