Short answer: gums that bleed when you brush are usually an early sign of gum disease, not something to brush around. The NHS says it is caused by a build-up of plaque, and in its early stages it is generally managed with better cleaning at home and a professional clean from a dental hygienist. Getting it looked at early matters, because untreated gum disease can lead to receding gums and loose teeth.
Most people know they should see a dentist, but fewer are sure what a hygienist does, how often to go, or whether it is covered on the NHS. If you are weighing up dental hygienist appointments in Lewisham, this guide explains the warning signs, what happens in the chair, how NHS charges apply to gum treatment in England, and the routine that keeps gums healthy between visits.
What are the early signs of gum disease?
The NHS lists these symptoms of gum disease:
- Gums that bleed when you brush, floss or eat hard food.
- Gums that look swollen, red or sore.
If it is not treated, the NHS says it can go on to cause bad breath, gums that shrink back from the teeth, loose teeth and dental abscesses. Because early gum disease is often painless, many people only notice the bleeding, and some stop brushing that area, which tends to make it worse.
Gingivitis or periodontitis: what is the difference?
Dental teams usually describe gum disease in two broad stages. The table below is a plain-English summary; your dentist will diagnose which applies to you.
| Gingivitis (early) | Periodontitis (advanced) | |
|---|---|---|
| What is affected | The gums only | The gums and the tissues that hold the teeth in place |
| Typical signs | Bleeding, redness, swelling | Receding gums, bad breath, teeth that feel loose |
| Usual first steps | Better cleaning at home plus a professional clean | Deeper cleaning below the gum line, closer monitoring, sometimes further treatment |
| Can it be reversed? | Usually, with good plaque control | Damage to supporting tissues is generally managed rather than undone |
What does a dental hygienist actually do?
A dental hygienist is a registered dental professional who focuses on prevention and gum health. At a typical appointment, a hygienist will:
- Assess your gums. They check for bleeding and inflammation and may measure the small gaps between gums and teeth.
- Remove hardened deposits. Plaque that is left on the teeth hardens into tartar (calculus), which a toothbrush cannot remove. The hygienist removes it with hand instruments or an ultrasonic scaler. This is the "scale" in "scale and polish".
- Clean below the gum line if needed. Where gum disease is more established, deeper cleaning may be needed, sometimes over more than one visit.
- Polish the teeth. This removes surface staining and leaves the surfaces smoother.
- Coach your home care. Good hygienists spend real time showing you the right interdental brush size and where your brushing is missing.
That last step is often the most valuable part. A professional clean resets the mouth, but it is what you do every day afterwards that decides whether the bleeding comes back.
Is gum treatment available on the NHS?
Yes, where it is clinically needed. Under the NHS charges for England from 1 April 2026, published by the NHS Business Services Authority:
- Band 1 (£27.90) covers an examination, diagnosis and advice, X-rays if needed, and simple gum care such as scaling if clinically needed.
- Band 2 (£76.60) includes everything in Band 1 plus more extensive treatment for gum disease, as well as fillings, root canal treatment and extractions.
The key phrase is "clinically needed". A cosmetic polish to remove staining, or more frequent hygiene visits than your dentist considers necessary, are typically offered privately. Many practices offer both routes, so it is worth asking which applies to the visit you are booking. NHS dental treatment is free for some groups, including anyone under 18, those who are pregnant or have had a baby in the last 12 months, and people on certain benefits.
How often should I see a hygienist?
There is no single answer. It depends on how healthy your gums are, how quickly tartar builds up for you, and other factors such as smoking. Some practices suggest anything from every three months to once a year, and the NHS gum disease guidance recommends regular check-ups with a hygienist alongside dental check-ups. Your dentist or hygienist should explain the interval they recommend and why.
The NHS also flags that people with type 2 diabetes and people who are pregnant should make sure they keep up regular check-ups, as gum health deserves extra attention in both situations.
A daily routine that protects your gums
The NHS prevention advice for gum disease is practical and inexpensive:
- Brush with fluoride toothpaste at least twice a day, last thing at night and at one other time.
- Spit, do not rinse after brushing, so the fluoride stays on your teeth.
- Clean between your teeth every day with floss or interdental brushes.
- Do not use mouthwash straight after brushing.
- Do not smoke.
If you have never used interdental brushes, expect some bleeding for the first week or two. That usually settles as the gums become healthier; if it does not, tell your dentist.
What if I feel nervous about a scale and polish?
Some people avoid hygiene visits because a previous clean felt uncomfortable. It is reasonable to say so when you book and at the start of the appointment. Ask the hygienist to explain each step, agree a hand signal for a pause, and ask whether your gums are inflamed enough that a numbing gel or local anaesthetic would help. Gums that are cleaned regularly usually become less tender over time.
A local example
Inspire Dental Lewisham, an NHS and private practice at 8-12 Lee High Road, SE13 5LQ, describes its hygiene service as an assessment of teeth and gums followed by a professional scale and polish, with advice on brushing, flossing and interdental brushes. Its hygiene page suggests visits every 3 to 12 months depending on individual needs, and the practice offers 0% finance through Tabeo for private treatment, which, like any finance, is a form of credit with its own terms to check.
Frequently asked questions
Is it normal for gums to bleed when I floss?
Bleeding is a common sign of gum inflammation. It often improves with consistent cleaning, but you should mention it to your dentist so they can check your gums.
Can a hygienist cure gum disease?
Early gum disease can usually be controlled with professional cleaning and good home care. More advanced disease is managed over time, and your dentist will advise on the plan.
Does a scale and polish cost the same on the NHS as a check-up?
When simple scaling is clinically needed, it falls under Band 1 (£27.90 in England from April 2026), the same charge as a check-up. More extensive gum treatment falls under Band 2.
Will a hygienist whiten my teeth?
A polish can remove surface staining, but it does not change the natural shade of your teeth.
Sources
- NHS: Gum disease
- NHS Business Services Authority: Current NHS dental charges
- NHS: Understanding NHS dental charges
- NHS: Who is entitled to free NHS dental treatment in England
General information only, not personal medical advice. Always follow the advice of your own dentist or hygienist.