What is the recommended treatment for gingivitis?

Treatment of Gingivitis

The recommended treatment for gingivitis consists of professional mechanical plaque removal (scaling) combined with improved daily oral hygiene practices and adjunctive 0.2% chlorhexidine mouthwash used twice daily for 60 seconds. 1

Primary Treatment Approach

The cornerstone of gingivitis management involves:

• Professional mechanical plaque removal through scaling and root planing performed by a dental professional to remove accumulated biofilm and calculus 1
• Patient education on proper oral hygiene techniques including correct toothbrushing and flossing methods 2
• Reassessment after 2-4 weeks to evaluate treatment response and adjust the plan as needed 1, 2

Daily Oral Hygiene Protocol

Patients should implement the following regimen:

• Brush with a soft toothbrush after meals and before sleep using the Bass or modified Bass technique 1
• Use mild fluoride-containing, non-foaming toothpaste for optimal cleaning 1
• Replace toothbrush monthly to maintain effectiveness 1
• Consider rechargeable power toothbrushes which provide additional reductions in gingival inflammation and plaque beyond manual brushing 1, 3
• Perform interdental cleaning once daily using interdental brushes as the device of choice (flossing only recommended where interdental brushes cannot pass without trauma) 3

Adjunctive Chemical Plaque Control

Chlorhexidine (First-Line Adjunctive Agent)

• Use 0.2% chlorhexidine mouthwash twice daily for 60 seconds to reduce plaque and gingival inflammation 1, 4
• Wait 30 minutes after toothbrushing before using chlorhexidine to avoid inactivation by toothpaste ingredients 1
• Be aware of side effects including tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 2

Natural Product-Based Alternatives

For patients concerned about chlorhexidine side effects or for long-term maintenance, evidence-based alternatives include:

• 0.25% lemongrass oil mouthwash used twice daily for 1 minute shows comparable efficacy to chlorhexidine 1, 2
• 0.1% turmeric mouthwash (10 mL twice daily for 21 days) demonstrates similar effectiveness 1, 2
• 100% aloe vera mouthwash used twice daily for 1 minute reduces plaque and inflammation 1, 2
• Green tea mouthwash (1-5% concentration) shows similar anti-plaque and anti-gingivitis effects 2
• Triphala mouthwash (10 mL twice daily) is a cost-effective alternative with no reported side effects 1

These natural alternatives offer the advantage of minimal side effects, particularly no tooth staining, though most studies are short-term 2

When Antibiotics Are Indicated

Antibiotics are generally NOT recommended for routine gingivitis treatment 1

Consider antibiotics only when:

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

Critical Pitfalls to Avoid

• Do not use antibiotics unnecessarily for routine gingivitis—this contributes to antibiotic resistance 1
• Do not rinse immediately after toothbrushing when using chlorhexidine—wait 30 minutes 1
• Do not discontinue treatment prematurely before complete resolution of inflammation 1
• Do not eat or drink for 30 minutes after using mouthwash to maintain therapeutic contact time 1

Treatment Algorithm Summary

1. Professional scaling and plaque removal 1
2. Implement twice-daily brushing with proper technique and fluoride toothpaste 1
3. Add once-daily interdental cleaning with interdental brushes 3
4. Use adjunctive chlorhexidine mouthwash (or natural alternative) twice daily 1, 2
5. Reassess at 2-4 weeks and adjust treatment as needed 1, 2