What is the treatment for gingivitis?

Treatment for Gingivitis

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

Primary Treatment Approach

Mechanical Plaque Control

• Brushing: Brush teeth twice daily for at least 2 minutes with fluoridated toothpaste 1, 2
  • For patients with existing gingivitis, 2 minutes may be insufficient 2
  • Use proper brushing technique (Modified Bass method is recommended) 3
• Interdental Cleaning: Clean between teeth once daily 2
  • Interdental brushes (IDBs) are the preferred device for interproximal plaque removal 2
  • Flossing is only recommended for areas where interdental brushes cannot pass without trauma 2
• Professional Treatment: Scaling and polishing by a dental professional to remove plaque and calculus deposits 1

Treatment Protocol Based on Severity

Mild Gingivitis

• Optimize mechanical plaque control techniques
• Professional scaling and polishing
• Re-evaluation after 2 weeks 1

Moderate to Severe Gingivitis

• All treatments for mild gingivitis, plus:
• Adjunctive antimicrobial mouthwash therapy 1
  • First-line: Chlorhexidine gluconate (0.12%) mouthwash twice daily for 2-4 weeks 1, 4
  • Rinse for 30-60 seconds with 10-15mL of solution 3

Persistent Gingivitis

• Re-evaluate oral hygiene technique
• Consider longer course of adjunctive therapy (8-12 weeks)
• Follow-up professional cleaning 1

Alternative Mouthwash Options

When chlorhexidine is contraindicated or poorly tolerated (due to staining, taste alteration, or other side effects), consider these evidence-based alternatives:

1. Triphala mouthwash: 15mL twice daily for 60 days 3, 1

   • Cost-effective with no reported side effects
   • Comparable effectiveness to chlorhexidine

2. Green tea mouthwash (containing 1% tannin): 15mL twice daily for 1 minute 3, 1

   • Safe and feasible adjunct to mechanical plaque control

3. Aloe vera mouthwash: 10mL twice daily for 1 minute 3, 1

   • Equal effectiveness to chlorhexidine without side effects

4. Essential oil mouthwash: Particularly effective for short-term (2 weeks) anti-gingivitis effects 5

5. Cetylpyridinium chloride (CPC) mouthwash: Equally effective as essential oils for long-term plaque control 5

Special Considerations

• Timing: Use mouthwashes 30-45 minutes after brushing for optimal effect 3
• Duration: Complete the full prescribed course (typically 2-4 weeks) 1
• Adjunctive nature: Chemical plaque control should supplement, not replace, mechanical plaque removal 1, 2
• Desquamative gingivitis: Requires particularly meticulous oral hygiene and professional care 6
• Medical conditions: Patients undergoing treatments like chemotherapy may require more intensive oral hygiene protocols 7

Common Pitfalls to Avoid

• Insufficient mechanical cleaning: Relying solely on mouthwashes without proper brushing and interdental cleaning
• Inadequate treatment duration: Discontinuing treatment before inflammation has fully resolved
• Improper technique: Insufficient contact time with mouthwash (should be 30-60 seconds)
• Neglecting professional care: Skipping professional scaling and polishing appointments
• Inconsistent application: Not following the twice-daily regimen as prescribed

Remember that gingivitis is reversible with proper treatment, but if left untreated, it can progress to periodontitis, which causes irreversible damage to supporting structures of the teeth 2.