What is the recommended treatment for gingivitis?

Treatment for Gingivitis

The American Dental Association recommends professional mechanical plaque removal through scaling and root planing, combined with improved daily oral hygiene practices and 0.2% chlorhexidine mouthwash used twice daily for 60 seconds as the primary treatment approach for gingivitis. 1

Core Treatment Protocol

Professional Mechanical Treatment

• Professional scaling and root planing is the foundation of gingivitis treatment, removing plaque and calculus that patients cannot eliminate through home care alone 1
• Supragingival scaling and polishing should be performed thoroughly to remove all deposits and staining 1
• Reassessment after 2-4 weeks is mandatory to determine if the treatment plan requires adjustment 1, 2

Patient-Administered Mechanical Plaque Control

• Brush teeth twice daily for at least 2 minutes using fluoridated toothpaste, though expert opinion suggests periodontitis-prone patients likely need longer brushing time 3
• Rechargeable power toothbrushes provide statistically significant additional reductions in gingival inflammation and plaque compared to manual brushing 3
• Once-daily interdental cleaning with interdental brushes (IDBs) is the device of choice for interproximal plaque removal 3
• Flossing should only be used at sites where interdental brushes cannot pass through without trauma 3
• Patient education on proper brushing and flossing techniques is essential for treatment success 1, 2

Adjunctive Chemical Plaque Control

Chlorhexidine Mouthwash (First-Line Adjunctive)

• Use 0.2% chlorhexidine mouthwash twice daily for 60 seconds to reduce plaque and gingival inflammation 1
• Critical timing: Wait 30 minutes after toothbrushing before using chlorhexidine, as toothpaste ingredients inactivate it 1
• Be aware that chlorhexidine causes tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 2

Natural Product-Based Alternatives (Equal Efficacy)

When chlorhexidine side effects are problematic or for long-term maintenance, the following natural alternatives show comparable efficacy 1, 2:

• 0.25% lemongrass oil mouthwash - twice daily for 1 minute 1, 2
• 0.1% turmeric mouthwash - twice daily for 1 minute (note: turmeric has anticoagulant effects; avoid in patients on anticoagulants or within 2 weeks of surgery) 1, 2
• 100% aloe vera mouthwash - twice daily for 1 minute 1, 2
• Green tea mouthwash (1-5% concentration) - demonstrates similar anti-plaque effects to chlorhexidine 2
• Triphala mouthwash (10mL) - twice daily, cost-effective with no reported side effects 1

These natural alternatives avoid tooth staining while maintaining comparable anti-plaque and anti-inflammatory effects 1, 2

Antibiotic Use (Rarely Indicated)

• Antibiotics are NOT recommended for routine gingivitis treatment 1
• Consider antibiotics only when systemic involvement is present: fever, malaise, lymphadenopathy, or extension into facial spaces 1
• When necessary, amoxicillin is first-choice, with amoxicillin-clavulanic acid as second-line 1

Common Pitfalls to Avoid

• Do not use antibiotics unnecessarily - this is the most common error in gingivitis management 1
• Do not rinse with chlorhexidine immediately after brushing - the 30-minute gap is critical to avoid inactivation 1
• Do not discontinue treatment prematurely - continue until complete resolution of inflammation 1
• Do not rely solely on flossing for interdental cleaning - interdental brushes are superior except where they cannot fit 3
• Be aware that most natural product studies are short-term; long-term efficacy requires further investigation 2

Treatment Algorithm Summary

1. Perform professional scaling and root planing 1
2. Provide detailed oral hygiene instruction (brushing technique, interdental cleaning) 1, 2
3. Prescribe 0.2% chlorhexidine mouthwash twice daily (or natural alternative if staining is a concern) 1
4. Instruct patient to wait 30 minutes after brushing before using mouthwash 1
5. Reassess at 2-4 weeks and adjust treatment as needed 1, 2
6. Reserve antibiotics only for cases with systemic involvement 1