Blood in Saliva | Causes of Bloody Spit, Saliva

The presence of blood in the saliva may not necessarily be an indication of bleeding from the mouth cavity (stomatorrhagia). The mouth communicates with the nose, esophagus and larynx via the throat. This could mean that any bloody saliva may be due to bleeding in the nasal cavity, respiratory or gastrointestinal tracts.

Tracing the cause may be easier if the blood in the saliva is only evident or more pronounced in one of these situations :

  • After or during vomiting, regurgitating or when belching indicates bleeding from the esophagus. Read more under Blood In Vomit.
  • After or during coughing (hemoptysis) or sneezing indicates bleeding from the airways or lungs. Read more under Coughing Up Blood.
  • After sneezing, blowing the nose,  in post nasal drip, with nasal congestion or accompanying a bleed from the nose indicates bleeding from the nasal cavity. Read more under Epistaxis.

If there is blood in the saliva without any clear correlation with the features mentioned above, then pathology within the mouth has to first be excluded before the neighboring cavities are investigated.

In order to help with a diagnosis, it is important to identify if the bleeding is only evident in the saliva during or after one or more of the following :

  • Eating or drinking
  • Biting, chewing or swallowing
  • Brushing, gargling with a mouth rinse or flossing
  • Talking or shouting
  • Breathing through the mouth

Causes of Bloody Saliva

Persistent or recurring mouth sores and ulcers known as recurrent aphthous stomatitis are a common condition and needs to be excluded as a possible site of bleeding. These sores/ulcers may be due to one or more of the causes mentioned below or occur for no known reason (idiopathic).


Vigorous brushing and excessive flossing are the most common causes of blood in the saliva.  Other causes of trauma may include :

  • After dental work/surgery or oropharyngeal surgery
  • Poorly fitting dentures and other dental prosthetics
  • Mouth biting
  • Chemical injury to he mouth may be seen with :
    • Ingesting caustic substances
    • Excessive gum chewing
    • Tobacco chewing
    • Acidic foods


A number of bacteria, even naturally occurring bacteria, may become pathological if there are untreated wounds or sores in the mouth.

Many viral and fungal infections, especially recurrent cases, are seen in immunocompromised patients (HIV, uncontrolled diabetes).

  • Viral
  • Varicella zoster virus (chickenpox)
  • Herpes simplex virus (HSV-1)
  • Epstein-Barr virus (EBV)
  • Cytomegalovirus (CMV)

Bleeding from the mouth is seen with many uncommon tropical infections and hemorrhagic fevers.

  • Fungal
  • Candida spp (candidiasis)
  • Mucorales spp (mucormycosis)

Nutritional Deficiencies

Pathology in the mouth due to nutritional deficiencies may result in lesions that could lead to bleeding in the mouth.

  • Scurvy – vitamin C
  • Pellagra – vitamin B3/niacin
  • Iron-deficiency anemia – iron

Drugs and Toxins

Stomatorrhagia (bleeding in the mouth) is commonly seen in patients undergoing chemotherapy and/or radiation therapy. Radiation sickness may also cause mouth bleeding. Warfarin and other anticoagulants may lead to profuse bleeding due to even minor trauma in the mouth.

Other substances :

  • Poisons, including venom
  • Narcotics like crystal meth (long term ~ meth mouth)


  • Oral cavity cancer (primary)
  • Lymphoma
  • Leukemia

Blood and Bleeding Disorders

  • Thrombotic thrombocytopenic purpura
  • Thrombocytopenia
  • Hemophilia
  • Von Willebrand’s disease

Articles Related to Bloody Saliva

  1. Blood in Mouth
  2. Sore Mouth
  3. Bleeding Gums

Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

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  • mesia

    Hi, I have had a deep cough associated with earaches and blood in I need to visit the doctor or is just possibly just a minor cold?

    • Hi Mesia. The presence of blood in any discharges or secretions should prompt you to seek medical attention. It may not be very serious but it is advisable to get medical advice.

  • Ashok

    Hii I have blood in my saliva and some time comes from nose since last 1 Month do i need to visit the doctor? plzz suggest me

  • Irving

    I spit out blood like from the back of my throat not in my mouth. But after I cae gargled water it stopped bleeding.

    • Hi Irving. A once off episode of spitting out blood may not always be a cause fo concern. However, if it has occurred repeatedly then it definitely needs to be investigated. The source of the bleed can be from teh throat, mouth, nose, airways and esophagus. So further investigation may very likely be needed to diagnose the exact cause. Your doctor will be able to advise your further.

  • hilary hughes

    Hi my daughter is 7yrs of age she has been bleeding from her mouth over a week now just tis morning her pillow was full of blood and a small clot came up wat should I do

    • Hi Hilary. Hopefully you have sought medical attention by now. The bleeding could be coming from the teeth, gums, throat, nose and so on which may exit through the mouth. However, this is not a common occurrence and it should be investigated immediately. If your daughter has not seen a doctor as yet then please do so as soon as possible.

  • parvesh rawat

    Sir resently blood come whn i spitting what shoud i do first…. Pleas help

    • Hi Parvesh. There are a number of possible causes of blood in your saliva. The bleed may be in the mouth, nose or throat or it could be coming from the airways, lungs and even the esophagus (food pipe). The first priority is to identify where the blood is coming from and then consider possible causes. We cannot do that through this online platform. You need to see a doctor and you may have to follow up with a specialist like an ENT specialist. First speak to your family doctor.

  • Matthew Mccrone

    I recently and might still be going through an upper respiratory infection and I got amoxicillin from the doctor and now after 2 weeks of finishing the prescription my saliva has a red tint to it sometimes. Could it be because I smoke or because my immune system is still removing the mucus and ripping muscle tissue because I have cough fits till I gag and spit reddish mucus.

    • Hi Matthew. One course of antibiotics may not have totally resolved the infection. It is always advisable to see a doctor for a follow up after finishing any medication. A cough can persist for a few days to a week or two after an infection is resolved. However, the reddish tint in your saliva is a cause for concern. This could be blood which means that the infection is probably persisting or it could be an entirely new infection. Some bacteria can cause a red to orange discoloration of the mucus even though there is no blood present. You need to speak to your doctor. A sputum sample may be needed for further laboratory testing.