Differential Diagnosis of Gingivorrhagia

Primary Local Causes

Patients with periodontal disease history have increased risk of periodontal abscesses with rapid tissue destruction 1
Clinical signs of periodontal disease include gingival swelling, increased tooth mobility, and sinus tract formation 2
Failed endodontic treatment with persistent infection can present with gingival swelling and bleeding 1
Periapical abscess or granuloma may manifest as gingival changes above tooth apex 1
If fistula is present, obtain intraoral radiograph with gutta-percha cone inserted to identify source 1, 3

Oral lichen planus, cicatricial pemphigoid, and pemphigus vulgaris can cause desquamative gingivitis with associated bleeding 4
Crohn's disease can cause esophageal and oral ulcerations 4
Sjögren's disease presents with nonspecific edema and crepe paper-appearing tissue 4
Lupus, mixed connective tissue disease, and dermatomyositis may have oral manifestations 4

Obtain complete blood count, PT/INR, and PTT to evaluate for bleeding disorders 4
Anticoagulant therapy increases bleeding risk 4
Lymphoma may involve oral tissues with associated bleeding 4
Peripheral blood smear and bone marrow evaluation may be indicated in cases of suspected leukemia or lymphoproliferative disorders 1

Document bleeding pattern: spontaneous versus provoked, frequency, severity, and duration 1
Evaluate for systemic signs: fever, weight loss, lymphadenopathy, hepatosplenomegaly 4
Periapical intraoral X-ray using paralleling technique is first-line imaging for localized dental pathology 1
Panoramic radiography for comprehensive dental assessment 5
If fistula present, radiograph with gutta-percha cone insertion identifies source tooth 1, 3

Complete blood count with differential to assess for leukemia, thrombocytopenia, anemia 1
PT/INR and PTT for coagulation assessment 1
Consider peripheral blood smear if hematologic malignancy suspected 1

Persistent bleeding despite treatment of local factors necessitates tissue diagnosis 1