What is the treatment for chronic gingivitis?

Treatment for Chronic Gingivitis

The primary treatment for chronic gingivitis is professional mechanical plaque removal (scaling and root planing) combined with improved daily oral hygiene practices and adjunctive chlorhexidine mouthwash (0.2%, twice daily for 60 seconds), with reassessment after 2-4 weeks. 1

Primary Treatment Components

Professional Mechanical Plaque Removal

• Scaling and root planing performed by a dental professional is the cornerstone of treatment, removing bacterial plaque and calculus that trigger gingival inflammation 1, 2
• Professional debridement significantly improves gingival inflammation and lowers plaque scores 2
• Reassessment of gingival health after 2-4 weeks is crucial for adjusting the treatment plan 1, 3

Daily Oral Hygiene Protocol

• Brush teeth twice daily for at least 2 minutes using a soft toothbrush with fluoride-containing, non-foaming toothpaste 1
• Use the Bass or modified Bass brushing technique 1
• Replace toothbrush monthly 1
• Rechargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque compared to manual brushing 1, 2

Interdental Cleaning

• Use interdental brushes (IDBs) as the device of choice for interproximal plaque removal 2
• Flossing should only be used for sites where interdental brushes will not pass through without trauma 2
• Clean interdental spaces once daily 2

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
• Wait 30 minutes after toothbrushing before rinsing with chlorhexidine, as toothpaste ingredients may inactivate it 1
• Avoid eating or drinking for 30 minutes after rinsing 1
• Common side effects include tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 3

Natural Product-Based Alternatives (Evidence-Based Options)

When chlorhexidine side effects are problematic or for long-term maintenance, consider these alternatives that show comparable efficacy:

• Triphala mouthwash (10 mL, twice daily): Cost-effective with no reported side effects, comparable efficacy to chlorhexidine 4, 1, 3
• Green tea mouthwash (1-5% concentration): Similar anti-plaque and anti-gingivitis effects to chlorhexidine 3
• Aloe vera mouthwash (100%): Used twice daily for 1 minute, reduces plaque and gingival inflammation 4, 3
• Lemongrass oil (0.25%): Used twice daily for 1 minute for 21 days, shows comparable results to chlorhexidine 1, 3
• Turmeric/Curcumin (0.1-20%): Used twice daily for 1 minute for 21 days, demonstrates effectiveness similar to chlorhexidine 4, 1, 5
• Arimedadi oil: Comparable effects to chlorhexidine after 21 days of use 4

Treatment Algorithm

1. Initial visit: Perform professional scaling and root planing 1
2. Patient education: Instruct on proper brushing technique (Bass method), interdental cleaning, and mouthwash use 1, 3
3. Prescribe adjunctive mouthwash: Start with chlorhexidine 0.2% twice daily, or natural alternative if preferred 1
4. Timing: Use mouthwash 30 minutes after brushing, avoid eating/drinking for 30 minutes after 1
5. Reassessment: Evaluate at 2-4 weeks and adjust treatment plan based on response 1, 3
6. Maintenance: Continue daily oral hygiene and consider switching to natural alternatives for long-term use to avoid chlorhexidine side effects 3

Critical Pitfalls to Avoid

• Do not prescribe antibiotics for routine chronic gingivitis treatment - they are only indicated if systemic involvement (fever, malaise, lymphadenopathy) or facial space extension occurs 1
• Do not allow patients to rinse with chlorhexidine immediately after toothbrushing - the 30-minute gap is essential to prevent inactivation 1
• Do not discontinue treatment prematurely before complete resolution of inflammation 1
• Do not recommend flossing when interdental brushes can be used - IDBs are more effective for interproximal cleaning 2
• For patients using turmeric mouthwash, be aware of anticoagulant effects if surgical procedures are planned 6

Special Considerations

• Most natural product studies are short-term (2-12 weeks); long-term efficacy requires further investigation 3
• Natural alternatives offer the advantage of minimal side effects, particularly no tooth staining 1
• Mechanical plaque removal remains the bedrock of successful treatment; chemical agents are adjunctive only 2, 7