Visible Bleeding upon Brushing and Clinical Gingivitis Severity

Objectives: This pilot study was conducted to evaluate relationships between visible bleeding upon brushing (subject and hygienist) and clinical gingivitis severity. 

Methods: Informed consent was obtained from generally healthy adults with gingival bleeding (10+ sites).  Enrolled subjects brushed thoroughly under supervision using a regular anticavity dentifrice and soft manual brush.  Before rinsing, subjects expectorated into a white cup, and the presence/absence of visible bleeding in expectorate was assessed separately by the subject and a hygienist.  After self and hygienist bleeding assessment, an experienced clinical examiner measured whole mouth gingivitis using a standard index (Loe-Silness GI), bleeding sites were derived from GI site scores of 2+, and logistic regression modeling was used to predict the likelihood of bleeding perception by clinical bleeding severity. 

Results: 35 subjects (mean age of 37 years, 46% female) participated in the survey, of which, 34% identified visible bleeding in expectorate.  There was 100% in agreement between self and hygienist scoring of evident bleeding.  The population exhibited considerable variation in clinical bleeding, ranging from 13-80 sites, and on average, bleeding was detected at 24.3% of sites (SD=8.7).  Subjects reporting visible bleeding had a higher proportion of bleeding sites (29.5% vs. 21.6%), differing significantly (p=0.009) from those who did not report bleeding.  In the regression model, every 10% increase in proportion of clinical bleeding sites significantly (p=0.02) increased the odds ratio of visible bleeding by 3.52. 

Conclusions: Individuals with visible bleeding after a single brushing had a significant 37% increase in the proportion of bleeding sites measured on clinical examination compared those without evident bleeding.