What is the treatment for gingivitis (inflammation of the gums)?

Treatment for Gingivitis (Inflammation of the Gums)

The most effective treatment for gingivitis combines proper mechanical plaque removal through twice-daily brushing and once-daily interdental cleaning, with adjunctive use of chlorhexidine or alternative natural mouthwashes as needed for more severe cases. 1, 2

Primary Treatment Approach

Mechanical Plaque Control

• Toothbrushing:

  • Brush twice daily for at least 2 minutes 3
  • Power toothbrushes are more effective than manual toothbrushes 4
  • Use a soft-bristled toothbrush with fluoridated toothpaste

• Interdental Cleaning (once daily):

  • Interdental brushes are the preferred method where they can fit without trauma 3
  • Dental floss should be used where interdental spaces are too tight for brushes 5
  • Flossing followed by brushing is more effective than brushing followed by flossing 6

Professional Treatment

• Professional scaling and polishing to remove plaque and calculus deposits 1, 4
• Personalized oral hygiene instruction and reinforcement 3

Adjunctive Chemical Plaque Control

First-line Option:

• Chlorhexidine gluconate (0.12%) mouthwash:
  • FDA-approved for gingivitis treatment 2
  • Use 10-15 mL twice daily for 1 minute
  • Rinse for 30 seconds, 30 minutes after brushing
  • Treatment duration: 2-4 weeks 1
  • Common side effects: temporary taste alteration and tooth staining

Alternative Natural Options:

Based on the most recent evidence, several natural products have shown comparable efficacy to chlorhexidine 1:

• Hyaluronic acid (Gengigel):

  • Apply twice daily for 2-4 weeks
  • Use 10-15 mL as mouthwash for 1-2 minutes or apply gel directly to affected areas 2-3 times daily 7

• Triphala mouthwash:

  • 10-15 mL twice daily for 2-4 weeks
  • Shown to be cost-effective with no reported side effects 1

• Green tea mouthwash (containing 1% tannin):

  • 15 mL twice daily for 1 minute
  • Effective as an adjunct to mechanical plaque control 1

• Aloe vera mouthwash:

  • 10 mL twice daily for 1 minute
  • Comparable effectiveness to chlorhexidine without side effects 1

Treatment Algorithm

1. For mild gingivitis:

   • Optimize mechanical plaque control (brushing + interdental cleaning)
   • Professional scaling and polishing
   • Re-evaluate after 2 weeks

2. For moderate to severe gingivitis:

   • All steps for mild gingivitis
   • Add adjunctive chlorhexidine mouthwash (0.12%) twice daily for 2-4 weeks
   • If chlorhexidine is contraindicated or poorly tolerated, use one of the natural alternatives

3. For persistent gingivitis:

   • Re-evaluate oral hygiene technique
   • Consider longer course of adjunctive therapy (up to 8-12 weeks) 7
   • Assess for underlying systemic conditions

Important Considerations

• Gingivitis is reversible with proper treatment, but if left untreated can progress to periodontitis, which is irreversible 3
• Even short-term gingivitis can induce systemic inflammatory markers 8
• Inconsistent application, insufficient contact time, or discontinuing treatment too early can reduce effectiveness 7
• Adjunctive mouthwashes should supplement, not replace, mechanical plaque removal 1, 7
• Chlorhexidine should not be used immediately after brushing as toothpaste components can inactivate it