What is the recommended treatment for acute gingivitis?

Treatment for Acute Gingivitis

The primary treatment for acute gingivitis involves professional mechanical plaque removal through scaling and root planing, combined with improved daily oral hygiene practices and chlorhexidine mouthwash as an adjunctive therapy. 1, 2

Primary Treatment Approach

Professional Treatment

• Professional mechanical plaque removal (scaling and root planing) significantly improves gingival inflammation and lowers plaque scores 3
• Supragingival scaling and polishing have been shown to significantly reduce the extension of lesions and activity of gingivitis 4
• Reassessment of gingival health after 2-4 weeks is crucial for adjusting the treatment plan 2

Daily Oral Hygiene

• Toothbrushing twice daily for at least 2 minutes with fluoridated toothpaste is universally recommended, though patients with gingivitis likely need more time 3
• Interdental cleaning once daily is essential for gingivitis patients 3
• Interdental brushes are the device of choice for interproximal plaque removal where they can pass without trauma 3
• Flossing is recommended only for sites where interdental brushes cannot pass through without causing trauma 3

Adjunctive Chemical Plaque Control

Chlorhexidine Mouthwash

• 0.2% chlorhexidine mouthwash used twice daily for 60 seconds is highly effective in reducing plaque and gingival inflammation 5
• Chlorhexidine may cause tooth staining, taste alteration, and increased calculus formation with prolonged use 2

Natural Product Alternatives

• Several natural product-based mouthwashes show comparable efficacy to chlorhexidine:
  • 0.25% lemongrass oil mouthwash used twice daily for 1 minute for 21 days 5, 2
  • 0.1% turmeric mouthwash used twice daily for 1 minute for 21 days 5
  • 100% aloe vera mouthwash used twice daily for 1 minute 2
  • Green tea mouthwash (1-5% concentration) 2

Special Considerations

Acute Necrotizing Ulcerative Gingivitis

• Requires more aggressive treatment with periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine 6
• This therapeutic regimen can reverse the disease process and potentially allow damaged papillae to regenerate 6

Systemic Involvement

• Antibiotics are generally not recommended for routine gingivitis treatment 5
• Consider antibiotics only if there is systemic involvement (fever, malaise, lymphadenopathy) or if the infection extends into facial spaces 1
• When antibiotics are necessary, amoxicillin is the first choice, with amoxicillin-clavulanic acid as a second option 5

Treatment Algorithm

1. Professional mechanical plaque removal (scaling and root planing) 3, 4
2. Patient education on proper oral hygiene techniques 2
3. Daily oral hygiene regimen:
   • Toothbrushing twice daily for at least 2 minutes 3
   • Interdental cleaning once daily using appropriate devices 3
   • Adjunctive use of antimicrobial mouthwash (chlorhexidine or natural alternatives) 5, 2
4. Reassessment after 2-4 weeks 2
5. Maintenance therapy with continued daily oral hygiene and periodic professional cleaning 3

Common Pitfalls to Avoid

• Relying solely on antimicrobial rinses without addressing mechanical plaque removal (both professional and at home) 7
• Neglecting interdental cleaning, which is crucial for controlling gingivitis 3
• Using antibiotics unnecessarily for routine gingivitis treatment 5, 1
• Discontinuing treatment prematurely before complete resolution of inflammation 2
• Failing to address potential contributing factors such as smoking or systemic conditions 3