Bleeding gums: A symptom—not a diagnosis

Bleeding gums don’t always mean gingivitis. This eye-opening case reveals how mouth breathing, nitric oxide disruption, and tissue stress—not bacteria—can drive gingival bleeding, highlighting why testing before treating is essential to truly preventive, biologic dental hygiene.
Feb. 2, 2026
2 min read

Bleeding gums are one of the most common findings in dentistry, and they are almost automatically labeled as gingivitis. From there, the clinical path is predictable: more “gum therapy,” more frequent cleanings, sometimes antimicrobial rinses, and a re-evaluation in a few months. It feels logical. It feels responsible. But what if the bleeding has nothing to do with infection at all?

This patient forced me to slow down and listen to what his mouth was actually telling us.

When I first examined him, there was clear bleeding on probing, as well as during air polishing and scaling. If I had stopped there, the diagnosis would have been simple. But before assigning a label, I looked under the phase-contrast microscope. What I saw immediately challenged the assumption that bleeding equals disease. His plaque sample was clean. There were no spirochetes, no red-complex pathogens, no motile rods, and no signs of active periodontal infection. In fact, his microbial profile looked remarkably stable.

Continue reading in my blog Bleeding gums are a symptom—not a diagnosis

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Barbara Tritz, MSB, BSDATE, BRDH, is a biological dental hygienist and orofacial myofunctional therapist whose blog, Queen of Dental Hygiene, provides patients the information they need to help them on their healing journey. “Our one-hour appointment time was just not long enough to share all the many important facts I wanted our patients to learn. Dental hygiene is about so much more than just teaching brushing and flossing," says Barbara. “We are healers, educators, and lifesavers, and we need to give our patients the tools and skills to empower them to true wellness and health.”

About the Author

Barbara Tritz, MSB, BSDATE, BRDH

Barbara Tritz, MSB, BSDATE, BRDH

Barbara is a practicing biological dental hygienist at Green City Dental in Edmonds, Washington. She is the owner of Washington Oral Wellness in Kirkland, Washington, where she practices orofacial myofunctional therapy. She completed her accreditation in biological dental hygiene through the International Academy of Oral Medicine and Toxicology, and is laser certified through the Academy of Laser Dentistry. In 2019 Barbara received the HuFriedy-American Dental Hygienist Association Master Clinician Award. Barbara can be contacted at [email protected].

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