Every toothbrush manufacturing company emphasises that their brushes are ideal for gums. Yet, often it is observed that bleeding occurs from gums after brushing the teeth. Could it be because we were harsh on gums? Were the gums spongy? Or there is some disease of the gums?

Overused toothbrush, uneven bristles, brushing in hurry giving undue pressure on gums and mother keeping an eye on the child who wants to avoid brushing are the regular events causing bleeding from gums. The modern society uses toothpicks to remove the remains of food particles and chewing gum to hide the odour. In India, we still use gargling after taking food. Due to this, dentistry was not a favourable branch. Only those who could not secure good percentage in high schools were reluctantly went for dentistry with the inner desire to prefix ‘Dr’ before their names. Specdialities like Cosmetic, Maxillo–facial, Dental implant, etc. have changed the attitude of the students and by preference they opt for dentistry.

CAUSES OF BLEEDING FROM GUMS

SCURVY

 Parson with the bleeding from gums on his own goes to the dentist with the complaint. Spongy gums could be due to Vit. C deficiency. The disease is called Scurvy. If deficiency of Vit. C continues patient gets pain in legs (on shin) or blood clotting occurs under the skin producing reddish or dark areas. Single males particularly of developed countries feel lazy to cook. They warm the tin food and eat. This can also produce Scurvy. Doctors call it ‘ Bachelor’s Scurvy’. People on sea voyage like sailors are often deprived of fresh vegetables and fruits. They survive on tin food that can cause Scurvy.

TARTER

Tarter is the coating developing on the gums. Food particles remain between the teeth producing dental carries and also affect the gums. Patient complaints of bad breath and pain besides bleeding from gums.

DENTURES

 Edge of the partial or complete ill-fitting dentures can cause bleeding from gums and even ulcer (detail in chapter of ‘Ulcer’ on gums. Even powder used before inserting denture in the mouth can produce Allergy and bleeding from gums. Improperly fitted Dental implant can also produce bleeding from gums.

ALLERGY

 Allergy from any vegetarian or non-vegetarian food, particularly seafood or egg can produce bleeding from gums and ulcers on gums, tongue and mouth (detail in chapter of ‘Ulcer’). Certain medicines like Sulpha, Aspirin, and Penicillin are known for Allergic reaction. Human beings are unpredictable creatures. Any medicine can produce Allergy even though earlier he was consuming that without side effects or Allergy.

TOOTH EXTRACTION

 Tooth extraction by trainee student is the known cause of bleeding from gums but even the experienced dental surgeon how so ever senior he may be, at times have inadvertently caused bleeding from gums. This could be due to curved tooth in the gum or impacted tooth (particularly Wisdom tooth).

BEDRIDDEN PATIENT

Diminished protein in the body in prolonged illness incapacitates patients. Unhygienic condition thereby produces dental carries and bleeding from gums. Unhygienic condition of the mouth is often encountered in children. Late night watching TV, late getting up in morning is responsible for children going for early morning schools. Such children compromise in mouth hygiene, toilet and bathing. It is the opinion of Paediatrician that such children often suffer from constipation because of their habit of controlling motion.

CONTAGIOUS DISEASES

 Like Syphilis or Aids can produce bleeding of gums with or without ulcers in mouth.

BLEEDING DISORDERS

God has given amazing property to blood. It flows like liquid in the body but clots when comes out of the body. The clotting mechanism is a complex phenomenon requiring many components of blood. Deficiency in any component can delay the clotting process that can prolong the bleeding from any cut area or gums, mouth, nose, stomach, intestines, etc. Only skin cut does not bleed long. But while shaving or in menstrual period if bleeding occurs for a longer period it needs investigation. Such patient often develops dark patches under the skin. These patches are due to capillary bleeding under the skin. Condition is called Haemophilia. Every patient undergoing any kind of surgery or tooth extraction should undergo bleeding and clotting test.

Every Haemophilia patient should have a card in the pocket mentioning: Name, Address, Tel.No, Blood group, name of the family doctor and the type of disease. God forbid, if any accident occurs, this will help the doctor to treat him. He must also inform the surgeon or dentist about his condition prior to any surgery or tooth extraction.

CANCER OF GUM

 Cancer affecting only the gums is rare. Gums may be involved as a continuity of roof of mouth (Palate), tongue or mouth cancer.  Any ulcer which bleeds or any growth appearing on gums, palate or in mouth should be investigated. Biopsy from that ulcer or growth should be taken for diagnosis.

INVESTIGATIONS:

 * Blood routine

* Bleeding Time, Clotting Time, Prothrombin Time. If any abnormality is seen in these report then complete test for Coagulation factors.

* Blood group

* Vit. C. Estimation in suspected Scurvy

* VDRL and other tests for Syphilis

* Test for HIV

* Biopsy of the ulcer or growth

TREATMENT

Scurvy needs large dose of Vit. C Preferably by injection (Dose, company???????)

For Allergy, see chapter on Allergy

Treatment of Syphilis or Aids by Specialist doctor

Bleeding disorder may require fresh blood transfusion, as it will provide coagulation factors from the blood if bleeding is severe.

Cancer of the gum may require surgery, radiation or chemotherapy either curative or palliative (detail in chapter of Ulcer)

LET’S SMILE

Patient was sitting in dental chair. Dentist asked,” Where do you get pain”

Patient replied,” in my feet”

Doctor screamed,” Why the hell you have come to me then? Since when are you getting pain in feet?”

Patient said,” From the time you are standing on my feet”

*

Lady was sitting in dental chair screamed with pain,” Doctor, it is almost like labour pain”

Dentist said,” Madam, decide fast so that accordigly I can adjust the dental chair”

Patient was doorkeeper of the theatre.

Dentist asked, “ Which tooth is hurting you?”

He said, “ Right side third of the balcony”.

Villager came to dentsit with tooth cavity. Dentist explained in the language which this villager can easily understand, “ There is a worm sitting on tooth eating your tooth. The tooth should be removed”. But, instead of removing the tooth with cavity, he extracted the health next tooth. This infuriated the villager. Dentist then cooly explained, “ You don’t understand. This worm was sitting on that tooth. I have removed the tooth. Now where he will sit and eat you diseased tooth?”

Man asked for the appointment of Chinese Dentist for his toothache. Dentist with his Chinese accent said, “Two Thirty”

Patient understood and replied, “ Yes, yes, tooth hurting”. Conversations went on till dentist slammed the receiver out of annoyance.

One bully was frightening a thin lean fellow, “ I will break 35 teeth if you say a word more”

Passer by said, “ Look, man has only 32 teeth. From where you will get another 3 teeth?”

Bully, “ I know some body will become overwise when I was tellying this fellow. Remaining 3 will come from your mouth”