What is the best treatment approach for an adult patient with no significant medical history experiencing gum swelling?

Treatment of Gum Swelling in Adults

For an adult with gum swelling and no significant medical history, the primary treatment is professional dental evaluation with scaling and subgingival debridement to remove plaque and calculus, combined with improved oral hygiene practices. 1, 2

Immediate Assessment and Referral

• Refer to a dentist or periodontist within 24 hours for thorough evaluation, as dental infection is the most common and time-sensitive cause of gum swelling 2
• Assess for signs of dental pathology including tooth mobility, gingival swelling, parulis (gum boil), or tooth discoloration 2
• Examine for localized abscess formation, which may present as swelling with pus communicating through the gingival sulcus 3

Diagnostic Imaging When Indicated

• Intraoral X-ray examination using a dedicated film holder and beam aiming device is justified when periapical tissue swelling is present 4
• Radiographic evaluation helps identify periapical bone loss, enlarged pulp chambers, or other underlying pathology 4

Primary Treatment Approach

Professional Dental Intervention

• Scaling and subgingival curettage to remove local irritants (plaque and calculus) is the cornerstone of treatment 5
• Supragingival and subgingival debridement should be performed as needed 4
• For periodontal abscess: establish drainage via the pocket lumen, perform root planing, and curette inflamed tissue 3

Oral Hygiene Instructions

• Provide strict oral hygiene instructions including proper brushing technique 5
• Recommend alcohol-free mouth rinses rather than alcohol-containing products 4
• Advise a low-sucrose diet and avoidance of tobacco 4

When Antibiotics Are NOT Routinely Indicated

• Antibiotics should not be prescribed without dental evaluation, as swelling is often from inflammatory mediator release rather than bacterial infection 2
• Antibiotics are not a substitute for surgical/mechanical intervention and do not eliminate the source of infection 1
• Adding antibiotics to proper surgical management has not shown statistically significant differences in pain or swelling outcomes 1

When Antibiotics ARE Indicated

Consider systemic antibiotics only when:

• Systemic involvement is present (fever, malaise, lymphadenopathy) 1
• Infection extends into facial spaces or cervicofacial tissues 1
• Diffuse swelling cannot be drained effectively 1
• Patient is medically compromised 1
• Failure to respond to surgical treatment alone 1

Symptomatic Management

• Apply cold compresses to reduce pain and swelling 2
• Prescribe analgesic medications as needed for pain control 5
• Consider antimicrobial mouth rinses (chlorhexidine gluconate) for early stage lesions 4

Follow-Up Protocol

• Schedule follow-up within 7 days to assess response to initial treatment 5
• Expect reduced inflammation and gingival enlargement after removal of local irritants 5
• Recommend twice-yearly visits for ongoing periodontal risk assessment and supportive therapy 4

Common Pitfalls to Avoid

• Do not prescribe antibiotics as first-line treatment without addressing the mechanical source of infection - this is ineffective and contributes to antibiotic resistance 1, 2
• Do not delay dental referral - gum swelling requires prompt professional evaluation within 24 hours 2
• Do not assume all gum swelling is infectious - consider inflammatory causes, trauma history, and systemic conditions 2, 6
• Avoid recommending alcohol-containing mouth rinses, which can be irritating 4

Special Considerations

If the patient presents with:

• Jaw claudication (pain with chewing) and age >50 years: immediately check ESR and C-reactive protein to rule out giant cell arteritis 2
• Angular cheilitis (swelling at mouth corners): apply combination antifungal-corticosteroid therapy 2
• Recent trauma or dental injury: assess for delayed complications 2