Treatment for Gum Infections
Surgical intervention—not antibiotics—is the first-line treatment for gum infections, including drainage, root canal therapy for salvageable teeth, or extraction for non-restorable teeth. 1, 2
Primary Treatment Approach
The cornerstone of managing gum infections is mechanical removal of the infection source:
- Perform immediate surgical drainage for accessible abscesses through incision and drainage 1, 2
- Root canal therapy should be performed for teeth that are salvageable and periodontally sound 1, 2
- Extract non-restorable teeth when extensive caries, severe crown destruction, or structural compromise prevents adequate restoration 1
- Scaling and root planing is essential for periodontal infections to remove bacterial biofilm and calculus 2, 3
Critical pitfall to avoid: Prescribing antibiotics without surgical intervention is ineffective and contributes to antibiotic resistance—antibiotics do not eliminate the source of infection 1, 2
When Antibiotics Are Indicated
Antibiotics should be added to surgical management only in specific circumstances:
Systemic Involvement
- Prescribe antibiotics when fever, malaise, or lymphadenopathy is present 1, 2
- First-choice antibiotic: Amoxicillin 500mg three times daily for 5 days for acute dentoalveolar abscesses with systemic symptoms 2
- Alternative for penicillin allergy: Clindamycin 2, 4
Other Indications for Antibiotics
- Medically compromised patients (immunosuppressed, metabolic disorders) 1
- Infections extending into facial spaces or cervicofacial tissues require antibiotic treatment 1, 2
- Diffuse swelling that cannot be drained effectively 1
- Failure to respond to surgical treatment alone within 2-3 days 4
Second-Line Antibiotic Regimens
If no improvement occurs within 2-3 days of first-line therapy:
Treatment Algorithm for Periodontal Disease
Gingivitis (Reversible Gum Inflammation)
- Professionally administered plaque control significantly improves gingival inflammation 5
- Brush teeth twice daily for at least 2 minutes with fluoridated toothpaste 6, 5
- Use interdental brushes once daily for interproximal plaque removal (flossing only where interdental brushes won't fit) 5
- Rechargeable power toothbrushes provide additional reductions in gingival inflammation 5
- Chlorhexidine gluconate 0.12% oral rinse can be used as adjunctive chemical plaque control between dental visits 7, 5
Periodontitis (Irreversible Bone Loss)
- Initial non-surgical therapy: scaling and root planing with home care review 3
- Periodontal re-evaluation to identify residual sites with active disease 3
- Regenerative or resective surgical therapy for sites that don't respond to initial treatment 3
- Systemic antibiotics are only infrequently indicated and must always accompany mechanical debridement 4
- Periodontal maintenance therapy at regular intervals is crucial for long-term success 3
Necrotizing Ulcerative Gingivitis
- Metronidazole or amoxicillin-clavulanate are appropriate choices 4
- Surgical debridement remains essential 4
Special Considerations
- Dental evaluation should occur after cardiac stabilization but early enough that invasive procedures can be completed during IV antibiotic therapy for patients with infective endocarditis 6
- Full series of intraoral radiographs is required to identify caries, periodontal bone loss, and tooth fractures not evident on physical examination 6, 1
- Denture-related infections may require thorough disinfection of the denture (soak for 10 minutes in chlorhexidine 0.2%) 6
- Poor oral hygiene and periodontal diseases—not dental procedures—are responsible for the vast majority of oral infections 6
Preventive Measures
- Dental visits every 6 months for patients with ongoing oral manifestations 6
- Daily inspection of oral mucosa 6
- Soft toothbrush after meals and before sleep (replace monthly) 6
- Alcohol-free mouthwash at least four times daily after brushing 6
- Avoid smoking, alcohol, and irritating foods (tomatoes, citrus, hot/spicy foods) 6