What is the immediate treatment for gingivitis (inflammation of the gums) in the Emergency Room (ER)?

Immediate Treatment of Gingivitis in the Emergency Room

The immediate treatment for gingivitis in the emergency room should focus on oral hygiene measures including gentle brushing with a soft toothbrush, rinsing with an alcohol-free antimicrobial mouthwash such as 0.2% chlorhexidine, and removing obvious sources of gingival irritation. 1

Initial Assessment and Management

• Examine the oral cavity thoroughly to assess the extent of gingival inflammation, bleeding, and to identify any sources of trauma (e.g., ill-fitting dental prostheses, fractured teeth) 1
• Provide immediate pain relief with topical anesthetics such as viscous lidocaine 2% (15 mL per application) for severe gingival discomfort 1
• Remove obvious sources of irritation if possible and safe to do so in the ER setting 1

Immediate Interventions

Oral Hygiene Measures

• Instruct the patient to brush teeth gently with a soft toothbrush after meals and before sleep 1
• Recommend using a mild fluoride-containing, non-foaming toothpaste 1
• Advise brushing according to the Bass or modified Bass method (angling bristles 45° toward the gumline) 1

Antimicrobial Therapy

• Prescribe an alcohol-free antimicrobial mouthwash such as:
  • 0.2% chlorhexidine mouthwash (10 mL, twice daily for 1 minute) 1
  • Alternative natural options if chlorhexidine is unavailable include:
    • Aloe vera mouthwash 1
    • Triphala mouthwash 1
    • Green tea mouthwash 1

Pain Management

• For moderate pain, consider topical NSAIDs (e.g., amlexanox 5% oral paste) 1
• For severe pain, consider systemic analgesics following the WHO pain management ladder 1
• Topical anesthetics like benzydamine hydrochloride oral rinse can be used every 3 hours, particularly before eating 1

Patient Education and Home Care Instructions

• Advise patients to:
  • Rinse mouth with prescribed antimicrobial mouthwash at least four times daily 1
  • Maintain adequate hydration to keep the mouth moist 1
  • Lubricate lips with lip balm or petroleum jelly (short-term use only) 1
  • Avoid irritants such as smoking, alcohol, spicy foods, hot drinks, and acidic foods 1

Special Considerations

• For patients with dentures:

  • Remove dentures before performing oral care 1
  • Clean dentures thoroughly with toothpaste and rinse with water 1
  • Consider soaking dentures in antimicrobial solution (e.g., 0.2% chlorhexidine) for 10 minutes before reinsertion 1
  • Limit wearing dental prostheses until gingival tissues heal 1

• For patients with suspected secondary infection:

  • Take oral and lip swabs if bacterial or candidal infection is suspected 1
  • For candidal infection, prescribe nystatin oral suspension 100,000 units four times daily for 1 week or miconazole oral gel 1

Follow-up Care

• Arrange dental follow-up within 1-2 weeks for professional cleaning and comprehensive dental evaluation 1
• Emphasize the importance of maintaining good oral hygiene to prevent recurrence and progression to periodontitis 2, 3
• Recommend interdental cleaning once daily with appropriate interdental cleaners as recommended by a dental professional 3
• Stress that untreated gingivitis can progress to periodontitis, which is irreversible and can lead to tooth loss 4

Pitfalls and Caveats

• Avoid prescribing antibiotics unless there are signs of systemic infection or severe local infection 4
• Do not recommend starting interdental cleaning during acute inflammation if the patient is not accustomed to it, as it may break the epithelial barrier and cause bleeding 1
• Recognize that gingivitis is reversible with proper treatment, while periodontitis is not 4
• Be aware that necrotizing periodontal diseases present with distinctive features (papilla necrosis, gingival bleeding, and pain) and may require more aggressive treatment including metronidazole 5