Gingivitis in children: when brushing is enough and when to seek care

Key points in brief

• For gingivitis in children, more thorough brushing alone is enough at first if gums bleed only when brushed and the child feels well. Improvement often comes within 1–3 weeks.
• The most common cause is plaque, a soft layer of bacteria along the gum line. A hard deposit the toothbrush does not remove needs a visit to the dentist.
• Brush at the gums morning and evening for 2 weeks, bleeding spots included, re-brushing an older child's teeth at night. If bleeding does not ease or returns, see a dentist.
• Call the paediatrician the same day if the gums bleed without brushing, the child has bruises, is pale or has a fever, and also when there are mouth ulcers.
• A swollen gum by one tooth needs a dentist within 24 hours, or the same day with a swollen cheek or fever. A teenager's loose tooth needs a gum specialist.

What gingivitis in children looks like and why the gums bleed

Red, slightly swollen gums that bleed when a child's teeth are brushed are most often gingivitis, an inflammation of the gums caused by plaque. Plaque builds up again every day, so the gum reacts to a few days of less careful brushing, but it also benefits quickly when brushing improves. Roughly half of children and teenagers have gingivitis.

In a preschool child, the inflammation usually shows as a narrow red line along the edge of the gum and slight bleeding during brushing. When the permanent teeth are coming through, the gum around them can be more swollen. In a teenager, it is most often the small triangles of gum between the teeth that swell.

Bleeding gums in children usually do not mean periodontitis - a disease that destroys the bone or the fibres holding the tooth in place. In healthy children it is rare. Gingivitis is reversible, and once the plaque is gone, the gum becomes healthy again. Whether it is ordinary gingivitis is something the dentist confirms on examination, for example at the next check-up. In adults, bleeding gums when brushing are assessed differently, because they may also be caused by periodontitis.

Gingivitis caused by plaque does not usually cause a fever, so a fever points to another cause. A tender, red gum over a tooth that is coming through is usually a sign of teething. If, however, the child has a fever or does not want to drink, call the paediatrician the same day.

How to brush your child's teeth for 2 weeks when the gums bleed

Two weeks of more thorough brushing make sense when the gums bleed only during brushing and the child otherwise feels well. If the gums bleed on their own, there are bruises on the body, or the child is pale, has a fever or is noticeably weak, do not wait and call the paediatrician the same day. The two weeks of brushing at home also do not apply to mouth ulcers, swelling next to one tooth or loose teeth. Do not postpone a dental check-up that is already booked, and showing the gums to a doctor straight away is never a mistake.

Up to about the age of 6, an adult brushes the child's teeth. An older child brushes on their own while an adult watches, and in the evening the adult goes over the teeth again. Guide the brush so that the bristles touch the edge of the gum, using small movements, tooth by tooth, including the tongue side and the palate side. Do not skip the places that bleed, because that is exactly where plaque stays. Brush twice a day, for about 2 minutes each time, with a soft toothbrush and fluoride toothpaste in an amount suited to the child's age.

Over these 2 weeks, note down three things:

• whether the gums bleed around many teeth or in one place,
• whether the gums bleed less from one day to the next,
• whether there is a hard deposit at the gum that the toothbrush does not remove.

Brushing at home, a dentist visit or the paediatrician

Go through the questions in order and stop at the first one you answer yes to.

