Dentistry focuses on diagnosing, preventing, and treating conditions of the teeth, gums, and oral structures, supporting oral health and overall well-being.

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Bleeding Gums: Common Symptoms

Bleeding gums can show up in many ways. Seeing blood is the main sign, but it is not the only one. Bleeding is a warning that there is a bigger problem affecting the look, feel, and function of your gums. It is important for patients to notice all the changes, not just the bleeding, to understand how serious the problem is. At Liv Hospital, we teach patients to pay attention to more than just blood in the sink and to watch for other changes in their gums and mouth.

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The Visual Spectrum of Inflammation

The appearance of the gingiva serves as a barometer for periodontal health.

Color Transformations: From Coral to Cyanotic

In a state of health, the gingiva is typically described as “coral pink,” although physiological pigmentation (melanin) is common and normal in many ethnic groups. The onset of disease triggers distinct color shifts driven by vascular changes.

  • Acute Erythema: In early gingivitis, the increased blood flow (hyperemia) causes the tissues to turn a bright, fiery red. This is often most noticeable at the gingival margin (the edge where the gum meets the tooth) and the interdental papillae (the tips of gum between teeth).
  • Chronic Cyanosis: As the condition progresses, blood flow becomes sluggish and congested. The oxygen-depleted blood gives the tissue a bluish-red, purplish, or cyanotic hue. This color change is a hallmark of long-standing, established periodontitis.
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Architectural Changes: Edema and Fibrosis

Healthy gingiva is firm and tightly adapted to the underlying bone and tooth.

  • Edematous Changes: The accumulation of inflammatory fluid (exudate) in the tissue spaces causes the gums to swell. The tissues become puffy, soft, and friable. The normal knife-edged margin becomes rolled and bulbous. The interdental papillae may bulge out of the embrasure space. This swelling creates “pseudopockets,” deepening the space around the tooth without actual bone loss.
  • Loss of Stippling: The surface of healthy attached gingiva has a textured appearance similar to an orange peel, known as stippling. In disease, edema stretches the epithelium, making the surface smooth, shiny, and glossy. The loss of stippling is a reliable early sign of gingival edema.
  • Fibrotic Changes: In some cases, particularly in smokers, the body attempts to wall off the infection by producing excess collagen. This results in fibrotic, enlarged, and leathery gums that may not bleed as easily but conceal deep, destructive pockets underneath.

Sensory and Functional Symptoms

Gum disease often develops slowly and without obvious pain, but there are certain signs you can notice.

  • Provoked Bleeding: The most common functional symptom is bleeding upon mechanical stimulation. This can occur during brushing, flossing, or even when biting into hard foods like apples or crusty bread. The severity of the bleeding (spotting vs. profuse flow) often correlates with the degree of inflammation.
  • Spontaneous Bleeding: In severe necrotizing diseases or systemic coagulopathies, bleeding may occur without any provocation. Patients may wake up with blood on their pillow or taste blood throughout the day.
  • Taste and Breath Alterations: The anaerobic bacteria responsible for periodontal disease produce Volatile Sulfur Compounds (VSCs) such as hydrogen sulfide and methyl mercaptan. This leads to persistent halitosis (bad breath) that is not resolved by brushing or mouthwash. Additionally, the presence of purulent exudate (pus) and iron-rich blood creates a distinct metallic or foul taste (dysgeusia).

Pain and Tenderness: While chronic periodontitis is often painless, acute gingivitis can cause the gums to feel tender or sore to the touch. Patients may report a “deep itch” within the gums. Acute periodontal abscesses cause severe, throbbing pain and localized swelling

Structural and Anatomical Evolution

As gum disease damages the support around your teeth, the way your teeth and gums fit together changes.

  • Gingival Recession: Chronic inflammation can cause the gum margin to migrate apically (away from the crown). This exposes the root surface (cementum), which is yellower and softer than enamel. Patients often complain that their teeth look “longer.”
  • Dentin Hypersensitivity: The exposed root surfaces contain thousands of microscopic tubules leading directly to the nerve pulp. This exposure causes sharp, transient pain in response to thermal (cold/hot), tactile (brushing), or osmotic (sweet/sour) stimuli.
  • Tooth Mobility and Migration: The ultimate consequence of bone loss is tooth loosening. Teeth may exhibit increased mobility, depressibility (moving vertically), or pathologic migration (flaring or spacing of front teeth). Patients may report that their “bite feels different” or that their partial dentures no longer fit.
  • Food Impaction: The loss of interdental papillae (“black triangles”) and the loosening of contact points between teeth allow food to become vertically impacted. This trapped food acts as a substrate for bacteria and a mechanical irritant, worsening the inflammation.

Suppuration (Pus Formation)

If you see pus coming from your gums, it means there is an active infection.

  • Clinical Appearance: In active pockets, digital pressure on the gingiva may cause a yellowish-white fluid to ooze from the gingival margin.
  • Significance: This suppuration indicates a massive recruitment of neutrophils (white blood cells) battling a high bacterial load. It is often associated with rapid tissue destruction and requires immediate intervention.

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FREQUENTLY ASKED QUESTIONS

Why do my gums itch?

CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.

Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.

Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.

CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.

Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.

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