What is the treatment for swollen gums?

Treatment for Swollen Gums

The primary treatment for swollen gums is professional mechanical plaque removal (scaling) combined with improved daily oral hygiene using a soft toothbrush twice daily and interdental cleaning, with adjunctive 0.2% chlorhexidine mouthwash for 2-4 weeks. 1

Immediate Treatment Steps

Professional Dental Care

• Professional scaling and root planing must be performed first to remove plaque and calculus deposits that cannot be eliminated by home brushing alone 1, 2
• Reassessment after 2-4 weeks is essential to determine if the treatment plan needs adjustment 1

Daily Oral Hygiene Protocol

Brushing technique:

• Use a soft toothbrush after meals and before sleep to reduce bleeding risk 3
• Brush twice daily for at least 2 minutes using the Bass or modified Bass method 3, 1
• Replace toothbrush monthly 3
• Use mild fluoride-containing, non-foaming toothpaste 3
• Ensure brushing includes the gingival portion of teeth and periodontal sulcus 2

Interdental cleaning:

• Use interdental brushes once daily if you already have this habit, as they are more effective than floss for plaque removal 1, 4
• Do NOT start interdental cleaning during active inflammation if you haven't used it before, as it can break the epithelial barrier and cause bleeding 3
• Floss is only recommended for sites where interdental brushes cannot pass without trauma 4

Adjunctive Antimicrobial Therapy

Chlorhexidine mouthwash (first-line):

• Use 0.2% chlorhexidine mouthwash twice daily for 60 seconds 1
• Rinse at least 4 times daily, particularly after brushing 3
• Critical: Wait 30 minutes after toothbrushing before using chlorhexidine, as toothpaste ingredients can inactivate it 1
• Avoid eating or drinking for 30 minutes after rinsing 3
• Be aware of side effects: tooth staining, taste alteration, and increased calculus formation with prolonged use 1

Natural alternatives (if chlorhexidine is contraindicated):

• Triphala mouthwash (10mL twice daily) shows comparable efficacy to chlorhexidine without staining 3, 1
• Other effective options include 0.25% lemongrass oil, 0.1% turmeric, 100% aloe vera, or green tea mouthwash 1

Supportive Measures

General care:

• Inspect oral mucosa daily for changes 3
• Drink ample fluids to keep mouth moist 3
• Lubricate lips with lip balm (avoid chronic vaseline use as it promotes dehydration) 3

Avoid irritants:

• Smoking and alcohol 3
• Acidic foods (tomatoes, citrus fruits) 3
• Hot, spicy, raw, or crusty foods 3

When Antibiotics Are Needed

Antibiotics are NOT recommended for routine gingivitis 1

Consider antibiotics only if:

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

Common Pitfalls to Avoid

• Do not ignore bleeding gums - bleeding indicates inflammation and is not a reason to stop brushing or flossing 2
• Do not rely solely on mouthwash - mechanical plaque removal through brushing is the primary treatment 2, 4
• Do not use antibiotics for routine gingivitis - they are unnecessary and promote resistance 1
• Do not discontinue treatment prematurely - continue until complete resolution of inflammation 1
• Do not rinse immediately after brushing if using chlorhexidine - wait 30 minutes 1

Follow-Up

• Monitor for reduction in gingival bleeding, decreased plaque accumulation, and healthier gingival appearance 2
• Schedule regular dental check-ups every 6 months 2
• If no improvement after 2-4 weeks, reassess and adjust treatment plan 1