Document 6583002

Bleeding gums
More than 80% of adults have
some form of periodontal disease
and 99% of those have no signs to
indicate they have a problem.
patient's mouth is a portal to
patient's body. More than 90% of
all systemic diseases have oral
manifestations! When pt research
the problem of bleeding gums, pt
will quickly realize that
EVERYONE has a toothpaste
solution to this problem.
Tooth anatomy
The structure of the tooth includes dentin, pulp and other
tissues, blood vessels and nerves imbedded in the bony
jaw. Above the gum line, the tooth is protected by the
hard enamel covering.
 Bleeding
gums can be a sign that
pt are at risk for, or already have,
gum disease. However, persistent
gum bleeding may be due to
serious medical conditions such
as leukemia and bleeding and
platelet disorders.

INCIDENCES Bleeding gums is
more commonly seen in adults.
In case of children, it is mostly
due to injury due to improper
brushing. In case of adults or
the aged, it is often found to be
related with disease. Females
have higher incidences than
males. Marginal gingivitis is
most common i.e. bleeding from
gums comes usually from / near
the base of the teeth.
Causes
 Bleeding
gums are mainly due to
inadequate plaque removal from the
teeth at the gum line. This will lead to
a condition called gingivitis, or
inflamed gums.
 If plaque is not removed through
regular brushing and dental
appointments, it will harden into what
is known as tartar. Ultimately, this will
lead to increased bleeding and a
more advanced form of gum and
jawbone disease known as
periodontitis.
 Other
causes of bleeding gums include:
 Use of blood thinners
 Brushing too hard
 Improper flossing
 Infection, which can be either tooth or
gum-related
 Scurvy
 Vitamin K deficiency
 Hormonal changes during pregnancy
 Leukemia
 Ill-fitting dentures
 Idiopathic thrombocytopenic purpura
 Bleeding
disorders
 Diabetes
 Dry
mouth
 Certain medications
 Infection
 Bacterial infection
 Viral infection
 Periodontal disease
 Dental caries
 Blood dyscrasias
 Aplastic anaemia
 Neoplastic infiltration
 Thrombocytopenia
 Hemophelia
 Bleeding
gums may be due to
 Injury / trauma which may be caused by a blow,
insertion of foreign substances, tooth picking,
dentures, improper brushing, flossing, etc. It
may also get injured from irritation of
chemicals/acids in foods, drinks, mouth
fresheners, tooth whiteners and medicines
 Disease conditions can also cause bleeding
gums. For example
 Gum problems – infection of gums, retracted or
receded gums, weak & spongy gums
 Dental problems – caries, excessive
tartar/plaque formation, periodontitis, etc
 Mouth – Mouth sores can also spread infection
to gums to cause bleeding.
 Blood
disorders - Bleeding & clotting
disorders - deficiency of coagulation factors,
Thrombocytopenic purpura, haemophilia,
leukemia, etc., can cause bleeding.
 Systemic – Liver disorders, kidney disorders,
arterial/capillary diseases, diabetes, heart
disorders, etc., can also reflect as bleeding
gums.
 Nutritional and physiological – Vitamin C & K
deficiency will lead to bleeding disorders.
Pregnancy and hormonal changes can also
cause bleed gums occasionally. Poor oral
hygiene often causes bleeding due to
infection and weakness.
 PATHOPHYSIOLOGY
- Infection
(bacterial / viral / fungal) arises in
the gums and teeth produce acids
and toxins which usually erode and
cause inflammation of the gums.
The inflammation makes gums
swollen, red and spongy which
increases the tendency to bleed
and weakens the stability of the
teeth by recession.
* Bleeding on slightest injury or even
touch
* Red, tender or swollen gums
* Blood with bloody taste in mouth
* Sometimes, due to bleeding gums,pus
can be squeezed from the gums
* Bad breath
* Recession of gums from the teeth
* Sensitive teeth
* Loose and shaky teeth
Difficulty and discomfort in mastication and
food intake occasionally due to pain and
sensitiveness
 For persistent bleeding gums, there
are some essential tests:
* oral examination of teeth and gums
* X-rays of teeth and jaw
* Blood analysis
* Tc, Dc, Esr, Hb%, sugar, calcium,
urea, and creatinine
* Coagulation factors and serum
prothrombin time
* Bleeding and clotting time
Gingivitis
Inflammation of the gums is called gingivitis.
