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Nearly everyone has the experience of hematemesis or blood in the saliva at one time or another. When you notice blood in the saliva is a very good indication of where it is coming from.

By far the most common cause of this symptom is gingivitis, or gum irritation, usually following some failure of dental hygiene.  If gum irritation is the cause, you are only likely to see blood in your saliva right after you brush your teeth. Bleeding without brushing is a signal it is time to see the dentist right away. Acute necrotizing ulcerative gingivitis, also known as ANUG or trench mouth, is a condition requiring urgent treatment. It causes severe halitosis, and it comes on suddenly, usually after some kind of traumatic event. It occurs in soldiers in combat, and in disaster victims.

Sometimes blood in saliva is primarily a symptom of lifestyle excess. Strongly flavored chewing tobacco can result in bleeding gums or a bleeding mouth. They are a sign it's time to change your chew. 

Bleeding gums or a bleeding mouth occur after consuming large amounts of extremely acidic foods, like vinegar, or extremely alkaline foods, like lutefisk, fish soaked in lye. Even healthy intentions can result in a bleeding mouth, as in the case of flossing too much or brushing too vigorously. Remember, you floss your teeth, not your gums, and you don't need to brush your gums to keep them clean.

Recurring or persistent mouth sores or ulcers known as recurrent aphthous stomatitis can also be a source of fresh, red blood in spittle. These sores are often said to be idiopathic, that is, they have no known cause, although sometimes they are associated with gluten sensitivity or they may be a complication of autoimmune conditions such as Behçet syndrome, systemic lupus erythematosus, or inflammatory bowel disease.

Spitting up blood after belching or vomiting is a strong sign of bleeding in the gastrointestinal tract. Red, fresh blood is a sign that the bleeding is occurring above the lower esophageal sphincter. Severe vomiting can lead to tears in the lining of the esophagus that cause bleeding. Brown, clotted blood could be coming from the stomach or as far down as the small intestine.

Spitting blood when you have postnasal drip or sinusitis is an indication of epistaxis, or bleeding from the nose. Blood in the saliva after a cough is a sign of bleeding in the throat, bronchial passages, or lungs. 

Collecting fresh blood in the mouth after a cough can be a sign of rupture of esophageal varices, which are enlarged veins in the throat, most common in people who have severe liver disease.

Two life threatening conditions can cause bleeding from the mouth. One is myocardial infarction, or heart attack. In a massive heart attack, the ventricles lose their ability to pump blood from the lungs back to the heart to be distributed to the rest of the body. Blood builds up in the lungs and breaks through the linings of the alveoli. The blood mixes with water and saliva to form a frothy spittle. This is a sign of an extreme need for medical attention. It will not be the only symptom of the heart attack.

Another condition that can cause bleeding from the mouth is pulmonary embolism, or blood clots in the lungs. This is a medical emergency. In addition to bleeding from the mouth, there is a very fast breathing rate along with a progressive inability to breathe, often along with chest pain, flank pain, profuse sweating, fever, and a racing heart. With anti-clotting medication, pulmonary embolism is survivable, but never without medical treatment.

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