To begin with, you should keep in mind that healthy gums do not bleed. So, if during orthodontic treatment the gums become swollen and bleed, there is a problem. Before cementing the brackets, it is important to check the teeth and gums to remove calculus or tartar and start orthodontics with a healthy mouth and free of bacterial plaque.
Many times only prophylaxis is necessary, and other times periodontal treatment by scaling and root planing is necessary before orthodontics.
But what causes bleeding gums if you wear braces?
If you are already wearing braces and your gums are still bleeding and swollen, we explain the reasons why this may happen:
1. There is tartar and bacteria between your teeth.
Bacterial plaque causes gum inflammation and bleeding gums. A mouth cleaning or periodontal treatment should be sufficient.
2. You are not cleaning your teeth properly.
The brackets and archwire make it easier for food debris to be retained between the orthodontic attachments and the teeth. If you do not clean well with an electric or manual toothbrush, dental tape with threaders or interdental brushes, these bacteria will cause inflammation and bleeding.
3. Gingival hyperplasia and enlargement secondary to orthodontics.
Some gums react to braces by increasing in size, growing and thickening. This is a common problem in adolescent patients and may be due to ill-fitting appliances. Occasionally, fixed appliances in orthodontic treatment have a negative impact on periodontal health and, in these cases, the treatment of choice for gingival hyperplasia is gingivectomy.
4. Hormonal changes.
The hormonal changes that occur during adolescence (the stage in which many patients receive orthodontics) facilitate gingival inflammation, since there are periodontal bacteria in the gum that proliferate with certain hormones.
What should you do if bleeding gums do not stop?
The orthodontist must first evaluate the causes of the bleeding, whether it is due to poor hygiene or the presence of calculus and tartar around the teeth. In principle, extreme oral hygiene with interdental floss and a good brushing technique should be sufficient to eliminate bleeding. We recommend prophylaxis or mouth cleaning every 3–4 months while wearing orthodontic appliances to avoid the recurrence of gingivitis.
Should orthodontic treatment be stopped?
Sometimes orthodontics must be stopped. We can find cases in which gingival inflammation and the presence of bacteria in the mouth is so high that a specific periodontal treatment has to be performed to prevent bone loss and gum recession around the teeth.
On the other hand, as we have mentioned, there are cases, especially in adolescents, in which the gum grows around the bracket and prevents the correct placement of the archwire and rubber bands. In these cases, the appliance must be removed, the appropriate treatment must be performed (often a gingivectomy or coronary lengthening), and then orthodontics must be continued.