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Hi, I have had bleeding gums for two months. I thought that the toothbrush was to blame, so I bought a new one. This did not help me with my gums so I went to see my dentist. He told me that I have gingivitis and that I have to change my dental hygiene habits. I was prescribed chlorhexidine to rinse my mouth. Can you tell me how chlorhexidine works?


Hello, gingivitis is an infection of the gums around the teeth. It can lead to teeth loss if not treated. The only thing you can do to stop the infection from spreading is to keep your teeth clean. That is why your dentist prescribed you chlorhexidine. It is an antiseptic and disinfectant agent. This means that it can kill bacteria and other micro-organisms that cause mouth and throat infections. Chlorhexidine is mostly used in the form of a mouthwash, but it can be found in a form of a gel or a spray. However, the use of chlorhexidine does not mean that you can stop brushing and flossing your teeth. In fact, in order to stop the infection you will have to brush and floss more frequently than usual. Because you have constant teeth problems you should talk to your dentist about everyday usage of chlorhexidine mouthwash as a preventive against mouth infections.


yup, gingivitis is caused by the byproducts of the bacteria in "plaque".

Spending adequate time toothbrushing/flossing to remove the plaque will allow your gums to heal over time.

I'd suggest brushing twice a day with flouridated toothpaste, and flossing a few times a week. Mouth rinses also can help (esp. chlorhexidine)

Gums take time to heal and generally after taking the plunge into taking care of your oral health, it'll be about 2-3 weeks before they heal up!


Bleeding gums can be primarily caused by two factors:

1. Poor brushing technique and in between cleaning -- Using too much pressure and incorrect technique can be damaging your gingiva (gums) and more seriously, it can be irreversibly damaging your tooth enamel and gingiva. Over long duration of bad brushing habits, tooth structure can be slowly removed resulting in tooth abrasion in the long term (appears as notches in the teeth), and gingival recession causing receded gums and exposed roots. Correct technique begins with using a soft-bristled brush in a technique taught to angle the bristles diagonally into the gum pocket (area where tooth and gums meet). Once in the proper location, small back-and-forth vibration movements should be made across the entire mouth taking 2-3min in total. Avoid "scrub-brushing" and avoid excessive pressure, especially near the corners of the mouth where the canine teeth are located. If current habit is brushing once a day in the morning, begin with a goal of brushing before bed instead of the mornings, and using a mouthrinse in the mornings.
Cleaning in between one's teeth is also important, avoiding this and merely brushing is similar to cleaning only half the teeth! It is in between where plaque likes to hide and become mature after several days. This is also a place where beginning cavities can occur easily without visibility unless x-rays (radiographs) are taken for diagnostic purposes. Correct technique includes use of dental floss, with or without floss aids such as holders or picks, use of a water-pik, toothpicks, proxy brush, etc. When using dental floss, be sure to see-saw in between the teeth and once in, to wrap the floss in both directions on the adjacent teeth, making a "C" shape with the floss. Also take care to floss between the farthest posterior (back) teeth even though no tooth is adjacent. Avoid injuring gums by using the see-saw technique when teeth are tight together.
Use of a mouthrinse is an excellent aid in keeping the oral cavity healthy . Use of Listerine is often recommended and shown to reduce gingivitis and plaque by 25% in random trials. Although it contains alcohol, dry-mouth (xerostomia) patients should be advised that alcohol stimulates salivary flow and contrary to the myth- does not contribute to drying of the mouth. Although Listerine is a less-than-optimal alternative to flossing and interdental cleaning, it is recommended for those who rarely floss as a beginning goal. Remember, something is better than nothing!
Chlorhexidine, CHX, is often prescribed in rinse form (.12% chx) for patients exhibiting periodontal disease and cavity risk. The chlorhexidine is used temporarily to reduce the bacteria levels in the mouth and thus reduce disease. CHX works better than Listerine because it has substantivity to stay in the mouth working longer. It binds to molecules and hard/soft tissue surfaces to have a longer duration. Chemically, it binds to bacteria and prevents the transfer of ions and minerals across the bacteria membrane, effectively starving the bacteria by disrupting its membrane transport. CHX has been shown to reduce Gingivitis and plaque by near 50%. Temporary use is recommended to prevent the formation of resistant strains of bacteria, and due to side effects such as taste, tooth staining (removable), and increased tarter formation.

2. Another cause of bleeding is gingivitis, often as a result of insufficient self-care whether due to negligence or inability. Gingivitis is a result of a bacterial infection of the gums. Just as cavities are formed, gingivitis is formed by bacteria. These microorganisms begin in plaque, and proceed to invade the gum tissues near the tooth when the plaque is not routinely removed. Bacterial continue to thrive and change composition to more pathogenic (disease causing) bacteria the longer they are allowed to stay. The byproduct of bacteria is a type of acid which lacerates the gum tissue. Once this happens, bacteria spreads deeper into gums causing an infection. The body host response is to send blood to the area containing many white blood cells, immunoglobins, mast cells, and lymphocytes. This body reaction is why we see inflammation, redness, and swelling of gums. Thankfully, this is all reversible using the above mentioned self-care techniques. However, if left untreated, gingivitis, a form of periodontal disease may easily progress to periodontitis which is NOT reversible.
Periodontitis involves destruction of the attachment apparatus which holds the teeth in place. Basically, the destruction of bone, which will not come back without expensive and intrusive surgery. Periodontitis is the leading cause of tooth loss making losing teeth due to periodontal disease a very real concern. It is caused initially by the same bacteria causing gingivitis. As the gingivitis progresses to destroy gum tissue near the tooth, the underlying bone will begin to recede. The body's response to combat this infection triggers bone destroying osteoblasts to activate. This is why periodontitis is considered to be more dependent on the individual's body than the actual bacteria, once the infection has begun. These areas where the bacteria has destroyed gum and bone is often referred to as periodontal pockets. The pocket being the space between the tooth and the gums which is what the dental hygienist or dentist will measure with a special miniature measuring device called a probe. this device measures in millimeters. Pockets directly related to periodontal disease measuring over 4 milimeters of depth is commonly indicative of early disease. The probe is also used to measure the amount of bone loss that has occured. Any amount bone loss is considered disease (milimeters speak miles in dentistry).
Remember, this all began due to a bacterial infection, generally plaque in origin which may have been preventable with proper-self care. Because periodontitis (bone loss) is irreversible, the hygienist and dentist will work with you to control the disease and maintain oral health to prevent further progression of the disease. This is termed Periodontal Maintenance. At appointments, the dental professional will use a number of fine area specific instruments to reduce the level of disease and irritants around roots and tooth anatomy to promote healing and prevent further destruction. However, the success of any treatment is depending on the patients ability to take proper self-care measures at home, to control his or her own disease and will to maintain their oral health. The dr. or hygienist will talk with you about a number of different aids to assist you with proper patient orientated realistic goals for good oral health.
If the level of disease is beyond maintainable levels, referal to a periodontist (a periodontal disease specialist) and surgery may be recommended to prevent the loss of teeth (keeping true real teeth is always preferred over prosthetic replacement).
3. A last possibility of bleeding gums is systemic conditions, such as pemphigoid which is an autoimmune disorder.

Regular visits with your dentist and hygienist are imperative to maintaining good oral health and the prevention of disease. The link between oral health and overall health is becoming increasingly evident with the results of newer research, further increasing the importance of oral health. They will help with oral cancer screening, cavity detection and prevention, self-care techniques, and motivation to keep you and your teeth healthy for a lifetime!

Robert Sibell
Dental Hygienist, B.S. RF
University of Minnesota