Bleeding Gums in Children: Causes and What to Do

Seeing a little blood on your child's toothbrush can be alarming. In most children, though, bleeding gums have a simple cause: plaque sitting along the gumline. With good daily cleaning, the gums usually settle down within one to two weeks. Occasionally, bleeding can be a sign of something else, so it helps to know what to look for.

The most common cause: gingivitis

Plaque is a soft, sticky layer of bacteria that builds up on teeth every day. When it is left along the edge of the gums, the gums become irritated and inflamed. This is called gingivitis. Signs include:

• Gums that look red or puffy instead of pale pink
• Bleeding when brushing or flossing
• Bad breath
• Gums that feel tender

Gingivitis is very common in children, and the important news is that it is usually reversible. It doesn't mean your child has "weak gums". It means the gums need better cleaning.

Situations that make gingivitis more likely

• Missed spots when brushing. Children often brush the front surfaces well and miss the gumline and back teeth.
• New teeth coming through. Gums around erupting teeth can be tender and harder to clean.
• Braces and other appliances. Brackets and wires trap plaque, so gums around them often bleed unless cleaning is very thorough.
• Mouth breathing. Children who breathe through their mouth, for example due to blocked nose, allergies or large adenoids, often have dry, red gums at the front of the mouth. It's worth mentioning to your paediatrician.
• Teenage hormones. During puberty, gums can react more strongly to even small amounts of plaque.
• Frequent sugary snacks and drinks, which feed the bacteria in plaque.

What to do at home

1. Keep brushing, including where it bleeds. It is natural to avoid the sore areas, but that lets plaque build up and the bleeding continues.
2. Use a soft toothbrush and small, gentle circles, tilting the bristles towards the gumline. Brush twice a day for two minutes with fluoride toothpaste.
3. Help with brushing. Most children need an adult to brush or check their brushing until around age 7 or 8, and many older children still benefit from a quick check.
4. Start flossing once teeth touch each other. Floss picks are easier for small hands. Gums may bleed a little at first, which usually improves as they heal.
5. For braces, use an orthodontic or interdental brush to clean around brackets, and follow your orthodontist's advice.
6. Choose water between meals and keep sweets to mealtimes.

If you clean well and the bleeding gets better over one to two weeks, that is a good sign the cause was gingivitis. If it doesn't improve, book a dental check-up. Hardened plaque (tartar) may need a professional clean, and the dentist can check for other causes.

When bleeding needs a doctor

Rarely, bleeding gums are a sign of a medical problem, such as a blood or clotting disorder or another illness. Please see your paediatrician promptly if bleeding gums come with any of the following:

• Easy bruising, or bruises in unusual places without a clear injury
• Frequent or long nosebleeds
• Fever, tiredness, pale skin or looking generally unwell
• Very swollen, painful gums, or gum bleeding that starts on its own without brushing
• Bleeding that is hard to stop, for example after losing a baby tooth
• Tiny red or purple dots on the skin

Also let your doctor and dentist know if your child takes any regular medicines, as some can affect the gums or bleeding.

Preventing gum problems

• Brush twice daily and floss once daily, with adult help as needed
• Regular dental check-ups, usually every six months
• A balanced diet with plenty of fruit and vegetables
• Extra care with cleaning during braces and the teenage years