- Important clinical sign bleeding on probing - dentistry relevant

1. Bleeding on
probing
Guided by: Dr. Mayank Parmar
Dr. Bansari Shah
Dr.Mayur Parmar
Prepared by: Meera Dobariya

2. Content
 Introduction
 Gingival bleeding on probing
 Local factor
 Systemic factor
 In diagnosis
 bleeding point index
 Conclusion

3. Introduction
 The bleeding on probing is a widely used
clinical sign as indicator of the periodontal
condition & disease progression.

5. Gingival bleeding on probing
 The two earliest signs of gingival inflammation
preceding established gingivitis are
1. Increased gingival crevicular fluid production
rate.
2. Bleeding from gingival sulcus on gentle
probing.
 It has been shown that bleeding on probing
appears earlier than a change in color or
other visual signs of inflammation.
 Gingival bleeding on probing indicates an
inflammatory lesion both in the epithelium &
in the connective tissue.

7. Local factor associated with BOP
 Contributing factors to plaque retention may lead
to gingivitis & ultimately leads to gingival bleeding
on probing.
 Example: caries,malpositioned teeth, mouth
breathing, partial dentures, lack of attach
gingiva,orthodonic treatment & fixed orthodontic
treatment.
 CHRONIC & RECURRENT BLEEDING:
 Most common cause is inflammation.
 Bleeding is chronic or recurrent & is provoked by
mechanical trauma.
 e.g.: from tooth brushing, toothpicks or food impaction.
 it also occur by biting in to solid food such as apple.

8.  Histological evaluation revealed that in early stages of
gingivitis, cytokines are responsible for connective tissue
breakdown.
 Matrix metaloproteinases also play a role in tissue
breakdown.
 Histopathologic alteration that result in abnormal gingival
bleeding include dilatation & engorgement of the capillaries &
thinning or ulceration of the sulcular epithelium.
 After the vessels are damaged & ruptured interrelated
mechanism induce hemostasis.
 Vessel wall cntract,blood flow diminishes,blood platelets
adher to the edges of the tissue , & a fibrous cloat is
formed,which contracts & results in approximation of the
edges of the injured area.bleeding recurs when the area Is
irritated.
 In case of moderate or advanced periodontitis the presence
of bleeding on probing is a sign of active tissue destruction.

9.  Laceration of gingiva by toothbrush bristales
during aggressive toothbrushing or by sharp
pieces of hard food can cause gingival
bleeding even in the absence of gingival
disease.
 Gingival burn from hot foods or chemicals
increases the ease of gingival bleeding,.
 Spontaneous bleeding or bleeding on slight
provocation can occur in ANUG.

10. Acute necrotizing ulcerative gingivitis
Gingival burns

11. l SYSTEMIC FACTOR:
• Hemorrhagic disprdets in which abnormal gingival
bleeding is encounterd include:
1. Vitamin C deficiency(scurvy):interdental &
marginal gingiva is bright red with
swollen,smooth,shiny surface.in fully develope scurvy
gingiva becomes boggy,ulcerated & bleeds.
2. Platelet disorders(thrombocytopenic purpura):
abnormalreduction in number of circulating blood
platelets.so patient develops focal hamorrhage into
tissue & organs,including skin & mucous membrane.
3. Vitamin K deficiency:it is involved in prothrombin
synthesis. It also regulates the level of factorVII,IX &
X(proconvertin,Christmas factor & Stuart-Prower
factor, respectively.)So leads to gingival bleeding.

12. Oral manifestation of scurvy Oral manifestation of purpura

13. 4. Other coagulation defects:
 Hemophilia: characterized by prolonged coagulation time
& hemorrhagic tendencies. Gingival hemorrhage may
massive & prolonged.
 Leukemia: progressive overproduction of white blood
cells which usually appear in circulating blood in an
immature form. Oral manifestations are gingivitis, gingival
hyperplasia, hemorrhage & ulceration of the mucosa.
 Christmas disease: Also known as Hemophilia B,in which
deficient level of coagulant factor IX(Christmas factor).
5.The effect of hormonal replacement therapy, oral
contraceptives, pregnancy & the menstrual cycle
are also reported to affect the gingival bleeding.
6.Diabetes: marked inflammation affects both epithelium &
C.T., which leads to destruction of reticulin fibers.
7.Medication: Anticonvulsant, antihypertensive &
immunosuppressant are known to cause gingival
enlargement.

14. Drug induced gingival enlargement
Gingival inflammation in pregnancy
Hemophilia Leukemia

15. In diagnosis
 The insertion of probe to the bottom of the
pocket elicits bleeding if the gingiva is
inflamed & the pocket epithelium is atrophic
or ulcerated.
 To test for bleeding, the probe is carefully
introduced to the bottom of the pocket &
gently moved laterally along the pocket wall.
 Sometimes bleeding appears immediately
after removal of the probe; other times it
may be delayed for a few seconds.
 Therefore rechecking for bleeding 30 to 60
seconds after probing.

17. Bleeding point index
 It is used for evaluation of gingival inflammation.
 For record the index retract the cheek & place the
periodontal probe 1mm into the sulcus or pocket at the
distal aspect of the most posterior tooth in the quadrant on
the buccal surface.
 Carry the probe lightly across the length of the sulcus to the
mesial interproximal area on the facial aspect.
 Wait for the 30 sec. & record the presence of bleeding on
the distal, facial & mesial surface.
 Repeat the same for palatal/lingual surface.
 Percentage of the number of bleeding surfaces is calculated
by dividing the number of the surfaces that bled by the total
no. of tooth surface(4 per tooth) & by multiplying by 100.
 Goal of 10% or fewer bleeding points is good, but 0 is ideal.

18. conclusion
 Bleeding on probing is indicates the
progression of attachment loss.
 If periodontal treatment is successful,
bleeding on probing will cease.