What is the recommended treatment for gingivitis?

Recommended Treatment for Gingivitis

The primary treatment for gingivitis is professional mechanical plaque removal (scaling) combined with improved daily oral hygiene practices and adjunctive chlorhexidine 0.12-0.2% mouthwash twice daily, with mandatory reassessment after 2-4 weeks. 1, 2

Core Treatment Algorithm

Step 1: Professional Mechanical Intervention

• Perform professional scaling and root planing to remove dental plaque and calculus as the foundation of treatment 1, 2
• This initial debridement establishes baseline oral health and is essential before any adjunctive therapy 2

Step 2: Daily Mechanical Plaque Control

• Toothbrushing protocol: Use a soft toothbrush after meals and before sleep, employing the Bass or modified Bass technique 1
• Replace toothbrushes monthly 1, 2
• Use mild fluoride-containing, non-foaming toothpaste 1, 2
• Rechargeable power toothbrushes provide additional reductions in gingival inflammation and plaque beyond manual brushing 1, 2
• Brush for at least 2 minutes twice daily 3

Step 3: Interdental Cleaning

• Use interdental brushes (IDBs) as the device of choice for interproximal plaque removal 3
• Flossing should only be used for sites where interdental brushes cannot pass through without trauma 3
• Clean interdental spaces once daily 3
• Critical caveat: Do not initiate interdental cleaners in patients receiving active cancer therapy due to risk of epithelial barrier disruption 1, 2

Step 4: Adjunctive Chemical Plaque Control

First-Line: Chlorhexidine

• Use 0.12-0.2% chlorhexidine mouthwash twice daily for 60 seconds 1, 2
• Critical timing requirement: Wait 30 minutes after toothbrushing before using chlorhexidine to prevent inactivation by toothpaste ingredients 1, 2
• Use 15 mL of alcohol-free formulation, gargle, then spit out 1, 2
• Avoid eating or drinking for 30 minutes after rinsing 1, 2
• Common side effects: Tooth staining, taste alteration, and increased calculus formation with prolonged use 1, 4

Evidence-Based Natural Alternatives (Comparable Efficacy to Chlorhexidine)

When chlorhexidine side effects are problematic or for long-term maintenance, consider these alternatives with comparable efficacy and minimal side effects 1, 4:

• Triphala mouthwash: 10 mL twice daily—cost-effective with no reported side effects 1, 2, 4
• Aloe vera mouthwash: 100% concentration, twice daily for 1 minute 1, 2, 4
• Turmeric mouthwash: 0.1% concentration, twice daily for 1 minute for 21 days 1, 2, 4
• Lemongrass oil: 0.25% concentration, twice daily for 1 minute for 21 days 1, 4
• Green tea mouthwash: 1-5% concentration with similar anti-plaque effects 1, 4

Step 5: Patient Education

• Provide individually tailored instruction on proper toothbrushing technique 1, 5
• Demonstrate correct interdental cleaning methods 1
• Emphasize the importance of systematic daily oral hygiene regimen 5

Step 6: Mandatory Reassessment

• Reassess gingival health after 2-4 weeks to adjust the treatment plan 1, 2, 4
• This follow-up is crucial and non-negotiable 1

When Antibiotics Are Indicated

Antibiotics are NOT recommended for routine gingivitis treatment 1, 2

Consider antibiotics ONLY when systemic involvement is present 1, 2:

• Fever
• Malaise
• Lymphadenopathy
• Extension into facial spaces

When necessary:

• First-line: Amoxicillin 1
• Second-line: Amoxicillin-clavulanic acid 1

Critical Pitfalls to Avoid

• Never use antibiotics for routine gingivitis—this is unnecessary and promotes resistance 1, 2
• Never rinse with chlorhexidine immediately after toothbrushing—wait 30 minutes to prevent inactivation 1, 2
• Never discontinue treatment prematurely before complete resolution of inflammation 1
• Never skip the 2-4 week reassessment—this is essential for treatment success 1, 2, 4

Evidence Quality Considerations

The strongest evidence supports mechanical plaque removal as the cornerstone of treatment 6, 5, 7. While chlorhexidine has FDA approval and robust evidence for adjunctive use 2, natural alternatives show comparable short-term efficacy with fewer side effects 1, 4. However, long-term data on natural products remain limited 4. The recommendation for power toothbrushes over manual brushing is supported by meta-analyses showing statistically significant additional reductions in inflammation 3.