Bleeding on Probing
Bleeding on probing is an indicator of the presence of inflammation of the periodontal tissues and is a sign of damage to the lining of the gingival sulcus, which is the area where the gums meet the teeth. Also referred to as bleeding gums or gingival bleeding, bleeding on probing refers to bleeding that may be caused by any manipulation of the tissue at the depth of the gingival sulcus. The most common cause of bleeding on probing is the buildup of plaque at the gum line. This plaque can harden and form calculus, or tartar, which leads to gingivitis and eventually periodontitis. Plaque builds up at the gum line, and eventually hardens, when it is not properly removed through brushing and flossing the teeth. Bleeding on probing can also be a sign of infection in the teeth or gums; a symptom of diabetes, hypertension, purpura, or leukemia; a manifestation of hormone imbalance, malnutrition, or iron overload; or a byproduct of aspirin or anticoagulant therapy. While uncommon, bleeding on probing may also indicate dengue fever, scurvy, or a vitamin K deficiency.
Bleeding on probing is diagnosed by a dentist or dental hygienist. This diagnosis also allows certain causes to be eliminated; for example, a verbal assessment of the patient’s diet can rule out malnutrition as a potential cause. Other diagnostic measures to determine the possibility of disease may also be recommended; these may include oral glucose tolerance tests, blood draws, and x-rays. Bleeding on probing is assessed during a basic periodontal examination, during which the dental hygienist or dentist notes the depths of the gingival sulcus with a WHO 621 periodontal probe. These basic periodontal exams are part of most routine dental checkups. Dental floss may also be used to determine the index for bleeding in the gingiva. The number of areas that bleed upon probing is used as part of an initial, broad evaluation of a patient’s periodontal health. While bleeding on probing is, in and of itself, not a positive predictor of periodontal disease, its absence is a strong negative predictor. This means that presence of bleeding on probing does not necessarily indicate periodontal disease, but that its absence usually indicates periodontal health.
If underlying diseases are discovered as a result of bleeding on probing, the priority is to treat the underlying disease, which may eliminate further bleeding. When bleeding on probing is not a symptom of a larger health issue, the patient should visit a dentist or dental hygienist every three months for professional removal of plaque and tartar. Between professional cleanings, patients should use a soft-bristled toothbrush for home care. If a soft-bristled brush is not available, patients can soften their toothbrush’s bristles by rinsing in very hot water, and an over-the-counter toothpaste containing triclosan may be recommended. Patients should also be instructed to brush gently, to avoid irritating the gums, and to floss daily to remove excess plaque. Smoking cessation therapy may be recommended if necessary, as tobacco use can aggravate or exacerbate bleeding from the gums, and a balanced diet plan should be implemented. If bleeding continues, a prescription mouth rinse may be beneficial.