Gingival Bleeding

DEPARTMENT OF PERIODONTICS A SEMINAR ON

GINGIVAL BLEEDING Presented by SYED NABI AHMED C.R.I.

INTRODUCTION 

The two earliest symptoms of gingival

inflammation proceeding established gingivitis are (1)

increased gingival crevicular fluid production rate

(2)

bleeding from gingival sulcus on gentle probing.



Gingival bleeding varies in severity, duration and

the ease with which it is provoked. 

Bleeding on probing is easily detectable clinically

& therefore is of value for the early diagnosis and prevention of were advanced gingivitis.

Pregnancy gingivitis.



It has been known that bleeding on probing

appears earlier than a change in color or other

visual

signs of inflammation, in addition the use of bleeding rather than color changes to diagnose

early

gingival inflammation is advantages in that bleeding is a were

objective

estimation.

sign

that

requires

less

subjective

CLASSIFICATION Gingival bleeding can be due to a series of factors, which can be grouped broadly into two categories such as 

Local



Systemic



Local factors a. Infectious Acute

:

1. ANUG (Acute Necrotizing Ulcerative Gingivitis) 2. AHGS (Acute Herpetic Gingive Stomatitis)

Chronic

:

1. Gingivitis 2. Periodontitis

b. Traumatic 1.

Brushing

2.

Food impaction

3.

Irritation (due to prosthesis)

4.

Tooth pick injury

5.

Gingival burns

c. Post Surgical d. Congenital (eg) Hemangioma



Systemic factors a. Deficiencies i)

Hereditary : Haemophilia A & B, Von.wille brand’s disease

ii)

Liver disease: vit K deficiency

iii)

Deficiency of factor II,VII,IX,X

iv)

Idiopathic: eg.Thrombocytopenic purpura

v)

Leubemic

vi)

Nutritional :vit A, vit C and protein deficiency

b. Dysfunction i) Multiple myeloma ii) Systemic Lupus Erythematous c. Drugs & chemical allergies Salicylates, anticoagulant d. Excess: Thrombocytosis e. Defective aggregation f. Infections: Infections mononucleuses g. Hereditary: Haemorhagic telengetiasis h. Hormones: Pregnancy, Menstruation I. Malignancies

HISTOPATHOLOGICAL

ALTERATION

IN

GINGIVAL

the

following

BLEEDING In

gingival

inflammation

histopathological alterations result in abnormal bleeding: 

Dilatation & eugargeuant of capillaries is thinning or ulceration of sulcular epithelium.

Gingival Inflammation



Because the capillaries are engorged and closes to the surface & the thinned, degenerated epithelium is less protective, stimuli that are ordinarily

innocuous cause rupture of capillaries and gingival bleeding.

GINGIVAL BLEEDING CAUSED BY LOCAL FACTORS This can be divided into: 

Chronic & recurrent bleeding



Acute

CHRONIC AND RECURRENT BLEEDING 

The most common cause of abnormal gingival

bleeding on probing is chronic inflammation. 

The bleeding is chronic or recurrent & is provoked

by mechanical trauma (e.g. from tooth brushing, picks or food impaction) or by biting into such as apples.

Chronic Generalized diffused Gingivitis

tooth

solid foods

ACUTE BLEEDING 

Acute episodes of gingival bleeding are caused by

injury or occur spontaneously in acute gingival disease. 

Laceration of gingival by tooth brush bristles

during aggressive tooth brushing or by sharp of hard food can cause gingival bleeding

pieces even in the

absence of gingival disease. 

Gingival burrs from foods or chemicals increase

the ease of gingival bleeding.

Gingival enlargement seen in a patient taking a calcium channel blocker.

Gingival bleeding associated with systemic changes.  In

some

haemorrhage

systemic occurs

disorders,

spontaneously

gingival or

after

irritation and is excessive and different to control. Such

conditions

have

the

common

hemostatic mechanism failure and bleeding in the skin, internal tissues including the oral

feature

result in abnormal organs and other

mucosa.

 The various systemic conditions that can result in gingival bleeding have been listed in the classification.

of

CLINICAL EVALUATION OF GINGIVAL BLEEDING Sites that bleed on probing have a greater area of inflamed connective tissue (i.e., cell-ribs, collagens per tissue) than do sites that do not bleed. In most cases the cellular infiltrate of sites that bleed on probing is predominantly lymphocytic. The severity of bleeding and the ease with which it is provoked depend on the intensity of inflammation. Hence they can be grouped into two categories: 1.

Spontaneous

2.

Bleeding on provocation

• SPONTANEOUS

BLEEDING

or

bleeding

on

slight

provocation can occur in acute necrotizing ulcerative gingivitis. In this condition, engorged blood vessels in the

inflamed

connective

tissue

are

exposed

by

ulceration of necrotic surface epithelium.

spontaneous bleeding of the gingiva

• BLEEDING ON PROVOCATION can be seen in varying stages

of

the

disease.

In

case

of

moderate

or

advanced periodontitis, the presence of bleeding on probing

is

considered

destruction.

bleeding of the gums upon probing.

a

sign

of

active

tissue

Thus bleeding can be considered of diagnostic value in many of the gingival diseases. However its relationship to disease progression is unclean. A periodontal probe or a wooden interdental cleaves can be used in the evaluation of gingival bleeding. It has to known that any force greater than 0.25N tissues.

can

produce

gingival

bleeding

in

healthy

GINGIVAL BLEEDING INDICES 

The clinical assessment of gingival color, form and texture is subjective in nature, gingival bleeding is an objective diagnostic sign of inflammation.



Periodontal probes are used with most indices

however toothpicks and dental floss are used to

elicit

bleeding with some indices. 

Gingival bleeding indices are used in clinical

practice, surveys of population groups and clinical trials of antiplaque and antigingivitis agents. 

Although there are many indices are available for

assessment of gingival bleeding.

Some which are used were commonly are as follows: 1.

Gingival sulcus bleeding index

2.

Gingival index-loe & sillness

3.

Gingival bleeding index

4.

Eastman interdental bleeding index

5.

NIDCR protoacd for recording gingival bleeding

MANAGEMENT OF GINGIVAL BLEEDING 

Increased gingival bleeding and tenderness

requires routine periodontal monitoring. 

Periodontal maintenance should be titrated to

the individual patients need. 

Preventive care including a vigorous program of oral hygiene is also vial.



Hilder gingivitis eases respond well to scaling

and root planning with frequent oral hygiene reinforcement. 

Some cases of gingivitis & bleeding may require

microbial culturing, antimicrobial mouthwashes and local site delivery, or antibiotic therapy. 

Periodontal maintenance appointments may

used to be frequent when periodontal instability is noted.

CONCLUSION Gingival bleeding therefore is critical in early diagnosis and prompt treatment of diseases involving the

periodontium.

Proper

awareness

should

be

inoculated in patients to consider bleeding as a early sign

of

gingival

disease.

The

woven

diagnostic

techniques should also be used for their purpose.