Healthy gums do not usually bleed. A little pink in the sink now and then is common, but regular bleeding is a signal worth acting on. The good news: the most common cause is reversible.
The usual cause: gingivitis
Plaque, the sticky film of bacteria on teeth, builds up along the gumline when it is not removed well. The gums react with inflammation: they turn red, puffy and bleed easily when brushed or flossed. This early stage of gum disease is called gingivitis.
Without better cleaning, it can progress to periodontitis, where the gums pull away from the teeth, bone is lost and teeth can loosen. Periodontitis cannot be fully reversed, only controlled, so catching gingivitis early matters.
Other common causes
- Brushing too hard or with a hard-bristled brush.
- Starting to floss: some bleeding for the first week or two is normal and settles as gums get healthier.
- Pregnancy: hormone changes make gums more reactive (“pregnancy gingivitis”).
- Medicines: blood thinners (such as warfarin, apixaban or daily aspirin) and some others.
- Smoking, which can actually hide bleeding while gum disease gets worse.
- Poorly fitting dentures or braces.
- Oral piercings: a lip or frenulum (smiley) piercing can rub against the gums, irritating them and contributing to gum recession over time.
Less common causes
- Vitamin C deficiency (scurvy), rare today but seen with very limited diets.
- Diabetes, which raises the risk of gum disease.
- Blood disorders such as clotting problems or leukemia, usually with other signs: easy bruising, nosebleeds, fatigue, frequent infections.
What to do at home
- Brush twice a day for two minutes with a soft brush and fluoride toothpaste, angling the bristles toward the gumline with gentle circles.
- Clean between teeth daily with floss, interdental brushes or a water flosser. Do not stop because of bleeding; it usually means the area needs more cleaning, not less.
- Replace a worn brush (see how often to change your toothbrush).
- Do not smoke, and limit sugary snacks.
With consistent care, gingivitis bleeding often improves within one to two weeks.
When to see a dentist or doctor
- Bleeding that continues after two weeks of good cleaning.
- Swollen, painful or receding gums, bad breath that will not go away, or loose teeth.
- Bleeding that is heavy or hard to stop, especially if you take blood thinners. Do not stop prescribed medicines on your own.
- Bleeding gums together with unusual bruising, fatigue or fever: see a doctor promptly.
A professional cleaning removes hardened tartar that brushing cannot. The NIDCR page on gum disease explains the stages and treatments.
