Are bleeding gums just “too much internal heat”, or a warning sign of periodontal disease?｜證據鏈

If you repeatedly see blood when brushing, the most common first question is whether plaque has inflamed the gingiva, rather than settling the matter with the Chinese folk concept of “too much internal heat”. Changes in plaque-induced gingivitis occur mainly in the gingiva; periodontitis, by contrast, already involves attachment loss in the tissues supporting the teeth and often needs to be interpreted together with changes in the alveolar bone. Both conditions can bleed, and the amount of blood on the toothbrush alone cannot tell you at which tissue level the inflammation has stopped. The true distinction depends on a set of data: plaque and the appearance of the gingiva, the distribution of bleeding on probing, pocket depth, clinical attachment level and imaging when needed. A systematic review of clinical diagnostic methods included 26 studies from 5,417 titles and found no clear superiority of pressure-sensitive or electronic probes over conventional manual probes; manual periodontal probing remains the clinical standard for diagnosing periodontitis and following it during maintenance. Persistent bleeding therefore warrants a periodontal examination, but it neither means that you already have severe periodontitis nor justifies ending the investigation after mouthwash temporarily suppresses the visible blood.