1. Do the gums bleed on their own, without brushing? Are there bruises on the body with no obvious cause, or tiny red dots on the skin or in the mouth? Is the child pale, running a fever or noticeably weak? If so, call the paediatrician the same day, without waiting for the result of two weeks of brushing. If, in addition, the gum next to one tooth or the cheek has swollen, also see a dentist that same day (question 3).
2. Are there small blisters, painful ulcers or a grey coating on the gums or elsewhere in the mouth? This is not ordinary gingivitis caused by plaque. Blisters with a fever are most often a viral infection. With a grey coating, a fever, feeling unwell, or if pain makes the child drink little, call the paediatrician the same day. A single ulcer with no other symptoms should also be shown to the paediatrician or a dentist, because brushing will not heal it.
3. Is the gum clearly swollen in one place, next to one tooth? This is usually what an infection around a tooth looks like, for example a baby tooth abscess. Have your child seen by a dentist within 24 hours. With a swollen cheek or a fever, go that same day to the nearest available dentist or to urgent care. If the child has difficulty breathing or swallowing, call 112, the emergency number in Poland. Swelling that spreads down to the neck, or a high fever with feeling unwell, is a reason to go to a hospital emergency department or call 112.
4. Are the gums getting bigger around many teeth in a child who takes medicine long term? Book a dental appointment and tell the doctor who prescribed the medicine. Do not stop or change the medicine yourself.
5. Is this a teenager with a loose tooth, or with a gum that is pulling back and exposing the neck of the tooth? Book a consultation with a periodontist, a dentist who specialises in diseases of the gums and the tissues around the teeth. Is a young child's baby tooth loose, or falling out much earlier than in other children of the same age? Have your child seen by a dentist without waiting the two weeks.
6. If none of the above fits, and the gums are red and bleed only during brushing, more thorough brushing with an adult's help is enough to start with. After 2 weeks you can often already see that the gums bleed less and less. Then keep brushing the same way and come for a check-up at the usual time. If the bleeding does not decrease, comes back despite good brushing, or there is a hard deposit at the gum, book a dental appointment. Such a deposit is usually tartar, also known as dental calculus.

Improvement often comes within 1–3 weeks, and slight redness may last a little longer than the bleeding. That is why, at 2 weeks, you look at the direction of change rather than at whether the redness has completely gone. The new way of brushing has to be kept up. In young children with a lot of plaque, whose parents changed how they brushed the children's teeth, the gums bled noticeably less - but where the change did not stick, the bleeding partly came back after a few months.

When to take your child to the dentist and what the dentist checks

Your child needs to see a dentist if, after 2 weeks of thorough brushing, the gums bleed just as much, if the gum inflammation in your child comes back despite good brushing, or if there is a hard deposit on the teeth. Bring your notes from the two weeks of brushing to the visit, along with a list of the medicines your child takes regularly.

The dentist first looks at the gums and teeth. They ask about illnesses, medicines, breathing through the nose and who brushes the child's teeth and how. Then they check where plaque is left behind and whether cavities, poorly fitting fillings or braces are holding it in place. If your child wears fixed braces, tell the orthodontist about the bleeding as well. During the examination a child's gums may bleed more easily than an adult's, which does not always mean disease. In a teenager, the dentist may also use a thin probe to measure how deep the gap between the gum and the tooth is.

Finally, the dentist or a dental hygienist shows the parent and the child how to brush at the edge of the gum. The dentist may decide that a professional cleaning at the clinic is needed, especially when there is tartar on the teeth. This removes what a toothbrush can no longer lift off, but it will not replace daily brushing at home.

At Modern Dental & Orthodontics, children are looked after by the paediatric dentistry team, and if your child has not yet been to the dentist or is afraid of the dentist, read beforehand how to prepare your child for a dental visit.

When changes in the gums may be caused by a general illness

Changes in a child's gums are rarely caused by a general illness - an illness of the whole body. A doctor looks for one when the inflammation is stronger than the amount of plaque would suggest, when it does not settle despite good brushing, or when the changes in the mouth come with symptoms elsewhere in the body.

Bleeding on its own, bruising and paleness may be signs of a blood disorder, including leukaemia, so with these symptoms call the paediatrician the same day. The doctor also looks out for a pale lining of the mouth and tiny red dots on it. Recurring mouth ulcers together with severe gingivitis in a young child also need to be assessed by a paediatrician, because they may result from a shortage of white blood cells.

In a child with well-controlled type 1 diabetes, the gums are usually no different from those of other children of the same age. When blood sugar is less well controlled, inflammation develops more easily, so tell the dentist about the diabetes. If needed, the dentist works together with a diabetes specialist.

