Gingival Bleeding on Probing

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.

Causes of Gingival Bleeding on Probing

Gingival Bleeding on Probing Local Factors

Gingival Bleeding On Probing.

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.

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.

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.