Bleeding on probing which is also known as bleeding gums or gingival bleeding is a term used by dentist

Dentist

A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...

s and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus

Gingival sulcus

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival...

, or interface between the gingiva

Gingiva

The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...

 and a tooth

Tooth

Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...

. Bleeding on probing, often abbreviated BOP, is a sign of inflammation

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 and indicates some sort of destruction and erosion

Erosion

Erosion is when materials are removed from the surface and changed into something else. It only works by hydraulic actions and transport of solids in the natural environment, and leads to the deposition of these materials elsewhere...

 to the lining of the sulcus

Gingival sulcus

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival...

 or the ulceration of sulcular epithelium

Sulcular epithelium

The sulcular epithelium is that epithelium which lines the gingival sulcus. It is apically bounded by the junctional epithelium and meets the epithelium of the oral cavity at the height of the free gingival margin. The sulcular epithelium is nonkeratinized....

. The blood comes from lamina propria

Lamina propria

The lamina propria is a constituent of the moist linings known as mucous membranes or mucosa, which line various tubes in the body ....

 after the ulceration of the lining.

Causes

There are many possible causes of gingival bleeding. The main cause of gingival bleeding is the formation and accumulation of plaque

Dental plaque

Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

 at the gum line due to improper brushing and flossing of teeth. The hardened form of plaque is called tartar

Calculus (dental)

In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...

. An advanced form of gingivitis

Gingivitis

Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

 as a result of formation of plaque is periodontitis. Other causes that can exacerbate gingival bleeding include:

• placement of new dentures
  Dentures
  Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental...
  
  
• tooth or gum infection
• diabetes mellitus
  Diabetes mellitus
  Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
  
  
• idiopathic thrombocytopenic purpura
  Idiopathic thrombocytopenic purpura
  Idiopathic thrombocytopenic purpura is the condition of having an abnormally low platelet count of no known cause . As most incidents of ITP appear to be related to the production of antibodies against platelets, immune thrombocytopenic purpura or immune thrombocytopenia are terms also used to...
  
  
• leukemia
  Leukemia
  Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...
  
  
• malnutrition
  Malnutrition
  Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
  
  
• use of aspirin and anticoagulants(blood thinners) such as warfarin
  Warfarin
  Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
  
   and heparin
  Heparin
  Heparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
  
  
• hormonal imbalances during puberty and pregnancy

Other less common causes are:

• vitamin C (scurvy
  Scurvy
  Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic...
  
  ) and vitamin K deficiency
• dengue fever
  Dengue fever
  Dengue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles...
  
  

Diagnosis

An examination by the dentist or dental hygienist should be sufficient to rule out the issues such as malnutrition and puberty. Additional corresponding diagnosis tests to certain potential disease may be required. This includes oral glucose tolerance test for diabetes mellitus, blood studies, human gonadotrophin levels for pregnancy, and X-rays for teeth and jaw bones.

In order to determine the periodontal health of a patient, the dentist or dental hygienist records the sulcular depths of the gingiva and observes any bleeding on probing. This is often accomplished with the use of a periodontal probe

Periodontal probe

A periodontal probe is an instrument in dentistry commonly used in the dental armamentarium. It is usually long, thin, and blunted at the end. The primary purpose of a periodontal probe is to measure pocket depths around a tooth in order to establish the state of health of the periodontium...

. Alternatively, dental floss may also be used to assess the Gingival bleeding index. It is used as an initial evaluation on patient's periodontal health especially to measure gingivitis. The number of bleeding sites is used to calculate the gingival bleeding score.

Peer-reviewed dental literature thoroughly establishes that bleeding on probing is a poor positive predictor of periodontal disease

Periodontal disease

Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...

, but conversely lack of bleeding is a very strong negative predictor. The clinical interpretation of this research is that while BOP presence may not indicate periodontal disease, continued absence of BOP is a strong predictor (approximately 98%) of continued periodontal health.

Treatment

Corresponding treatments for diagnosed diseases should be taken as first priority. Dentist or hygienists should be visited once every three months for plaque removal. Soft-bristle toothbrush is recommended for brushing your teeth. Hard-bristled toothbrushes may be softened by leaving under hot running water (very hot) before brushing every time, followed by gentle brushing. Flossing twice a day can prevent the building up of plaques. Tobacco should be avoided as tobacco can aggravate the bleeding gums. A balanced healthy diet should also be taken into account. Physiotherapy programme using over-the-counter toothpaste with triclosan

Triclosan

Triclosan is an antibacterial and antifungal agent. It is a polychloro phenoxy phenol. Despite being used in many consumer products, beyond its use in toothpaste to prevent gingivitis, there is no evidence according to the American Food and Drug Administration that triclosan provides an extra...

should be used with home care. If there is persistent continuation of inflammation and bleeding, a prescription of antiplaque rinse would be useful.