Some medicines taken long term - for example some epilepsy medicines or medicines given after an organ transplant - can cause the gums to overgrow. In children taking such medicines, this happens often. If gum overgrowth from medication appears, any change of medicine is decided only by the doctor who prescribed it.

How puberty and mouth breathing affect the gums

During puberty, hormonal changes make the gums react to plaque more strongly than before. This is usually temporary and passes once brushing improves. A teenager still needs regular check-ups, though. Parents no longer brush a teenager's teeth, but they can ask whether the gums bleed and remind them to brush in the evening.

In some young people, periodontitis also begins during puberty. It is rare, and the signal for a parent is a loose tooth or a gum that is pulling back and exposing the neck of the tooth. More thorough brushing alone is not enough then, and a consultation with a periodontist is needed.

In children who breathe mainly through the mouth, bleeding gums and more plaque on the teeth are seen more often. If your child breathes through the mouth all the time, including during sleep, tell the dentist, and the paediatrician will assess the cause of the blocked nose.

What to do when your child's gums bleed during brushing

Gums that stop bleeding once the teeth are brushed more thoroughly usually do not need any treatment. It is enough to keep brushing at the edge of the gum and come for a check-up at the time the dentist has set. Book an earlier dental appointment if the gums keep bleeding or the bleeding comes back. With bleeding without brushing, bruising, paleness or a fever, call the paediatrician the same day.

Frequently asked questions

Can gingivitis in children harm the permanent teeth?

Gingivitis itself clears once plaque is removed and does not damage teeth. But the same plaque causes tooth decay, and newly emerging permanent teeth, which are hard to clean, are most at risk. Thorough brushing at the gum line protects gums and new teeth at once. In a teenager, check-ups show whether inflammation has reached deeper around the tooth.

Until what age should a parent finish brushing a child's teeth?

Until about age 6, an adult brushes, because a young child cannot yet clean the gum line. Then the child brushes alone, and an adult re-brushes and checks until about 12. A good test is that the gums do not bleed and no plaque stays at the gum line. How quickly a child takes over depends on how they cope.

From what age should a child clean between the teeth?

Cleaning between the teeth starts once the baby molars begin to touch, around age 3 in many children. An adult flosses once a day, ideally in the evening. For gingivitis in a young child, thorough brushing at the gum line helps most. For a teenager, the dentist may also advise cleaning between the teeth, depending on the gums' condition.

Is tartar on a child's teeth always caused by brushing mistakes?

Not always, because how quickly tartar builds up also depends on saliva. Children with cystic fibrosis sometimes have more tartar despite good hygiene. A toothbrush will no longer remove tartar, and the dentist decides whether to remove it at the clinic. The visit also makes it possible to check whether the tartar is keeping the gingivitis going.

How often should a child come for check-ups after gingivitis?

The dentist sets the interval between check-ups, depending on how the gums responded to the change in brushing and how fast plaque builds up in that child. Children with fixed braces and children with gum overgrowth from medication usually need more frequent visits. A teenager with gingivitis needs check-ups until the inflammation settles, then at the usual intervals.

Can a child's gums bleed for a few days after a professional cleaning?

For a day or two after a cleaning, the gums may bleed slightly when brushed and feel tender. Brush as usual, with a soft toothbrush. If bleeding or tenderness lasts more than 2–3 days or gets worse, take your child to a dentist. Bleeding without brushing is a reason to call the paediatrician the same day and tell the dentist.

How should I care for my child's gums in the first weeks after a dental visit?

In the first weeks, brush as the dentist or hygienist showed you, twice a day, right at the gum edge. In the evening, an adult also goes over an older child's teeth. Do not skip places that bleed, because that is where plaque stays. If bleeding does not ease, book an earlier visit without waiting for the next check-up.

Read more:

• Paediatric dentist in Warsaw Wola
• Paediatric dentistry: How to prepare your child for their first dental visit — a guide for parents
• How to protect your teeth from caries effectively? A guide to prevention
• Bleeding gums when brushing — when is it normal and when is it a sign of disease?
• Dental calculus — how to recognise it and remove it effectively

Content and liability disclaimer

This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.

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