Bleeding gums may be a sign of a lack of vitamin C, according to a multi-institute team of researchers.
“When you see your gums bleed, the first thing you should think about is not ‘I should brush more.’ You should try to figure out why your gums are bleeding. And vitamin C deficiency is one possible reason,” said Philippe Hujoel, PhD, DDS, MSD, MS, professor of oral health sciences at the University of Washington (UW) School of Dentistry.
The researchers analyzed published studies of 15 clinical trials in six countries, involving 1,140 predominantly healthy participants, and data from 8,210 residents of the United States surveyed in the Centers for Disease Control and Prevention’s Health and Nutrition Examination Survey.
The results showed that bleeding of the gums on gentle probing, or gingival bleeding tendency, and also bleeding in the eye, or retinal hemorrhaging, were associated with low vitamin C levels in the bloodstream. Also, increasing the daily intake of vitamin C in those people with low vitamin C plasma levels helped to reverse these bleeding issues.
Of potential relevance, both a gum bleeding tendency and retinal bleeding could be a sign of general trouble in one’s microvascular system, of a microvascular bleeding tendency in the brain, heart, and kidneys, said Hujoel, who also is an adjunct professor of epidemiology at the UW School of Public Health.
The study does not imply that successful reversing of an increased gingival bleeding tendency with vitamin C will prevent strokes or other serious health outcomes, Hujoel said.
However, they do suggest that vitamin C recommendations designed primarily to protect against scurvy are too low and that such a low vitamin C intake can lead to a bleeding tendency that should not be treated with dental floss, he said.
Consequently, Hujoel recommends that people monitor their vitamin C intake through incorporation of non-processed foods such as kale, peppers, and kiwis into their diets. And if people cannot find palatable foods rich in vitamin C, they should consider a supplement of about 100 to 200 milligrams a day, he said.
Also, it’s important for people on specialized diets such as the paleo diets to take a look at their vitamin C intake, Hujoel said.
“Vitamin C-rich fruits such as kiwis or oranges are rich in sugar and thus typically eliminated from a low-carb diet,” he said.
This avoidance may lead to a vitamin C intake that is too low and is associated with an increased bleeding tendency. People who exclusively eat lean meats and avoid offal, the vitamin-rich organ meats, may be at a particularly high risk for a low vitamin C intake.
The recognition between gum bleeding and vitamin C levels was recognized more than 30 years ago. Studies in 1986 and 1991 coauthored by Paul Robertson, DDS, MS, former dean of the UW School of Dentistry, identified gum bleeding as a biological marker for vitamin C levels. Yet this connection got lost in dental conversations around bleeding gums, the researchers said.
“There was a time in the past when gingival bleeding was more generally considered to be a potential marker for a lack of vitamin C. But over time, that’s been drowned out or marginalized by this over-attention to treating the symptom of bleeding with brushing or flossing, rather than treating the cause,” Hujoel said.
The researchers also associated retinal hemorrhaging and cerebral strokes with increased gingival bleeding tendency and that vitamin C supplementation reverses the retinal bleeding that is associated with low vitamin C plasma levels. Missing the possible connection between gum bleeding and low vitamin C levels could have serious health consequences, they added.
Even if they’re partially effective in reversing gingival bleeding, the researchers said, a default prescription of oral hygiene and other periodontal interventions to address microvascular pathologies is risky because it doesn’t address any potential morbidity and mortality associated with the systemic microvascular-related pathologies, the researchers said.
The study, “Bleeding Tendency and Ascorbic Acid Requirements: Systematic Review and Meta-Analysis of Clinical Trials,” was published by Nutrition Reviews.
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