Gingiva Bleeding on Probing
Bleeding on probing is also known as gingival bleeding on probing.
- Bleeding on probing indicates an inflammatory lesion in both epithelium and the connective tissue that exhibits specific histologic differences compared with healthy gingiva.
- The two earliest signs of gingival inflammation preceding established gingivitis are increased gingival crevicular fluid production rate and bleeding from the gingival sulcus on gentle probing.
- Bleeding on probing is an important diagnostic factor for the clinicians to use in planning periodontal therapy.
- This is associated with inflammation and the ulceration of epithelial lining of gingival sulcus.
- Presence of plaque for two days can initiate the bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.
- Presence of bleeding is an indication of active gingival inflammation, and until it is controlled, the patient is at a risk of continuing periodontal disease and tissue destruction.
- Bleeding on probing indicates an inflammatory lesion in the epithelium and the connective tissue that exhibits specific histologic differences compared with healthy gingiva. Although bleeding on probing may not be a good diagnostic indicator of clinical attachment loss, its absence is an excellent negative predictor of future attachment loss.
Read And Learn More: Periodontics Question And Answers
Causes of Gingival Bleeding on Probing
Gingival Bleeding on Probing Local Factors
Gingival Bleeding on Probing Chronic and Recurrent Bleeding
- Most common cause of abnormal gingival bleeding on probing is chronic inflammation.
- Chronic or recurrent bleeding is provoked by:
- Mechanical trauma
- Biting into solid foods such as apples
- Gingival bleeding consists of dilation and engorgement of capillaries and thinning or ulceration of sulcular epithelium.
- As degenerated epithelium is less protective, stimuli that are normally innocuous cause rupture of the capillaries and gingival bleeding.
- Sites which bleed on probing have a greater area of inflamed connective tissue, e.g. cell-rich, collagen-poor tissue than sites that do not bleed.
- In most of the cases, cellular infiltrate of sites which bleed on probing is predominantly lymphocytic which is characteristic of early gingivitis.
- Severity of the bleeding and the ease of its provocation depend on the intensity of the inflammation.
- After the vessels are damaged and ruptured, interrelated mechanisms induce hemostasis. Vessel walls contract, and blood flow is diminished; blood platelets adhere to the edges of the tissue and a fibrous clot is formed, which contracts and results in approximation of the edges of the injured area. Bleeding recurs when the area is irritated.
- In moderate or advanced periodontitis, presence of bleeding on probing is considered a sign of active tissue destruction.
Acute Gingival Bleeding
- The acute episodes of gingival bleeding are caused due to an injury and can occur spontaneously in a gingival disease.
- Laceration of gingiva by toothbrush bristles during aggressive toothbrushing or by sharp pieces of hard food can lead to gingival bleeding even in the absence of a gingival disease.
- Spontaneous bleeding or bleeding on slight provocation can occur in acute neorotizing ulcerative gingivitis.
Gingival Bleeding Associated with Systemic Changes
- Occurrence of spontaneous gingival irritation, or after irritation is excessive and is difficult to control in patients with systemic changes.
- Hemorrhagic disorders in which abnormal gingival bleeding is encountered are as follows:
- Vascular abnormalities (vitamin C deficiency or allergy, e.g. Schonlein-Henoch purpura)
- Platelet disorders (thrombocytopenic purpura)
- Hypoprothrombinemia (vitamin K deficiency)
- Other coagulation defects (hemophilia, leukemia and Christmas disease), deficient platelet thromboplastic factor (PF3) resulting from uremia, multiple myeloma and post rubella purpura.
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