What is the significance of bleeding on probing?

This question was submitted to us by a general dentist: What is the significance of bleeding on probing?

Dr. Sayed Mirbod, representing the Canadian Academy of Periodontology (CAP), provided this initial quick response:

The classical signs of gingival inflammation associated with gingivitis are:

• Bleeding from the gingival sulcus upon gentle probing,
• Increased gingival fluid flow rate, and
• Swelling, and discolouration of the gingival units.

Bleeding from the sulcus is the earliest clinical symptom of gingivitis and precedes discolouration and swelling (1). Therefore, since gingival colour changes are less obvious during the early stages of gingivitis and are most often overlooked, bleeding from sulcus can be considered a clear-cut sign of pathology.

The diagnostic predictive value of plaque scores, bleeding, probing depth, and other clinical periodontal criteria is a complex topic. However, it is safe to say that after a few years of maintenance, an increase in probing depths, particularly if combined with high frequency of bleeding on probing, shows the highest predictive value for attachment loss and disease progression (2).

Resources

1. Mühlemann HR, Son S. Gingival sulcus bleeding–a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15(2):107-13.
2. Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J. Diagnostic predictability of scores of plaque, bleeding, suppuration and probing depth for probing attachment loss. 3 1/2 years of observation following initial periodontal therapy. J Clin Periodontol. 1990;17(2):108-14.

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