Bleeding on Probing

Bleeding on probing is a clinical term that denotes bleeding that occurs when gum tissue is gently manipulated. Specifically, bleeding on probing refers to bleeding in the depth of the gingival sulcus, which is the crescent-shaped crevice where the gum line meets the tooth. Bleeding on probing, which may also be called bleeding gums or gingival bleeding, is the primary indicator of inflammation in the periodontium, which is the specialized set of tissues that surround and support the teeth. Generally, bleeding on probing indicates some level of damage or ulceration to the lining of the gingival sulcus.

While there are multiple causes of gingival bleeding, the most common cause of bleeding in the gums is an excessive buildup of bacterial plaque at the gum line. This accumulation of plaque is most often caused by improper oral hygiene, which includes regularly brushing and flossing the teeth. When bacterial plaque remains on the surfaces of the teeth and is allowed to harden, this forms dental calculus, which is also known as tartar, which further damages the soft tissues of the gums. When calculus remains unaddressed on and between the teeth and in the gingival sulcus, this leads to gingivitis, a reversible type of gum disease that can be treated by deeply cleaning the surfaces of the teeth both above and below the gums to remove accumulated calculus. If gingivitis goes untreated and is allowed to progress, it often develops into periodontitis, which is a more damaging, irreversible form of gum disease that can lead to significant destruction, including loss of the teeth and resorption of the bones of the jaw.

Bleeding on probing may also be associated with infection in the teeth or gums, diabetes, high blood pressure, such illnesses as leukemia and purpura, hormone imbalances, malnutrition, an excessive amount of systemic iron, and treatment with aspirin or other blood thinners. While less common, bleeding of the gingival tissue may also be a sign of dengue fever or vitamin deficiency, specifically deficiency in vitamin C or vitamin K. A simple periodontal examination can determine the cause of bleeding on probing or can help rule out obviously unrelated possible causes. In some cases, additional tests must be conducted to determine if any undiagnosed pathologies or conditions are present, and these tests may necessitate consultations with other medical practitioners. If any of these diagnoses are confirmed, the priority is to treat the disease first; in many cases, treatment reduces or eliminates gingival bleeding.

The periodontal examination is a routine part of nearly every dental examination. A dentist or dental hygienist uses a specialized probe that measures the depth of pockets in the gingival sulcus; these sulcular depths are recorded and used to diagnose gum disease. As they probe the patient’s gums, the dental health practitioner will also note any bleeding on probing, calculating the patient’s gingival bleeding score to assist with diagnosis. While bleeding on probing does not always correlate with periodontal disease, a lack of bleeding on probing is usually an accurate predictor of gingival and periodontal health. When periodontal disease is present, treatment involves frequent clinical removal of dental calculus along with modification of home hygiene habits. Dentists may also recommend cessation of tobacco use and the adoption of more beneficial nutritional habits, or they may prescribe medicated dental rinses to reduce the bacterial load in the oral cavity.