What is the recommended treatment for a patient with gingivitis?

Gingivitis Treatment

The cornerstone of gingivitis treatment is professional mechanical plaque removal (scaling) combined with improved daily oral hygiene using proper brushing technique twice daily, interdental cleaning, and adjunctive 0.12-0.2% chlorhexidine mouthwash, with reassessment at 2-4 weeks. 1, 2

Primary Treatment Approach

Professional mechanical intervention combined with patient education forms the foundation of gingivitis management:

• Professional scaling and root planing should be performed to remove plaque and calculus 1
• Patient education on proper oral hygiene techniques is essential and must include correct toothbrushing and flossing methods 1, 3
• Reassessment after 2-4 weeks is crucial to determine if the treatment plan requires adjustment 1, 3

Daily Oral Hygiene Protocol

Patients should implement a systematic twice-daily brushing 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 1
• Replace toothbrush monthly 1
• Rechargeable power toothbrushes (particularly oscillating-rotating types) provide additional reductions in gingival inflammation and plaque beyond manual brushing 1, 4

Interdental Cleaning

Once-daily interdental cleaning is recommended for all gingivitis patients:

• Interdental brushes are the device of choice for interproximal plaque removal 4
• Flossing should only be used for sites where interdental brushes cannot pass through without trauma 4
• Do not initiate interdental cleaning during active cancer therapy due to epithelial barrier disruption risk 1

Adjunctive Chemical Plaque Control

Chlorhexidine mouthwash serves as the gold standard adjunctive therapy:

• Use 0.12-0.2% chlorhexidine mouthwash twice daily for 60 seconds 1, 2
• Critical timing: Wait 30 minutes after toothbrushing before using chlorhexidine, as toothpaste ingredients inactivate it 1
• Use 15 mL of alcohol-free mouthwash, gargle, spit out, and avoid eating/drinking for 30 minutes afterward 1
• Be aware that chlorhexidine causes tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 3

Natural Product Alternatives

Evidence-based natural alternatives show comparable efficacy to chlorhexidine without tooth staining:

• Triphala mouthwash (10 mL twice daily) is cost-effective with no reported side effects 1, 3
• Green tea mouthwash (1-5% concentration) demonstrates similar anti-plaque and anti-gingivitis effects 3
• Aloe vera mouthwash (100%) used twice daily for 1 minute reduces plaque and inflammation 1, 3
• Lemongrass oil (0.25%) used twice daily for 1 minute for 21 days shows comparable results 1, 3
• Turmeric (0.1%) used twice daily for 1 minute for 21 days demonstrates effectiveness similar to chlorhexidine 1, 3

These natural alternatives are particularly valuable for long-term maintenance when chlorhexidine's side effects become problematic 3

Antibiotic Considerations

Antibiotics are NOT recommended for routine gingivitis treatment:

• Reserve antibiotics only for systemic involvement (fever, malaise, lymphadenopathy) or facial space extension 1
• When necessary, amoxicillin is first-line, with amoxicillin-clavulanic acid as second-line 1
• Common pitfall: Avoid unnecessary antibiotic use for uncomplicated gingivitis 1

Treatment Algorithm

1. Initial visit: Professional scaling + patient education on proper technique 1
2. Home care: Twice-daily brushing with fluoride toothpaste + once-daily interdental cleaning 1, 4
3. Adjunctive therapy: Chlorhexidine or natural alternative mouthwash twice daily (remember 30-minute gap after brushing) 1
4. Reassessment: Evaluate at 2-4 weeks and adjust plan as needed 1, 3
5. Maintenance: Continue optimal home care; professional intervention only if disease activity persists 4

Critical Pitfalls to Avoid

• Never rinse with chlorhexidine immediately after toothbrushing—the 30-minute waiting period is essential 1
• Avoid discontinuing treatment before complete resolution of inflammation 1
• Do not use antibiotics for routine gingivitis without systemic involvement 1
• Do not perform subgingival scaling in patients with no signs of active disease 5