Treatment of Denture-Related Gum Infection in Edentulous Patient
For this edentulous patient with a week-old lower gum infection from ill-fitting dentures, immediately remove the dentures from continuous wear, initiate intensive oral hygiene with warm saline rinses 4-6 times daily, and prescribe amoxicillin 500 mg three times daily for 5 days only if systemic signs (fever, lymphadenopathy, malaise) are present. 1, 2
Immediate Denture Management
The dentures must be removed from the mouth for extended periods (at least 8 hours per 24 hours) until the gum tissue heals completely. 3 This is critical because:
- Ill-fitting dentures are the direct cause of trauma leading to infection in edentulous patients 4, 5
- Continuous denture wear prevents tissue healing and perpetuates the infectious process 3
- The dentures should be cleaned thoroughly by brushing with toothpaste, rinsing with water, and soaking for 10 minutes in 0.2% chlorhexidine solution before any reinsertion 3, 6
Oral Hygiene Protocol (Most Important)
Mechanical cleaning and oral hygiene are the cornerstone of treatment, not antibiotics. 1 The patient should:
- Rinse vigorously with warm saline solution (1 teaspoon salt, 1 teaspoon baking soda in 4 cups water) 4-6 times daily, especially after meals 3, 1, 6
- Clean the affected gum areas gently with a soft toothbrush or swab twice daily 3
- Use alcohol-free antimicrobial mouthwash (such as 0.2% chlorhexidine) for approximately 1 minute, then spit out 3, 6
- Avoid smoking, alcohol, and irritating foods (tomatoes, citrus, hot/spicy foods) during the active infection 3, 1
Antibiotic Decision Algorithm
Antibiotics are indicated ONLY if any of the following are present: 1, 2
- Fever or systemic signs of infection
- Lymphadenopathy (swollen lymph nodes)
- Malaise or general unwellness
- Diffuse swelling extending beyond the localized gum area
- Immunocompromised status
If antibiotics ARE indicated: 1, 2, 7
- First-line: Amoxicillin 500 mg orally three times daily for 5 days 1, 2, 7
- Take at the start of meals to minimize gastrointestinal intolerance 7
- For penicillin allergy: Clindamycin 300-450 mg orally three times daily for 5 days 1, 2
If antibiotics are NOT indicated (localized infection without systemic signs):
- Do NOT prescribe antibiotics, as this contributes to antibiotic resistance without benefit 1
- Mechanical intervention (oral hygiene, denture removal) alone is sufficient 1
Critical Pitfalls to Avoid
The most common error is prescribing antibiotics without addressing the mechanical source of infection (the ill-fitting dentures). 1, 2 This approach:
- Fails to eliminate the ongoing trauma causing the infection 1
- Promotes antibiotic resistance unnecessarily 1
- Provides only temporary relief with inevitable recurrence 2
Another critical error is allowing continued denture wear during active infection. 3 The dentures must be removed for extended periods to allow tissue healing, as continuous wear perpetuates the cycle of trauma and infection 4, 5.
When to Escalate Care
Refer immediately to an oral surgeon or emergency department if: 1, 6
- Spreading infection develops (swelling extending to face, neck, or floor of mouth)
- Difficulty breathing or swallowing occurs 6
- Signs of systemic toxicity appear (high fever, severe malaise, inability to maintain hydration) 6
- The infection does not improve within 48-72 hours of appropriate treatment 2, 7
Follow-Up and Prevention
Once the infection resolves, the patient must see a dentist for denture adjustment or replacement before resuming regular wear. 3, 6 The ill-fitting dentures caused this infection and will cause recurrence if not corrected 4, 5.