Short answer: Gum bleeding during clear aligner treatment is, in most cases, caused by bacterial plaque building up on the teeth and irritating the gums. Because the aligners cover the teeth constantly, the natural cleansing effect of saliva is reduced; when cleaning is inadequate, the gums become red and bleed easily. If the bleeding continues, the dentist will assess the cause.
Why do the gums bleed?
Healthy gums normally do not bleed during brushing. Bleeding is a sign of irritation or inflammation in the gums. The most common causes during clear aligner treatment are the following:
- Inadequate brushing and interdental cleaning: If the teeth are not cleaned thoroughly before the aligners are put in, food debris and a bacterial layer become trapped between the aligner and the tooth.
- A newly started or restarted care routine: Starting to clean areas that were previously neglected can cause bleeding in the first days; with regular cleaning this mostly decreases.
- The edge of the aligner touching the gums: If the aligner edge rubs against the gumline, mechanical irritation can occur.
- Build-up around attachments: The area around the small bumps bonded to the teeth needs to be cleaned more carefully.
- Hormonal periods, smoking and certain medications: These can increase gum sensitivity.
- Pre-existing gum inflammation: A gum problem that went unnoticed at the start of treatment can become more obvious with the aligners.
If, besides bleeding, there is also redness, swelling and tenderness to touch in the gums, the picture may point to gum inflammation (gingivitis). This can mostly be reversed with regular and correct cleaning; if neglected, however, it can progress. For this reason it is important not to underestimate the symptoms and to take measures at an early stage.
Why does wearing aligners affect the gums?
A clear aligner works like a thin sleeve covering all of the teeth. This sleeve partly prevents saliva from washing over the teeth and balancing acidity. The plaque layer (bacterial layer) matures quickly and collects along the gumline. In addition, as the teeth move during orthodontic treatment, new areas that are difficult to clean can form. For this reason oral care is an integral part of aligner treatment.
What can you do at home?
- Take the aligners out and brush your teeth after every meal; then put the aligners back in.
- Hold a soft-bristled brush at a 45-degree angle to the gumline and use gentle, small movements. Pressing hard irritates the gums even more.
- Clean between the teeth once a day with an interdental brush or floss.
- Clean the aligners as well with a soft brush and lukewarm water; hot water can deform the aligner.
- Avoid drinking anything other than water while the aligners are in; sugary and acidic drinks stay trapped between the tooth and the aligner.
- Do not stop brushing because of the bleeding. Keeping the area clean is the basis of healing.
For a daily cleaning routine, our pages on oral hygiene with clear aligners and the usage and care guide may be helpful.
When should you see the dentist?
- If the bleeding does not decrease within a few days despite regular cleaning
- If the gums are noticeably swollen or painful, or there is a bad smell in the mouth
- If you feel gum recession or looseness in the teeth
- If the aligner edge is cutting your gums or causing sores; on this subject you can read our article on what to do if aligners cut the gums
If necessary, the dentist checks the aligner edge, may recommend professional cleaning and can review the check-up intervals until gum health improves. You can also read our article on gum recession and its prevention for monitoring gum health during orthodontics.
What can the dentist do?
- Examines the condition of the gums and tartar and, if needed, recommends professional cleaning.
- Goes over the correct brushing and interdental cleaning technique with you.
- Checks how the aligner edge fits against the gums and the area around the attachments.
- If considered necessary, reassesses the orthodontic plan and the check-up intervals until gum health improves.
Common mistakes in brushing and interdental cleaning
- Not brushing the bleeding area out of fear; this increases build-up and keeps the bleeding going.
- Using a hard-bristled brush or too much pressure; this can pave the way for gum recession.
- Only rinsing the aligners and putting them back in without brushing the teeth.
- Never using floss or an interdental brush; the surfaces between the teeth are places the brush cannot reach.
- Forgetting to clean the aligners; the layer on the aligner is carried back onto the tooth.
You can ask your dentist whether tools such as an electric toothbrush or a water flosser are suitable for you.
Habits to prevent bleeding
- Having a tartar and gum check before starting treatment
- Wearing the aligners regularly and for the duration the dentist recommends
- Not missing check-up appointments
- Reducing smoking or considering quitting
Frequently asked questions
If my gums are bleeding, should I take a break from the aligners?
Instead of taking a break on your own, consult your dentist. Not wearing the aligners can disrupt the planned tooth movement; in most cases treatment continues once cleaning has improved.
Does bleeding mean the aligners were made badly?
Generally not. Most of the time it is related to the cleaning routine. If the aligner edge does not fit well, the dentist assesses this at the check-up.
Can I use mouthwash?
It can be used if the dentist has recommended it; however, mouthwash does not replace brushing. Ask your dentist which product is suitable.
How do you find out what suits you?
The information here is general; the right plan for you is determined by an examination and the dentist’s assessment. At our clinic in Oran, Çankaya, Ankara, we go through your questions together during the first orthodontic examination.
