Straight periodontal probe at left, and Naber's probe on the right.

Bleeding on probing which is also known as bleeding gums or gingival bleeding is a term used by dentists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the gingiva and a tooth. Bleeding on probing, often abbreviated BOP, is a sign of inflammation and indicates some sort of destruction and erosion to the lining of the sulcus^[1] or the ulceration of sulcular epithelium.^[2] The blood comes from lamina propria after the ulceration of the lining.^[2]

[edit] Causes

There are many possible causes of gingival bleeding. The main cause of gingival bleeding is the formation and accumulation of plaques at the gum line due to improper brushing and flossing of teeth. The harden form of plaques is called tartar. An advanced form of gingivitis as a result of formation of plaques is periodontitis. Other causes that can exaceberate gingival bleeding includes:^[3]

• placement of new dentures
  
• tooth or gum infection
  
• diabetes mellitus^[4]
  
• idiopathic thrombocytopenic purpura
  
• leukemia
  
• malnutrition
  
• use of aspirin and anticoagulants(blood thinners) such as warfarin and heparin^[5]
  
• hormonal imbalances during puberty and pregnancy

Other less common causes are:

• vitamin C (scurvy) and vitamin K deficeincy
  
• dengue fever^[6]

[edit] Diagnosis

An examination by the dentist should be sufficient to rule out the issues such as malnutrition and puberty. Additional corresponding diagnosis tests to certain potential disease may be required. This includes oral glucose tolerance test for diabetes mellitus, blood studies, human gonadotrophin levels for pregnancy,^[4] and X-rays for teeth and jaw bones.^[3]

In order to determine the periodontal health of a patient, the dentist records the sulcular depths of the gingiva and observes any bleeding on probing. This is often accomplished with the use of a periodontal probe. Alternatively, dental floss may also be used to assess the Gingival bleeding index. It is used as an initial evaluation on patient's periodontal health especially to measure gingivitis. The number of bleeding sites is used to calculate the gingival bleeding score.^[7]

Peer-reviewed dental literature thoroughly establishes that bleeding on probing is a poor positive predictor of periodontal disease, but conversely lack of bleeding is a very strong negative predictor. The clinical interpretation of this research is that while BOP presence may not indicate periodontal disease, continued absence of BOP is a strong predictor (approximately 98%) of continued periodontal health ^[8].

[edit] Treatment

Corresponding treatments for diagnosed diseases should be taken as first priority. Dentist should be visited once every three months for plaque removal. Short-bristle toothbrush is recommanded for brushing your teeth. Flossing twice a day can prevent the building up of plaques. Tobacco should be avoided where tobacco can aggravates the bleeding gums. A balanced healthy diet should also be taken into account.^[3] Physiotherapy programme using over-the-counter toothpaste with triclosan should be used with home care. If there is persistent continuation of inflmmation and bleeding, a prescription of antiplaque rinse would be useful.^[4]

[edit] References

1. ^ Fermin A. Carranza. CARRANZA'S CLINICAL PERIODONTOLOGY, 9th edition, 2002. page 447
2. ^ ^{a b} Gingival bleeding URL assessed on November 21 2009
3. ^ ^{a b c} MedlinePlus: Bleeding gums URL assessed on November 21 2009
4. ^ ^{a b c} Charles R. Craig, Robert E. Stitzel (2004) In Modern Pharmacology with clinical applications (Edition 6). Lippincott Williams & Wilkins. p. 506. ISBN 0-7817-3762-1. Google Book Search. Retrieved on November 21, 2009.
5. ^ Howstuffworks Bleeding gums URL assessed on November 21 2009
6. ^ Hayes, E. B.; Gubler, D. J. Pediatr. Infect. Dis. J., 1992, 11, 311- 317.
7. ^ Gingival Bleeding Index of Carter and Barnes URL assessed on November 21 2009
8. ^ Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990 Nov;17(10):714-21.

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