DEPARTMENT OF PERIODONTICS

A SEMINAR ON

GINGIVAL BLEEDING

Presented bySYED NABI AHMEDC.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 sign that requires less subjective

estimation.

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. Dysfunctioni) Multiple myelomaii) Systemic Lupus Erythematous

c. Drugs & chemical allergiesSalicylates, 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

BLEEDING

In gingival inflammation the following

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,

tooth picks or food impaction) or by biting into solid

foods such as apples.

Chronic Generalized diffused Gingivitis

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 pieces

of hard food can cause gingival bleeding 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 systemic disorders, gingival

haemorrhage occurs spontaneously or after

irritation and is excessive and different to

control. Such conditions have the common

feature of hemostatic mechanism failure and result

in abnormal bleeding in the skin, internal organs and

other tissues including the oral mucosa.

The various systemic conditions that can result

in gingival bleeding have been listed in the

classification.

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 a sign of active tissue

destruction.

bleeding of the gums upon probing.

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 can produce gingival bleeding in healthy

tissues.

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.