Treatment of Gum Infections: Surgical Management First, Not Antibiotic Paste
Gum infections require surgical intervention (drainage, debridement, scaling) as the primary treatment, not antibiotic paste or systemic antibiotics alone. Antibiotics should only be added when there is systemic involvement (fever, malaise, lymphadenopathy) or in immunocompromised patients 1, 2.
Primary Treatment Approach
Surgical Management is Essential
- The cornerstone of treating gum infections is mechanical intervention, not antibiotics 2
- For periodontal infections (originating from gum tissue), treatment requires scaling, root planing, and curettage of infected root and gingival tissue 3
- For dental abscesses with gum involvement, incision and drainage must be performed for accessible collections 1, 4
- Antibiotics added to proper surgical management show no statistically significant difference in pain or swelling outcomes compared to surgery alone 1
Daily Oral Hygiene Protocol
- Brush teeth at least twice daily with a soft toothbrush using the Bass or modified Bass method 5
- Rinse mouth with alcohol-free mouthwash 4-6 times daily, especially after brushing, for approximately 1 minute with 15 mL 5
- For active gum inflammation (gingivitis), use sterile water, normal saline, or sodium bicarbonate rinses 5
- Clean between teeth once daily with appropriate interdental cleaners only if already accustomed to this practice; do not start during active infection as it can break the epithelial barrier and cause bleeding 5
When Antibiotics Are Indicated
Systemic Antibiotics (Not Paste)
Antibiotics should be prescribed systemically (oral tablets/capsules) only when 1, 2:
- Fever, malaise, or lymphadenopathy is present
- Patient is immunocompromised
- Diffuse swelling extends into facial spaces or cervicofacial tissues
- Inadequate response to surgical treatment alone
First-Line Antibiotic Regimen
- Amoxicillin 500 mg three times daily for 5 days is the first-line choice 2, 4
- For penicillin allergy: Clindamycin 300-450 mg three times daily 2, 4
- For treatment failure or enhanced anaerobic coverage: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 2, 4
Specific Periodontal Infections
- For regenerative or post-surgical periodontitis: amoxicillin-clavulanate, metronidazole, or metronidazole combined with penicillin 3
- For aggressive periodontitis (often involving Actinobacillus actinomycetemcomitans): tetracycline, amoxicillin-clavulanate, or metronidazole plus amoxicillin 3
- For necrotizing ulcerative gingivitis: metronidazole or amoxicillin-clavulanate 3
Critical Pitfalls to Avoid
Do Not Use Antibiotics as Monotherapy
- Prescribing antibiotics without surgical intervention is ineffective and contributes to antibiotic resistance 1, 2
- Antibiotics cannot eliminate the source of infection without mechanical debridement 2
- Only 12% of dentists adequately prescribe antibiotics according to guidelines 6
No Role for Topical Antibiotic Paste
- There is no guideline support for using oral antibiotic paste as primary treatment for gum infections
- Intracanal antimicrobial medication (such as calcium hydroxide) is used only for root canal infections originating from dental pulp, not for gum/periodontal infections 3
Escalation for Severe Cases
- Refer immediately to oral surgeon or emergency department if spreading infection or systemic illness develops 4
- Consider IV antibiotics (clindamycin 600-900 mg IV every 6-8 hours or piperacillin-tazobactam 3.375g IV every 6 hours) for severe cases 4
- Re-evaluate within 48-72 hours to ensure resolution 4
Prevention and Maintenance
- Poor oral hygiene and periodontal disease, not dental procedures, are responsible for the vast majority of oral infections 5
- Daily dental hygiene with thorough cleaning prevents recurrent gum infections 5
- Patients should avoid smoking, alcohol, and irritating foods (tomatoes, citrus, hot/spicy foods) during active infection 5