Bleeding on Probing

The term bleeding on probing (BoP), which is also called bleeding gums or gingival bleeding, is used by dental professionals to describe bleeding induced by gentle manipulation of the tissue. The probing is typically completed to the depth of the gingival sulcus, or the area between the gingiva and the tooth. In many cases, BoP is a sign of periodontal inflammation. It can also be an indicator of some level of destruction and erosion to the lining of the sulcus or the ulceration of sulcular epithelium. The blood which appears from probing is from the lamina propria after the ulceration of the lining. There appears to be a correlation between BoP and periodontal disease.

Causes

There are numerous things which can cause gingival bleeding. The primary cause of this type of bleeding is when plaque is able to form and accumulate at the gum line. This is often a result of improper brushing and flossing or inadequate oral hygiene. When plaque is able to harden over time, it becomes calculus. Calculus is incredibly difficult to remove without professional dental intervention. Periodontitis is an advanced form of gingivitis cause by the formation of plaque. Below are other conditions which may be associated with gingival bleeding:

  • Aspirin and anticoagulants
  • Diabetes mellitus
  • Hypertension
  • Hormonal imbalances common in puberty and pregnancy
  • Idiopathic thrombocytopenic purpura
  • Infection of the teeth and/or gums
  • Leukemia
  • Poor nutrition
  • Surplus of iron

While the following causes are less common, they can also be associated with gingival bleeding:

  • Dengue fever
  • Vitamin C deficiency or scurvy
  • Vitamin K deficiency

Diagnosis

Through an oral examination by a dentist or dental hygienist, they should be able to determine if the bleeding is a result of malnutrition or puberty. Additional testing for specific diseases may be required based on additional symptoms. This may include an oral glucose tolerance test for diabetes mellitus, blood tests, pregnancy-related testing, and X-rays.

To accurately determine the patient’s periodontal health, the dental professional will record the sulcular depths of the gingiva. Any bleeding which occurs upon probing will also be recorded. A periodontal probe is used for this test. Dental floss may also be used which can aid in assessing the gingival bleeding index. This initial evaluation is used to record the patient's periodontal health and to determine if gingivitis is present. The number of sites which bleed are used to calculate the gingival bleeding score.

Based on research, bleeding as a result of probing is not always a trustworthy indicator of periodontal disease. However, the lack of bleeding can be a reliable method to determine the lack of periodontal disease. Based on this research, the interpretation from a clinical perspective is that while the presence of BoP may not indicate periodontal disease, the continuous lac of BoP is a strong predictor of good periodontal health.

Treatment Options

The treatment for the BoP is highly dependent on the cause. Below is a summary of treatment recommendations.

  • Avoid the use of tobacco which can worsen bleeding gums Brush twice each day and floss daily to prevent the build-up of plaque
  • Consume a balanced, healthy diet
  • Follow the dental professional’s recommended frequency for professional plaque removal
  • Treatment for any diagnosed disease should be the top priority
  • Use a soft-bristle toothbrush to clean teeth and use gentle brushing methods
  • Toothpaste containing fluoride or a fluoride treatment may also be beneficial

Follow up with your dentist right away if you are experiencing bleeding on probing (BoP) as it could be a sign of a serious illness or oral issue.