Dear Doctor,

My fiancee normally experiences gum bleeding after brushing her teeth. And she also gets nose bleeding quite often. What causes these conditions and aren’t they risky for me in case she has any infection that can be transmitted through blood contact like AIDS?

Pierre Mugabo, Kigali

Dear Pierre Mugabmo

The most common cause for bleeding gums is chronic inflammation of the gums (gingivitis) and the underlying root and bones. This can occur due to poor hygiene. If teeth are not brushed regularly, plaques of food particles  form at the base of teeth, on and around gums. These are attacked by bacteria, causing infection and inflammation. The risk is more with sugar containing foods like candies and chocolates. Hormonal changes during pregnancy increase susceptibility to gingivitis and bleeding gums. Using hard tooth brush, tends to hurt the gums leading to gingival  bleeding. Ill fitting  dental appliances like dentures,  improper flossing are other reasons for bleeding gums.

Vitamin C deficiency, blood cancers like leukemia, bone marrow disorders, are other  conditions which lead to bleeding from gums. Drugs which stop clotting like aspirin, warfarin can lead to bleeding from any site in the body, including gums. These medical conditions can also cause bleeding from nose. Apart from these conditions, uncontrolled high blood pressure also causes nasal bleed.

The most common reason for nose bleed, in a young adult is dryness of nasal mucosa. The protective inner lining of nasal mucosa is a very delicate structure. In dry cold climate or exposure to wind/dust, it becomes dry and itchy. Recurrent cold as happens in allergic rhinitis also causes dryness of nasal mucosa. Excess dryness results in bleeding from the delicate small blood vessels of this site. Due to itching, people tend to scratch the nose inside, thus aggravating the situation.  Bleeding from the nose can also be due to nasal polyps.

None of these conditions are infective or contagious. Rarely can HIV/AIDS cause deficiency of platelets, manifesting as bleeding from any site, including gums or nose. But in  such  cases, there would be other  symptoms of HIV/AIDS.