Gingivitis Treatments

Gingivitis is an inflammation of the gums caused by the accumulation of dental plaque and the toxins they produce. Poor oral hygiene is most often the cause for the development of gingivitis.

The early symptoms of gingivitis are so mild that do not usually cause any discomfort to the patient. This lack of discomfort or pain is in most cases what allows the disease to progress in more advanced stages and start to seriously affect the health of the gums. Changes in the color or shape of the gums, which are the early symptoms of gum disease, can happen so gradually that the change may not be noticed. In other cases, although the symptoms are noticed, especially when gums start bleeding occasionally, many patients continue to ignore the significance of the symptoms.

If the patient knows how to spot gum disease and visits the dentist on the first alerting signs, gingivitis treatment can be relatively fast and easy, before the periodontal tissues suffer any permanent damage.

The main goals of gingivitis treatment are to:

• Reduce inflammation, stop the progress of gum disease and create conditions that enable tissues in the mouth to heal
• Eliminate the bacterial infection that causes gum disease
• Identify and address any underlying causes or contributing systemic illnesses
• Prevent the recurrence of gum disease

In many cases the involvement of the dentist in the treatment of gingivitis can remain minimal and only for advisory reasons. Gingivitis treatments, depending on the progress of the disease, may include the following:

• Oral hygiene
• Antimicrobial therapy
• Professional dental cleaning
• Tooth scaling and root planing
• Maintenance - prophylaxis

Better oral hygiene to treat gum disease

The first step in a successful treatment of gum disease is to reduce the number of bacteria in the mouth to normal levels. This can be achieved by controlling the accumulation of dental plaque with a careful daily oral hygiene schedule. An effective oral hygiene routine to stop gum disease should include:

• Brushing teeth, at least twice a day and if possible after each meal, to mechanically remove dental plaque and food debris from the teeth surfaces. A toothpaste containing an antibacterial agent is recommended especially for patients with a history of gum disease. Correct way of brushing is also important for effective removal of dental plaque.
• Flossing teeth, at least once a day, can help remove bacterial plaque and food debris from the interdental spaces that are harder to reach by the toothbrush.
• Antiseptic mouthwash, can compliment your oral hygiene plan helping to keep dental plaque under control.

The dentist will first evaluate the amount of dental plaque accumulated on teeth. Excessive amounts of dental plaque are indication that the patient either neglects oral hygiene or fails to adequately remove dental plaque due to poor brushing or flossing technique. The dentist will explain the significance of oral hygiene and demonstrate the correct way of brushing and flossing teeth.

For mild cases of gingivitis the patient is advised to follow the instructions for some weeks and return to the dental office for re-evaluation. Depending on the gums’ condition after this period, the dentist will decide if gingivitis has been cured or further gum disease treatment is needed.

Antimicrobial therapy to treat gingivitis

During the course of gum disease treatment, the dentist may recommend antimicrobial therapy using antibiotics to help eliminate the harmful bacteria from the mouth and improve the results of the mechanical control of plaque.

A chlorhexidine containing mouthwash is usually described for a period of one to two weeks to help control the dental plaque growth. However, the possible side effects of using antibiotics related with the development of bacterial resistance must be taken into consideration when prescribed with antibiotics. Patients should follow carefully their dentist’s instructions about dosage and period of use.

Topical application of antibiotics can help eliminate bacteria in deep periodontal pockets when gingivitis has progressed to periodontitis. Antibiotic treatments are also common during treatment of advanced periodontal disease and especially after surgical treatments to prevent infections.

Professional dental cleaning to treat gingivitis

If dental plaque is not removed thoroughly from the surface of the teeth, it starts to harden creating dental calculus. Unlike dental plaque that can be removed by regular brushing, dental calculus deposits can be removed only with professional dental cleaning by a dentist (or a dental hygienist). Dental calculus deposits do not only contribute to the irritation and inflammation of the gums but they also roughen teeth surface helping dental plaque to attach and accumulate more easily and making it harder to clean.

Professional dental cleaning is a procedure normally performed during regular dental check-ups. The dentist or the dental hygienist uses an ultrasonic scaler and/or hand instruments to remove plaque and dental calculus (tartar) from the surface of the teeth both above and slightly below the gum line. If there are signs of gum disease, a dentist may recommend professional dental cleaning more than twice-a-year.

Tooth scaling and root planing to treat gum disease

In more severe cases of gingivitis when the depth of sulcus is above normal and periodontal pockets start to develop, the dentist will recommend a deeper cleaning called scaling and root planing. Tooth scaling and root planing is a non-surgical procedure, performed under local anesthesia, that aims to provide a healthier mouth environment that is easier to keep clean. During the first phase of treatment, tooth scaling, plaque and tartar from above and below the gum line are scraped.

Root planing has two goals:

• to remove plaque or calculus from the roots of the teeth, much deeper below the gum line than in a dental cleaning, providing a clean surface for the gums to reattach to the teeth
• to smooth the rough spots on the surface of the teeth roots, making it more difficult for bacteria to attach again onto them.

Tooth scaling and root planing combined with improved oral hygiene and with the help of antimicrobial medications, can help the gums to completely heal and provide a successful treatment of gingivitis.

Other treatments to decrease the risk of gum disease

Identifying and addressing any underlying causes must also be part of any gum disease treatment. Poorly made restorations or malocclusion problems such as crowded teeth may contribute to the development of gum disease by allowing bacterial plaque to get trapped and accumulated in areas difficult to clean.

Orthodontic treatment and replacement of damaged fillings or not fitting crowns are often recommended to help in improving the quality of plaque removal and in maintaining good oral health.

The selection of the appropriate treatment for gingivitis, or the combination of treatments, depends on the severity of the problem. It is important for the patient to understand that gingivitis treatment may restore the health of the gums, but if the tooth plaque is not regularly and effectively removed, the gum disease will reappear.