How to treat gingivitis?

Treatment of Gingivitis

The most effective treatment for gingivitis combines twice-daily brushing with fluoridated toothpaste, daily interdental cleaning, and adjunctive use of chlorhexidine gluconate (0.12%) mouthwash for 2-4 weeks. 1

Mechanical Plaque Removal: The Foundation of Treatment

Toothbrushing

• Brush teeth twice daily for at least 2 minutes with fluoridated toothpaste 1
• Use proper brushing technique such as the Modified Bass method 1
• For patients with gingivitis, 2 minutes may be insufficient; longer brushing time is recommended 2

Interdental Cleaning

• Clean interdental spaces once daily 2
• Interdental brushes (IDBs) are the preferred device for interproximal plaque removal 1
• Use floss only for areas where IDBs cannot pass without trauma 1, 3
• Low-certainty evidence suggests interdental brushes may be more effective than floss for reducing gingivitis 3

Professional Treatment

• Professional scaling and polishing by a dental professional is essential to remove plaque and calculus deposits 1
• Re-evaluation after 2 weeks is recommended to assess improvement 1

Adjunctive Antimicrobial Therapy

First-Line Treatment

• Chlorhexidine gluconate (0.12%) mouthwash twice daily for 2-4 weeks 1, 4
• Rinse for 30-60 seconds with 10-15mL of solution 1
• Use 30-45 minutes after brushing for optimal effect 1

Natural Alternatives

When chlorhexidine is contraindicated or poorly tolerated, consider these alternatives with comparable effectiveness:

1. Green Tea Mouthwash

   • Contains 1% tannin
   • Use 15 mL twice daily for 1 minute
   • Shows comparable plaque inhibitory and bleeding reduction to chlorhexidine 5, 1
   • Multiple clinical trials show effectiveness similar to chlorhexidine 5

2. Turmeric Mouthwash

   • 0.1% concentration
   • Comparable to chlorhexidine in reducing plaque and gingivitis 5

3. Lemongrass Oil

   • 0.25% concentration
   • Comparable to 0.2% chlorhexidine in decreasing gingivitis and plaque indices 5

4. Terminalia chebula

   • 10% concentration
   • Reduces gingival inflammation and plaque levels comparable to chlorhexidine 5

5. Aloe Vera Mouthwash

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

Treatment Algorithm Based on Severity

Mild Gingivitis

1. Optimize mechanical plaque control (brushing + interdental cleaning)
2. Professional scaling and polishing
3. Re-evaluate after 2 weeks 1

Moderate to Severe Gingivitis

1. All steps for mild gingivitis
2. Add adjunctive chlorhexidine mouthwash (0.12%) twice daily for 2-4 weeks
3. If chlorhexidine is contraindicated, use a natural alternative 1

Persistent Gingivitis

1. Re-evaluate oral hygiene technique
2. Consider longer course of adjunctive therapy (up to 8-12 weeks)
3. More frequent professional cleaning 1

Important Considerations and Pitfalls

• Treatment Adherence: Complete the full prescribed course (typically 2-4 weeks); inconsistent application, insufficient contact time, or early discontinuation reduces effectiveness 1

• Interdental Cleaning Devices: Evidence suggests interdental brushes may be more effective than floss, but the quality of evidence is low to very low 3

• Chemical vs. Mechanical Control: Chemical plaque control should supplement, not replace, mechanical plaque removal 1, 2

• Timing: Use mouthwashes 30-45 minutes after brushing for optimal effect 1

• Long-term Management: Gingivitis can progress to periodontitis if not properly managed; consistent daily oral hygiene is essential for prevention 2, 6

By following this comprehensive approach to gingivitis treatment, patients can effectively manage inflammation, prevent progression to periodontitis, and maintain good oral health.