{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
{5000 - 24999} RedRed
{25000+} BlackBlack

Please confirm that you would like to report this for an admin to review.


So much blood

I have a patient who bleeds soo much but has excellent home care! We go over flossing and brushing and she insists she does it the way I do and I believe her. She does notice bleeding at home. She basically has no plaque and only a very slight amount of calculus on the lingual recession of her lower incisors (about 1mm).

She is 48 years old and takes claritin as needed. No anticoagulants and no herbal supplements. She has a family history of type II diabetes, gets her A1C checked (always good), and eats a healthy diet with almost no refined carbs.

She has some radiographic bone loss but her pockets are mostly 1-3mm with only a sprinkling of 4mms. Perio charting has been very stable for many years.

What could be going on here?



Confirm that you would like to Remove Email Alerts for your question. You cant undo this and you will not be able to re-subscribe.


3 Answers

I have a patient like this at my office. She has a bridge, crowns and restorative work. Her tissue appears healthy around virgin teeth but around her crowns/bridge and restorative work she has heavy bleeding and has inflamed, puffy gums. The doctor and I believe it is a form of contact dermatitis from the foreign material in her mouth. There are no other red flags for us on her health history, medications, or problems with homecare. We’ve tried prescription mouth rinses for her and nothing seems to help.

I’m interested to see if anyone else has answers for our patients.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


This doesn’t sound nice, but some patients swear up and down they are brushing and flossing the way you show them, but they simply aren’t. If they are, they aren’t doing it correctly or consistently. Bleeding is the first sign of infection, so this is the easiest cause of the bleeding. Have you suggested she try a different kind of interdental cleaner, such as an interdental brush?
 
Some patients also don’t disclose that they are taking over the counter herbal supplements because they don’t see them as “medicine” and don’t think it matters to disclose them. I mention this because bromelan, cayenne, camomile, dong quai, feverfew, garlic, ginger, and ginko have all been shown to have the potential to cause increased risk of bleeding. Even vitamin E, when combined with aspirin, can act as a blood thinner.
 
Like JjerlienRDH mentioned, if the bleeding is around restorative work, it could be a reaction to the materials, in which they should be replaced.
 
The only other cause I can think of is the patient has a bleeding disorder or has leukemia.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


I have found that patients that are in Peru menopause or menopause experience more bleeding due to hormonal fluctuations. Also, make sure you ask them if they take baby aspirin, omega 3, ginger, garlic, or ginseng which are all considered blood thinners. Hope this helps.

Confirm that you would like to select this answer as the "Best Answer" to your question. This will bring this answer to to top and be highlighted as "Best Answer". You can always change this if a better answer is given.


You must be Logged In to Answer this Question

Already a Member, Log In
Not a member yet? Sign Up