Bleeding on probing (BoP) which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the

gingiva The gums or gingiva (plural: ''gingivae'') consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health. Structure The gums are part of the soft tissue l ...

and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction and

erosion Erosion is the action of surface processes (such as water flow or wind) that removes soil, rock, or dissolved material from one location on the Earth's crust, and then transports it to another location where it is deposited. Erosion is d ...

to the lining of the sulcus or the ulceration of sulcular epithelium. The blood comes from lamina propria after the ulceration of the lining.
Gingival bleeding
' URL assessed on November 21, 2009 BoP seems to be correlated with Periodontal Inflamed Surface Area (PISA).

Causes

There are many possible causes of gingival bleeding. The main cause of gingival bleeding is the formation and accumulation of plaque at the gum line due to improper brushing and

flossing Dental floss is a cord of thin filaments used in interdental cleaning to remove food and dental plaque from between teeth or places a toothbrush has difficulty reaching or is unable to reach. Its regular use as part of oral cleaning is design ...

of teeth. The hardened form of plaque is

calculus Calculus, originally called infinitesimal calculus or "the calculus of infinitesimals", is the mathematics, mathematical study of continuous change, in the same way that geometry is the study of shape, and algebra is the study of generalizati ...

. An advanced form of

gingivitis Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attac ...

as a result of formation of plaque is

periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...

. Other conditions associated with gingival bleeding include:
MedlinePlus: Bleeding gums
' URL assessed on November 21, 2009 * Tooth and/or gum infection * Diabetes mellitusCharles R. Craig, Robert E. Stitzel (2004) In
Modern Pharmacology with clinical applications (Edition 6)
'. Lippincott Williams & Wilkins. p. 506. . Google Book Search. Retrieved on November 21, 2009. * Hypertension * Idiopathic thrombocytopenic purpura *

Leukemia Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ...

* Malnutrition * Aspirin and anticoagulants therapy * Hormonal imbalances during

puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a ...

and pregnancy *

Iron overload Iron overload or hemochromatosis (also spelled ''haemochromatosis'' in British English) indicates increased total accumulation of iron in the body from any cause and resulting organ damage. The most important causes are hereditary haemochromato ...

Other less common causes are: * vitamin C deficiency (

scurvy Scurvy is a deficiency disease, disease resulting from a lack of vitamin C (ascorbic acid). Early symptoms of deficiency include weakness, feeling tired and sore arms and legs. Without treatment, anemia, decreased red blood cells, gum disease, ch ...

) and vitamin K deficiency * dengue fever

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. 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, 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 (sometimes abbreviated as TCS) is an antibacterial and antifungal agent present in some consumer products, including toothpaste, soaps, detergents, toys, and surgical cleaning treatments. It is similar in its uses and mechanism of act ...

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

References

{{Periodontology Bleeding Periodontology