Treatment for Sore Gums
For sore gums, prescribe chlorhexidine gluconate 0.12% mouthwash 10 mL twice daily as the primary treatment, combined with proper mechanical oral hygiene including twice-daily toothbrushing and once-daily interdental cleaning. 1, 2
First-Line Pharmacologic Treatment
Chlorhexidine gluconate 0.12% oral rinse is the gold standard antiseptic treatment for gingivitis causing sore gums:
- Rinse with 10 mL twice daily for 30 seconds, then spit out (do not swallow) 1
- Use after meals to avoid taste interference 1
- Continue for at least 4-6 weeks to achieve significant reduction in gingival inflammation 3
- High-quality evidence demonstrates reduction in gingivitis by 0.21 points on the Gingival Index scale and large reduction in plaque 3
Important caveat: If the chlorhexidine causes excessive soreness, dilute the 0.2% formulation by up to 50% with water to reduce irritation 4. Alternatively, 1.5% hydrogen peroxide mouthwash (10 mL twice daily) can be substituted as an antiseptic 4.
Pain Management for Symptomatic Relief
Benzydamine hydrochloride oral rinse or spray should be used every 3 hours, particularly before eating, for anti-inflammatory pain relief 4, 5, 6:
- This provides topical analgesia without the numbing effect of lidocaine
- Can be used concurrently with chlorhexidine (space doses appropriately)
For more severe pain uncontrolled by benzydamine:
- Viscous lidocaine 2% (15 mL per application, up to 3-4 times daily) provides topical anesthesia 4, 5
- Apply before meals to facilitate eating
Protective Barrier Agents
Gelclair mucoprotectant gel applied three times daily forms a protective coating over inflamed gum surfaces 5:
- Reduces pain and promotes healing
- Particularly useful if ulceration is present
White soft paraffin ointment should be applied to affected areas every 2 hours if lips or exposed gum margins are involved 4, 5
Topical Corticosteroids for Refractory Cases
If inflammation persists despite antiseptic therapy:
- Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 4, 5
- For localized severe inflammation: Clobetasol propionate 0.05% mixed in equal amounts with Orabase, applied directly to affected areas daily 4, 5
Essential Mechanical Oral Hygiene
Pharmacologic treatment must be combined with proper mechanical plaque removal 2, 3:
- Toothbrushing twice daily for at least 2 minutes with fluoridated toothpaste 2
- Interdental cleaning once daily using interdental brushes (preferred) or dental floss 2, 7
- Rechargeable electric toothbrushes (oscillating-rotating type) provide additional benefit over manual brushing 2
Treatment for Secondary Infections
If candidal infection is suspected (white patches, persistent soreness despite treatment):
- Nystatin oral suspension 100,000 units four times daily for 1 week 4, 5, OR
- Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 4, 5
Common Pitfalls to Avoid
Chlorhexidine staining: Warn patients that chlorhexidine causes brown tooth staining in 56% of users after 6 weeks, with 15% developing heavy staining 3. This is removable by professional cleaning and does not harm oral tissues 1.
Taste alteration: Chlorhexidine commonly causes temporary taste disturbance 1, 3. Rare cases of permanent taste alteration have been reported 1. Using the rinse after meals minimizes this issue 1.
Inadequate mechanical hygiene: Mouthwash alone is insufficient—mechanical plaque removal is essential 2, 3. Many patients with good oral hygiene practices still develop gingivitis, so professional assessment and reinforcement are critical 8.
Contraindications: Do not prescribe chlorhexidine to patients with known hypersensitivity to chlorhexidine or its components 1. Seek immediate medical attention if allergic symptoms develop 1.