Bacteria in plaque around the teeth release
enzymes (collagenases) that can damage and
erode the gum tissues. The infected gums swell,
bleed
Bleeding gums
complications
pt must know it is important to
brush away the problem in
initial period itself.
Otherwise, complications like
constant bleeding, swelling and
pain in gums, periodontal
disease, jaw bone disease, and
finally tooth loss can occur.
 General treatment of bleeding gums
To keep healthy and smiling teeth, it is essential
to keep the gums healthy. The first and best
treatment is maintaining oral and dental
hygiene. Do it with proper brushing techniques.
Due to a wide range of problems occurring in
the gums and teeth, most of the patients are
prescribed antibiotics and varieties of paste to
control infection.. For complete cure, treatment
should be started at the early stage; otherwise,
the gums may recede or shrink, paving way for
infection to enter the base of the teeth to loosen
it.
 Once gums get retracted and receded, gaining
normalcy is tough, but even though we make gums
healthy by treatment, it will not adhere to the teeth
as tightly as before. In that case, the cementum of
the teeth will be exposed to cause sensitive teeth.
Therefore, treating bleeding gums earlier is a must.
Usually, pain is always preferable to numbness,
where some people go for benumbing the gum with
gum gel for pain relief and arresting the bleeding. It
will work only temporarily and in this case, the
disease often advances further, causing more and
more pain and more and more complications, since
this type of temporary alleviating maneuver always
allow the disease in the track with temporary hurdle.
Therefore, treatment of bleeding gums locally with
this type of gum gel will not help in the long run. We
should always aim at treating the cause and
symptoms internally with internal medicines for
reviving complete cure
Soft bristle tooth brushes to brush gently
Vitamin supplements in case of deficiency
Take care for Well balanced nutritious diet
Proper mastication Brush away the food
particles in mouth after every meal Proper
brushing i.e. gentle and careful. Ill-fitting
dentures if any .Oral hygiene and dental
health .Gargle with salty warm water after
every meal

Bleeding gums prevention
Everyone who want to prevent bleeding gums should avoid
hard and fast brushing, hard diets and snacks which can
cause injury such as chips, sour foods or drinks, hot drinks,
carbonated acid drinks, sticky chocolates, pain-killers,
blood thinners and unnecessary medication. pt should rinse
mouth with mouth fresheners often. Tobacco chewing, betel
nut chewing and smoking is something that pt should also
avoid. Take care of plaque deposits by proper cleaning and
visiting dentist regularly. Use soft bristle toothbrushes to
brush gently and use vitamin supplements in case of
deficiency. Use well-balanced nutritious diet, proper
mastication, and brush away the food particles in the mouth
after every meal. Oral hygiene and dental health is very
important as well. Try to gargle with salty warm water after
every meal
INTRODUCTION OF DANTA ACCORDING
TO AYURVEDA
 Danta i.e. tooth is also known as
“Ruchakasthi” and is a variety of bony
tissue. The word “Ruchaka” means that
which imparts taste and “asthi”means
bone.
 There are 32 permanent teeth and 24
deciduous teeth. It appears that over
5000 years since the time of kashyap,
children of have lost 4of their deciduous
teeth and at present only 20 deciduous
teeth are present .even many adults at
present either do not have their wisdom
teeth or they are very much
underdeveloped. Hence the number of
permanent teeth
 usually present in adults varies from 28 to
32



The time taken for the eruption of a teeth is the same
number in terms of days as the month in which the
tooth erupted ,eg if the central incisor erupts in the
sixth month it will take 6 days for complete eruption.
the primary teeth will fall in the same year as the
month, at which it erupted.
