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
Primary Treatment Protocol
- Professional mechanical plaque removal through scaling and root planing is the cornerstone of gingivitis treatment 1
- Patients must receive education on proper oral hygiene techniques, including correct toothbrushing and flossing methods 2
- Toothbrushing should be performed twice daily for at least 2 minutes with fluoridated toothpaste 3
- Interdental cleaning once daily is essential, with interdental brushes (IDBs) as the device of choice for interproximal plaque removal 3
- Flossing should only be used for sites where interdental brushes cannot pass through without trauma 3
Adjunctive Chemical Plaque Control
- 0.2% chlorhexidine mouthwash used twice daily for 60 seconds reduces plaque and gingival inflammation 1
- Critical timing: Wait 30 minutes after toothbrushing before using chlorhexidine, as toothpaste ingredients may inactivate it 1
- Chlorhexidine causes tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 2
Natural Product Alternatives
For patients concerned about chlorhexidine side effects, evidence-based alternatives with comparable efficacy include:
- 0.25% lemongrass oil mouthwash used twice daily for 1 minute 1, 2
- 0.1% turmeric mouthwash used twice daily for 1 minute 1, 2
- 100% aloe vera mouthwash used twice daily for 1 minute 1, 2
- Green tea mouthwash (1-5% concentration) 2
- Triphala mouthwash (10mL twice daily) with no reported side effects 1
These natural alternatives show comparable anti-plaque and anti-inflammatory effects without tooth staining 1, 2
Follow-Up and Reassessment
- Reassess gingival health after 2-4 weeks to adjust the treatment plan 1, 2
- This timeframe is crucial for determining treatment success and making necessary modifications 1
When Antibiotics Are 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
- First-line antibiotic: Amoxicillin 1
- Second-line option: Amoxicillin-clavulanic acid 1
Common Pitfalls to Avoid
- Never use antibiotics unnecessarily for routine gingivitis—this is inappropriate and contributes to resistance 1
- Do not rinse with chlorhexidine immediately after toothbrushing—the 30-minute gap is essential to prevent inactivation 1
- Avoid discontinuing treatment prematurely before complete resolution of inflammation 1
- Do not rely solely on toothbrushing—interdental cleaning is mandatory for effective plaque control 3
- For patients using turmeric mouthwash who require surgery, discontinue 2 weeks preoperatively due to anticoagulant effects 4