What is the best treatment for gingivitis?

Best Treatment for Gingivitis

The best treatment for gingivitis is professional mechanical plaque removal (scaling) combined with improved daily oral hygiene practices and adjunctive 0.2% chlorhexidine mouthwash used twice daily for 60 seconds, with reassessment after 2-4 weeks. 1

Primary Treatment Algorithm

Step 1: Professional Mechanical Intervention

• Professional scaling and root planing to remove plaque and calculus is the foundation of treatment 1
• This mechanical debridement directly addresses the microbial cause of gingival inflammation 2

Step 2: Patient Education and Home Care

• Instruct patients to brush teeth twice daily for at least 2 minutes with fluoridated toothpaste 3
• Teach proper interdental cleaning technique using interdental brushes (IDBs) as the device of choice for interproximal plaque removal 3
• Flossing should only be recommended for sites where interdental brushes cannot pass without trauma 3

Step 3: Adjunctive Chemical Plaque Control

• Prescribe 0.2% chlorhexidine mouthwash used twice daily for 60 seconds to reduce plaque and gingival inflammation 1, 4
• This is FDA-approved specifically for gingivitis treatment between dental visits 4

Step 4: Reassessment

• Re-evaluate gingival health after 2-4 weeks to adjust the treatment plan as needed 1, 5

Alternative Adjunctive Mouthwash Options

If chlorhexidine side effects (tooth staining, taste alteration, increased calculus formation) are problematic, natural product-based alternatives show comparable efficacy 1, 5:

• 0.25% lemongrass oil mouthwash twice daily for 1 minute demonstrates results comparable to chlorhexidine 6, 5
• 0.1% turmeric mouthwash twice daily for 1 minute shows effectiveness similar to chlorhexidine 6, 5
• 100% aloe vera mouthwash twice daily for 1 minute reduces plaque and gingival inflammation 5
• Green tea mouthwash (1-5% concentration) demonstrates similar anti-plaque and anti-gingivitis effects 5
• Triphala mouthwash (10mL twice daily) is effective and cost-effective with no reported side effects 1

When Antibiotics Are Indicated

Antibiotics are NOT recommended for routine gingivitis treatment 1. Consider antibiotics only in these specific circumstances:

• Systemic involvement present (fever, malaise, lymphadenopathy) 1
• Infection extends into facial spaces 1
• When necessary, amoxicillin is first-line, with amoxicillin-clavulanic acid as second-line 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for routine gingivitis - this is unnecessary and contributes to antimicrobial resistance 1
• Do not discontinue treatment prematurely before complete resolution of inflammation 1
• Do not rely solely on mouthwash - mechanical plaque removal remains the bedrock of successful treatment 3
• Do not recommend flossing universally - interdental brushes are superior for most interproximal spaces 3
• Be aware of chlorhexidine's cosmetic side effects - warn patients about potential staining and taste changes, especially with prolonged use 1, 5

Special Considerations

• For high-risk patients, the critical threshold for plaque accumulation to trigger periodontitis is low, making adjunctive chemical plaque control particularly beneficial 3
• Professional oral hygiene instruction and reinforcement provides additional benefit beyond initial instruction alone 3
• Most studies on natural product mouthwashes are short-term; long-term efficacy requires further investigation 5