What is the treatment for gingivitis?

Treatment of Gingivitis

The cornerstone of gingivitis treatment is professional mechanical plaque removal (scaling and polishing) combined with improved daily oral hygiene practices and adjunctive 0.2% chlorhexidine mouthwash used twice daily for 60 seconds. 1

Primary Treatment Protocol

Mechanical plaque removal remains the foundation of successful gingivitis management and should be implemented as follows:

• Professional scaling and root planing must be performed to remove all plaque and calculus deposits 1, 2
• Patient education on proper brushing technique is essential, with twice-daily brushing for at least 2 minutes using fluoridated toothpaste 1, 2
• Rechargeable power toothbrushes provide statistically significant additional reductions in gingival inflammation and plaque levels compared to manual brushing 2
• Interdental cleaning once daily is recommended, with interdental brushes as the device of choice (flossing only for areas where interdental brushes cannot pass without trauma) 2

Adjunctive Chemical Plaque Control

Chlorhexidine mouthwash is the gold standard adjunctive therapy:

• 0.2% chlorhexidine mouthwash used twice daily for 60 seconds effectively reduces plaque and gingival inflammation 1
• Common side effects include tooth staining, taste alteration, and increased calculus formation with prolonged use 1
• Alternative natural product-based mouthwashes show comparable efficacy to chlorhexidine, including 0.1% turmeric, 100% aloe vera, 0.25% lemongrass oil, and green tea mouthwash 3, 1
• Triphala mouthwash (10mL twice daily) is an effective and cost-effective alternative to chlorhexidine with no reported side effects 3, 1

Follow-Up and Reassessment

Reassessment of gingival health after 2-4 weeks is crucial for adjusting the treatment plan and ensuring resolution of inflammation 1

When Antibiotics Are Indicated

Antibiotics are generally NOT recommended for routine gingivitis treatment and should be avoided 1, 2

Consider antibiotics only if:

• Systemic involvement is present (fever, malaise, lymphadenopathy) 1
• Infection extends into facial spaces 1
• First-line choice: amoxicillin; second-line: amoxicillin-clavulanic acid 1

Critical Pitfalls to Avoid

• Do not use antibiotics unnecessarily for routine gingivitis—this is inappropriate and contributes to antimicrobial resistance 1, 2
• Do not discontinue treatment prematurely before complete resolution of inflammation 1
• Do not rely solely on chemical plaque control without mechanical removal—toothbrushing and professional cleaning remain the bedrock of treatment 2, 4
• Do not assume 2 minutes of brushing is sufficient for all patients—those with established gingivitis likely require longer brushing time and interdental cleaning 2