Definition and Correlation
- Bleeding on probing is the ulceration of sulcular epithelium.
- The blood comes from lamina propria after the ulceration of the lining.
- Bleeding on probing is correlated with Periodontal Inflamed Surface Area (PISA).
- X-rays for teeth and jaw bones can help determine periodontal health.
- The presence of bleeding on probing may not indicate periodontal disease, but the absence of bleeding is a strong predictor of continued periodontal health.

Diagnosis and Evaluation
- Dentists or dental hygienists use a periodontal probe or dental floss to assess sulcular depths and observe bleeding on probing.
- The Gingival bleeding index is used to measure gingivitis.
- The number of bleeding sites is used to calculate the gingival bleeding score.
- Bleeding on probing is a poor positive predictor of periodontal disease.
- Lack of bleeding is a very strong negative predictor of periodontal disease.

Treatment
- Corresponding treatments for diagnosed diseases should be prioritised.
- Regular visits to the dentist or hygienist for plaque removal are recommended every three months.
- Use a soft-bristle toothbrush for brushing teeth.
- Flossing twice a day can prevent plaque buildup.
- Avoid tobacco, as it can aggravate bleeding gums.
- Follow a balanced healthy diet.
- Consider using over-the-counter toothpaste with triclosan as part of a physiotherapy program.
- If inflammation and bleeding persist, a prescription of antiplaque rinse may be useful.

References
- CARRANZAS CLINICAL PERIODONTOLOGY, 9th edition, 2002. page 447
- Pietropaoli et al. (2020) Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing. Journal of Clinical Periodontology, 47(2), 160-172.
- MedlinePlus: Bleeding gums
- Charles R. Craig, Robert E. Stitzel (2004) In Modern Pharmacology with clinical applications (Edition 6), Lippincott Williams & Wilkins, p. 506.
- Pietropaoli et al. (2020) Active gingival inflammation is linked to hypertension. Journal of Hypertension, 38(10), 2018-2027.

Additional Resources
- Howstuffworks: Bleeding gums
- Hayes, E. B., Gubler, D. J. (1992) Pediatr. Infect. Dis. J., 11, 311-317.
- Gingival Bleeding Index of Carter and Barnes
- Miller, P. D., Miller, W. D., Misch, C. E., Riggs, J. M., Seibert, J., Slots, J., Stillman, P. R., Tarnow, D. P. (Authors of CARRANZAS CLINICAL PERIODONTOLOGY)
- Mermaid Clinic: Gum disease and periodontal disease.