What is the treatment for gum infections?

Treatment of Gum Infections

The primary treatment for gum infections is surgical management, including root canal therapy for salvageable teeth, extraction for non-restorable teeth, and incision and drainage for accessible abscesses, with antibiotics only indicated for specific situations such as systemic involvement or infections extending into facial spaces. 1

Types of Gum Infections and Primary Treatment Approaches

Gingivitis

• Gingivitis is a mild, reversible form of gum disease that can be completely treated with proper and timely intervention 2
• Treatment focuses on improving oral hygiene and mechanical plaque removal 3
• Brushing teeth twice daily for at least 2 minutes with fluoridated toothpaste is recommended for all patients 3
• Use of a soft toothbrush (manual or electric) helps remove plaque while avoiding mucosal trauma 4
• Rechargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels 3

Periodontitis

• Periodontitis is an advanced, irreversible inflammatory condition affecting the tissues supporting teeth 2
• Initial non-surgical periodontal therapy consists of home care review and scaling and root planing 5
• For residual sites with active periodontitis after initial therapy, either regenerative or traditional resective surgical therapy can be utilized 5
• Regular periodontal maintenance therapy and long-term follow-ups are crucial for treatment success and tooth retention 5

Mechanical Plaque Control

• Daily interdental cleaning is recommended for patients with gingivitis or periodontitis 3
• Interdental brushes (IDBs) are the device of choice for interproximal plaque removal 3
• Flossing is only recommended for sites where interdental brushes cannot pass through without causing trauma 3
• Professional plaque control significantly improves gingival inflammation and lowers plaque scores 3
• Reinforcement of oral hygiene provides additional benefit in reducing inflammation 3

Antibiotic Treatment Guidelines

• Antibiotics should not be used as a substitute for appropriate surgical intervention, as they do not eliminate the source of infection 1
• For acute dental abscesses, treatment is primarily surgical (root canal therapy or extraction of the tooth) 6
• For acute dentoalveolar abscesses, incision and drainage followed by amoxicillin for 5 days is recommended 6
• Adjunctive antibiotics are only recommended in specific patient groups 6:
  • Medically compromised patients
  • Patients with systemic involvement (fever, lymphadenopathy)
  • Patients with progressive infections requiring referral to oral surgeons
  • First choice antibiotic: phenoxymethylpenicillin

Treatment for Specific Conditions

Chronic Periodontitis

• The American Dental Association recommends systemic sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to scaling and root planning 6
• The Scottish Dental Clinical Effectiveness Programme advises against using antimicrobials for chronic periodontitis or peri-implantitis 6
• Metronidazole/amoxicillin combination has shown greater clinical attachment level gain and reduction in probing depth compared to scaling and root planing alone 6

Advanced Periodontitis with Abscesses

• Often treated with antibiotics such as amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole 2
• For infections extending to underlying soft tissues, tooth extraction is recommended, followed by treatment as necrotizing fasciitis 6

Candidal Infections of the Mouth

• For oropharyngeal candidiasis, treatment options include 6:
  • Clotrimazole troches (one 10-mg troche 5 times daily)
  • Nystatin suspension (100,000 U/mL, 4-6 mL four times daily)
  • Oral fluconazole (100 mg/d for 7-14 days)
  • Itraconazole solution (200 mg/d for 7-14 days)

Special Considerations

• Proper infection control practices should be followed during dental procedures to prevent cross-contamination 6
• For patients with dry mouth or sensitive mucosa, avoid products containing detergents and flavoring agents like peppermint, menthol, or cinnamon 4
• Patients undergoing or recovering from chemo/radiotherapy may benefit from mouthwashes that moisturize the oral mucosa 4
• Rapidly progressive periodontitis may require more aggressive treatment, including antibiotics for conventional time periods 7

Prevention Strategies

• Seal pits and fissures with flowable resin composite on both temporary and permanent teeth 6
• Regular dental visits every 6 months for those with ongoing oral manifestations 6
• Twice-yearly visits for adults to perform conventional supportive periodontal therapy, including periodontal risk assessment and supragingival and subgingival debridement if necessary 6
• Additional fluoridation with a fluoride gel or rinse can support dental care 4
• Products containing antiseptics such as chlorhexidine or triclosan can reduce the quantity of bacteria in the mouth 4