What is the best treatment for gingivitis?

From the Guidelines

The best treatment for gingivitis is a combination of professional dental cleaning and improved daily oral hygiene, with the addition of a 0.1% turmeric mouthwash, which has been shown to be as effective as a 0.2% chlorhexidine mouthwash in reducing plaque and gingivitis levels 1. To treat gingivitis, start by visiting a dentist for a professional cleaning (scaling) to remove plaque and tartar buildup that can't be removed by brushing alone. At home, brush your teeth thoroughly twice daily for two minutes using a soft-bristled toothbrush and fluoride toothpaste. Floss once daily to remove plaque between teeth where brushing can't reach. Some key points to consider:

• The use of a 0.1% turmeric mouthwash has been shown to be effective in reducing plaque and gingivitis levels, with results comparable to those of a 0.2% chlorhexidine mouthwash 1.
• Other natural products, such as Triphala mouthwash and green tea mouthwash, have also been shown to be effective in reducing plaque and gingivitis levels, although the evidence is not as strong as for turmeric mouthwash 1.
• Terminalia chebula mouthwash has also been shown to reduce gingival inflammation, although its effect on plaque levels is not significant 1.
• Lifestyle changes, such as quitting smoking, maintaining a balanced diet low in sugary foods, and replacing your toothbrush every 3-4 months, are also important in preventing and treating gingivitis.
• If left untreated, gingivitis can progress to periodontitis, causing permanent damage to gums and supporting bone structure. Most cases of gingivitis can be completely reversed within 10-14 days of consistent treatment.

From the FDA Drug Label

Paroex ® (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) is indicated for use between dental visits as part of a professional program for the treatment of gingivitis as characterized by redness and swelling of the gingivae, including gingival bleeding upon probing. The best treatment for gingivitis is the use of Chlorhexidine Gluconate Oral Rinse USP, 0.12% as part of a professional program, which includes:

• Use between dental visits
• As indicated for the treatment of gingivitis characterized by redness and swelling of the gingivae and gingival bleeding upon probing 2

From the Research

Treatment Options for Gingivitis

• The use of chlorhexidine mouthrinse as an adjunct to mechanical oral hygiene procedures has been shown to reduce gingivitis and plaque 3, 4, 5.
• Chlorhexidine mouthrinse has been found to reduce gingivitis by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse after 4 to 6 weeks of use 3.
• A similar effect size was found for reducing gingivitis at 6 months, indicating a long-term benefit of using chlorhexidine mouthrinse 3.
• Plaque was also reduced with the use of chlorhexidine mouthrinse, with a large reduction found at 4 to 6 weeks and 6 months 3.

Adverse Effects of Chlorhexidine Mouthrinse

• Extrinsic tooth staining was found to be a common adverse effect of chlorhexidine mouthrinse, with a large increase in staining found at 4 to 6 weeks, 7 to 12 weeks, and 6 months 3.
• Other adverse effects reported include taste disturbance, effects on the oral mucosa, and a general burning sensation 3, 6.
• Concentrations of 0.12% to 0.2% are recommended to minimize unwanted side effects 6.

Comparison of Chlorhexidine with Other Mouthwashes

• Mouthwashes containing chlorhexidine and essential oils had a large effect on plaque control and managing gingivitis, with no difference found between the two 7.
• Cetylpyridinium chloride was also found to have a moderate effect on plaque control and managing gingivitis 7.
• Chlorhexidine mouthwash appears to be more effective compared to gels 6.