More vitamin C may ease bleeding gums

Bleeding gums may suggest you need to add more vitamin C, found in kale, oranges, kiwi, and peppers, into your diet, says Philippe Hujoel. (Credit: Getty Images)

Bleeding gums may be a sign you need more vitamin C, according to a new study.

Current advice from the American Dental Association tells you that if your gums bleed, make sure you are brushing and flossing twice a day because it could be a sign of gingivitis, an early stage of periodontal disease. And that might be true. So if you are concerned, see your dentist.

Your vitamin intake could be another issue to check, however, the researchers report.

“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,” says lead author Philippe Hujoel, professor of oral health sciences in the University of Washington School of Dentistry and a practicing dentist.

The study, which appears in Nutrition Review, analyzed published studies of 15 clinical trials in six countries, involving 1,140 predominantly healthy participants, and data from 8,210 US residents 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, called gingival bleeding tendency, and also bleeding in the eye, called retinal hemorrhaging, were associated with low vitamin C levels in the bloodstream.

Researchers found that increasing daily intake of vitamin C in people with low  plasma levels of the vitamin helped reverse these bleeding issues.

Of potential relevance, says Hujoel, who is also an adjunct professor of epidemiology in the School of Public Health, 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.

The study does not imply that successfully reversing an increased gingival bleeding tendency with vitamin C will prevent strokes or other serious health outcomes, Hujoel stresses.

However, the results do suggest that recommendations designed primarily to protect against scurvy—a deadly disease caused by extremely low vitamin C levels—are too low, and that such a low vitamin C intake can lead to a bleeding tendency, which should not be treated with dental floss.

Consequently, Hujoel does recommend people attempt to keep an eye on their vitamin C intake and incorporate non-processed foods such as kale, peppers, or kiwis into their diet. If foods rich in vitamin C aren’t palatable, vitamin C supplements of about 100 to 200 milligrams a day will do.

If someone is on a specialized diet, such as a paleo diet, it’s important that they take a look at their vitamin C intake, Hujoel says. “Vitamin C-rich fruits such as kiwis or oranges are rich in sugar and thus typically eliminated from a low-carb diet.”

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.

Researchers recognized the association between gum bleeding and vitamin C levels more than 30 years ago. In fact, two studies cowritten by Paul Robertson, former dean of the School of Dentistry, identified gum bleeding as a biological marker for vitamin C levels.

However, this connection somehow got lost in dental conversations around bleeding gums.

“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 says.

Hujoel’s review also determined that “retinal hemorrhaging and cerebral strokes are associated with increased gingival bleeding tendency, and that (vitamin C) supplementation reverses the retinal bleeding associated with low (vitamin C) plasma levels.”

So, missing the possible connection between gum bleeding and low levels of vitamin C has the potential to have serious health consequences.

“A default prescription of oral hygiene and other periodontal interventions to ‘treat’ microvascular pathologies, even if partially effective in reversing gingival bleeding as suggested in this meta-analysis, is risky because it does not address any potential morbidity and mortality associated with the systemic microvascular-related pathologies,” the authors write.

Additional coauthors are the Mayo Clinic, the Harvard TH Chan School of Public Health, and the University of Washington School of Dentistry.

Source: University of Washington