The central incisiors,the lateral incisors ,the cannines
and the molars are called as Rajadanta, Vasta,Danshtra
and Hanavya respectively . There are 2 each of
rajdanta, Vasta and Danshtra and 6 of Hanavya in each
upper as well as lower jaw.The bony tissue as well as
the bone marrow are the primary tissues from which
the tissue develop.
NORMAL TEETH AND GUMS
Normal healthy teeth are strong ,white
,dense , smooth , clean ,slightly
,prominent, well developed and evenly
placed in relation to each other. They do
not decay and are not affected by disease.
The gums are even ,pink , smooth ,dense,
and steady. Gums are known as
Dantamansa or Dantaveshta . Thus diet
and tonics good for bony and muscular
tissue are useful for teeth and gums
respectively.
According to Sushrut there are 15
diseases of the roots of teeth and
gums. However ,Yogratnakar and
vaghbhat has included 1more
(Dantavidradhi)as the sixteenth
disease.Apart from this Madhavnidana
has given reference of karala,thus
increasing the number to 17.Now lets
discuss some of them in brief
DISEASE
SYNONYMS
ABNORMALITY
OF GUMS
1. Samvruta-danta
2. vivruta-danta
1.Hypertrophy
of gums
2.atrophy of gums
*TRAUMATIC
3.Dantavaidarbha
Injury to gums
DOSHAS
AFFECTED
*DOSHAJANA
4.Adhimansa
Pericoronitis of
wisdom teeth
Kaphaja
5.Dantaveshtha
Chronic
suppurative
gingivitis
raktaja
6.Upakusha
Recurrent acute
suppurative
gingivitis
Pitaj +raktaja
7.Sheetada
Chronic suppurative
recessive
gingivitis
Kafaj+raktaj
8.Soushira
Suppurative
periodontitis
Kaphaj+rakataj
9.Mahasoushira
Necrotising
Tridoshaj
ulcerative
gingivo-stomatitis
10.Paridara
Atrophic gingivitis
Tridoshaj
11.Dantavidaran
Alveolar abscess
with sinus
Tridoshaj
12.Dantapupputak
Periodonta Kaphaj+rakataj
l
abscess
13.Dantavidradhi
Alveolar Tridoshaj+raktaj
abscess
14.Dantamans
arbuda
Tumors of Tridoshaj+kaphaj
gums
15.Dantmansasruk Bleeding
from
gums
Raktaj +pitta
HEALTH AND HYGIENE OF TEETH
Each teeth should be brushed individually by koorchaka
i.e, a soft tooth brush .the brush should be rotated over
gums and the teeth in the vertical manner i.e from below
upwards in the lower jaw and from above downward in the
upper jaw .Side to side brushing must be avoided, as it
may damage the necks of the teeth and also the gums
.one should rinse and gargle the mouth after brushing the
teeth as well as after eating any food .
A soft brush can be made by bitting and chewing the
tips of fresh stem of the following plants:
*Arka
*Nyagrodha
*Khadir
*Karanja
*Arjuna
*Katunimb
ACCORDING TO PRAKRUTI LIST OF
PLANT WHICH SHOULD BE USED
FOR DANTDHAWAN
Constitution
Characteristics
of gums
Stem indicated
Taste
Vata
Thin, atrophic,
Glycerrhiza
dry and rough
Khadira
Madhur
Pitta
Spongy,inflamm Nimba Arjun
and red
Tikta
Kapha
Hypertrophic
and whitish
Karanja Arka
Katu
Rakta-Pitta
Bleeding and
spongy gums
khadira
Kashaya
TOOTH POWDER
Triphala
Trijataka
With honey and saindhav for kapha and pitta
constitution.
Trikatu
With honey and saindhav for kapha constitution.
DIET HARMFUL FOR GUMS
Pungent and salty food , drumstick, Chana
,Bringal, fish and raw mango are harmful for
gums.Curds ,Til, Mustard ,Chilly
Garlic ,fermented food
items,Jaggery,Alcoholic prepration and
incompatible diet should be avoided.Also
person suffering from bleeding gums should
avoid exposure to sun ,exercise traveling
,induction of sweating,sexual intercourse,
smoking and brushing teeth .Cold
environment has beneficial effects in this
condition.