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Bleeding Gums May Be Vitamin C Deficiency, Study Suggests

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Key Takeaways

  • Although gingivitis is the most-cited culprit for bleeding gums, new research suggests lack of vitamin C may play a role.
  • Researchers note that vitamin C deficiency has been associated with gum bleeding for some time, but emphasis was shifted to oral hygiene practices instead.
  • Vitamin C deficiency can also cause problems beyond the mouth, such as poor wound healing and difficulty fighting infections.

Bleeding gums are often associated with gingivitis, an early stage of periodontal disease, but new research in Nutrition Reviews suggests that vitamin C deficiency could be the real culprit.

In a meta-analysis, researchers looked at 15 trials in six countries, representing over 1,000 predominantly healthy participants. They found that vitamin C supplementation significantly reduced gingival bleeding, a conclusion that has been found in the past, according to the study’s lead author, Philippe Hujoel, PhD, DDS, a dentist and professor of oral health sciences at the University of Washington School of Dentistry.

“We’ve known for some time that gingival bleeding could be associated with lack of vitamin C, but over time, that insight has been marginalized by attention to treating the symptom instead of the cause,” he notes. “It’s important to look at whether vitamin deficiency may be the real reason for many people.”

Why Bleeding Happens

Given the breadth of vitamins utilized by the body, why would vitamin C—also known as ascorbic acid—play such an outsized part in causing bleeding gums? It all comes down to the tiny blood vessels in your mouth.

Adequate consumption of ascorbic acid keeps those blood vessels strong and resilient, but when levels are low, it can cause what’s called “microvascular fragility.” The walls of the blood vessels weaken, which means they can rupture easily with even minor trauma or disturbance, such as brushing your teeth or flossing. In some cases, the blood vessels may be so fragile that they can rupture simply by pressing a finger on your gums.

This isn’t just an issue for oral health, since these blood vessels are located throughout your body. The problem could cause difficulties in other ways as well. For example, a study in Current Osteoporosis Reports suggests these microvascular complications could contribute to low bone density, particularly among people with diabetes.

In addition to microvascular fragility, vitamin C deficiency can also affect the gum tissue itself, Hujoel adds. That may present as swollen or red gums, and if the deficiency is severe enough, gum tissue may even turn dark red or purple.

Vitamin Deficiency Prevalence

Before more emphasis was put on brushing and flossing habits as a precursor to gingivitis, bleeding gums were often seen as a sign of ascorbic acid deficiency, says Hujoel. That’s because it was a primary symptom of scurvy, a disease mostly linked to poorly nourished sailors in the 18th century and now considered an uncommon problem.

Vitamin C deficiency in general, however, is still enough of a challenge globally that a research review recently published in Nutrients suggested interventions are needed in many parts of the world. Beyond bleeding gums, other symptoms of vitamin C insufficiency include:

  • Fatigue
  • Mood changes
  • Higher depression risk
  • Dry skin
  • Joint pain
  • Poor wound healing
  • Problems fighting infections
  • Nosebleeds

“Unfortunately, we found that vitamin C deficiency is likely very common globally,” says Anitra Carr, PhD, researcher in the Nutrition in Medicine Research Group at the University of Otago, New Zealand. “That’s particularly true in low-income groups and low-to-middle income countries. Given the protective effects of vitamin C for a range of health issues, boosting intake of the vitamin may prove to be a cheap and effective public health intervention.”

Getting to a Better C-Level

For adequate vitamin C intake, the United States Department of Agriculture recommends 90 mg per day for men and 75 mg daily for women. The highest source is red bell peppers, which has 95 mg for just half a cup.

Although there are a breadth of supplement options for getting vitamin C on its own, consuming the vitamin from foods can also give you fiber, as well as other vitamins and minerals, and ascorbic acid is easily found in a range of fruits and vegetables. In addition to bell peppers, these include:

One spot of beneficial news, Hujoel adds, is that once you begin getting adequate vitamin C, your gums tend to improve quickly—but that doesn’t mean you get to skip brushing and flossing.

What This Means For You

Bleeding gums may not always be a result of poor oral hygiene. They could be a sign of a vitamin C deficiency instead. Try adding more vitamin-rich foods to your diet like bell peppers and citrus fruits to see if it alleviates the issue.

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Article Sources
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  1. Hujoel PP, Kato T, Hujoel IA, Hujoel MLA, Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trialsNutr Rev. 2021. doi:10.1093/nutrit/nuaa115

  2. Japatti SR, Bhatsange A, Reddy M, Chidambar YS, Patil S, Vhanmane P. Scurvy-scorbutic siderosis of gingiva: a diagnostic challenge - a rare case report. Dent Res J (Isfahan). 2013;10(3):394-400.

  3. Fajardo RJ. Is Diabetic skeletal fragility associated with microvascular complications in bone?Curr Osteoporos Rep. 2017;15:1-8. doi:10.1007/s11914-017-0341-8

  4. Rowe S, Carr AC. Global vitamin C status and prevalence of deficiency: a cause for concern?Nutrients. 2020;12(7):2008. doi:10.3390/nu12072008

  5. National Institutes of Health; Office of Dietary Supplements. Vitamin C: Fact Sheet for Health Professionals. Updated February 27, 2020.