eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat
Gingivitis: Treatment & Medication
Updated: Nov 23, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Emergency Department Care
- In simple chronic gingivitis, ED intervention is not needed.
- Proper oral hygiene (including brushing and flossing) should be stressed. The patient should be referred to a dentist or periodontist.
- General measures
- Remove irritating factors such as plaque, calculus, and faulty dentures.
- Use a warm saline rinse.
Consultations
- Dentist
Medication
In chronic gingivitis, brushing with a fluoride dentifrice will slow disease progression and may help resolution. Most electric toothbrushes have additional benefit over manual brushing. Daily flossing in addition to brushing will reduce plaque and bacterial counts. Recent studies show that brushing followed by rinsing with chlorhexidine or other solutions may have even better results over brushing and flossing.8,9 Gum-care–specific preparations that show benefit are available.10 Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to speed the resolution of inflammation when teeth are being cleaned and scaled to remove plaque.11,12
In patients with ANUG, treatment involves antibiotics, NSAIDs, and topical Xylocaine for pain relief. Saline rinses can help to speed resolution, and oral rinses with a hydrogen peroxide 3% solution also may be of benefit.
Antibiotics
These agents are used to eradicate the bacterial infection that is the hallmark of ANUG. In the future, antibiotics also may be used to treat simple chronic gingivitis, but no current evidence exists to justify this practice. Treatment of gingivitis may be warranted if dental surgery is planned.
Penicillin VK (Veetids)
DOC in patients with ANUG who are not allergic to penicillin.
Adult
500 mg PO qid for 10 d
Pediatric
<12 years: 25-50 mg/kg/d PO divided q6-8h; not to exceed 3 g/d (250 mg = 400,000 U)
>12 years: Administer as in adults
Probenecid may increase effectiveness by decreasing clearance; tetracyclines are bacteriostatic, causing a decrease in the effectiveness of penicillins when administered concurrently
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal impairment
Erythromycin (EES, Ery-Tab, Erythrocin)
Alternative DOC for patients allergic to penicillin.
Adult
1-2 h before the procedure: 1 g PO
6 h after initial dose: 500 mg PO
250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) q6h 1 h ac, or 500 mg q12h
Alternatively, 333 mg q8h; increase, depending on infection severity, up to 4 g/d
Pediatric
2 h prior to procedure: 20 mg/kg PO
6 h after initial dose: 10 mg/kg PO
Age, weight, and severity of infection determine proper dosage
30-50 mg/kg/d (15-25 mg/lb/d) in divided doses; double the dose for severe infection
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Minocycline microspheres (Arestin)
Used as an adjunct to scaling and root planing procedures for reduction of pocket depth in patients with adult periodontitis. May be used as part of a periodontal maintenance program that includes good oral hygiene and scaling and root planing.
Adult
Insert a unit-dose cartridge into base of pocket and then press the thumb ring in the handle mechanism to expel the powder while gradually withdrawing the tip from the base of the pocket; the handle mechanism should be sterilized between patients; minocycline microspheres do not have to be removed, as they are bioresorbable, and no adhesive or dressing is required
Pediatric
Not established
None reported
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Discoloration of teeth may occur in last half of pregnancy, infancy, and childhood to age 8 y (do not use unless benefits outweigh risks); photosensitivity may occur; use of minocycline microspheres in acutely abscessed periodontal pocket has not been studied and is not recommended; use of minocycline microspheres may result in overgrowth of nonsusceptible microorganisms, including fungi; effect of treatment for > 6 mo has not been studied; use minocycline microspheres with caution in patients with history of predisposition to oral candidiasis; safety and efficacy of minocycline microspheres has not been established for treatment of periodontitis in patients with coexistent oral candidiasis; use of microspheres has not been clinically tested in patients with immunocompromise (eg, diabetes, chemotherapy, radiation therapy, HIV infection)
Doxycycline (Periostat)
Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. However, some studies have shown that doxycycline reduces elevated collagenase activity in gingival crevicular fluid of patients with adult periodontitis. Clinical significance of these findings is not known.
Adult
Following scaling and root planing: 20 mg PO bid as an adjunct for <9 mo; safety beyond 12 mo and efficacy beyond 9 mo have not been established
Pediatric
Not established
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Clindamycin (Cleocin)
Alternative for penicillin-allergic patients, a popular choice for severe infections or those recalcitrant with penicillin.
Adult
300 mg PO tid
Pediatric
6-8 mg/kg/d PO divided tid/qid
Increases duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis
Antiseptic
This is shown to decrease bacterial counts in oral flora. It probably speeds resolution of gingivitis when combined with brushing and flossing.
Chlorhexidine 0.12% oral rinse (PerioGard)
Has bactericidal activity.
Adult
15 mL (1 tablespoon); swish in mouth for 30 s and expectorate bid
Pediatric
Not established
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May stain tooth enamel
Analgesics
Patients with ANUG should be given a strong analgesic along with topical anesthetics and NSAIDs because pain control is very important in allowing the patient to eat and carry out toothbrushing, flossing, and other oral hygiene maneuvers necessary to eradicate the disease. NSAIDs also help to decrease pain. Although effects of NSAIDs in the treatment of pain tend to be patient-specific, ibuprofen usually is the DOC for initial therapy.
Acetaminophen with codeine (Tylenol #3)
Narcotic analgesic well tolerated by most patients; it may induce severe nausea and vomiting in patients particularly sensitive to the drug.
Adult
1-2 tab PO q6h prn pain
Pediatric
0.5-1 mg/kg/dose PO based on codeine q4-6h; 10-15 mg/kg/dose PO based on acetaminophen content; not to exceed 2.6 g/d of acetaminophen
Toxicity increases with CNS depressants or tricyclic antidepressants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in patients dependent on opiates since this substitution may result in acute opiate-withdrawal symptoms; caution in severe renal or hepatic dysfunction
Ibuprofen (Ibuprin, Advil, Motrin)
Used for pain relief and to decrease gingival inflammation. Use with care in patients with history of asthma or peptic ulcer disease.
Adult
600 mg PO q6-8h
Pediatric
5 mg/kg PO q6-8h
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Topical anesthetics
These agents are helpful in providing pain control, which is very important in allowing the patient to carry out toothbrushing, flossing, and other oral hygiene maneuvers.
Lidocaine viscous 2% (Dilocaine)
An adjunctive therapy for pain control that decreases the permeability to sodium ions in neuronal membranes. This results in inhibition of depolarization, blocking the transmission of nerve impulses.
Adult
15 mL rinse PO and expectorate q6-8h prn
Pediatric
>12 years: 15 mL rinse PO and expectorate q6-8h prn
None reported
Documented hypersensitivity; Adams-Stokes syndrome and Wolff-Parkinson-White syndrome
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
For external or mucous membrane use only; do not use in eyes
More on Gingivitis |
| Overview: Gingivitis |
| Differential Diagnoses & Workup: Gingivitis |
 Treatment & Medication: Gingivitis |
| Follow-up: Gingivitis |
| Multimedia: Gingivitis |
| References |
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Further Reading
Keywords
gingivitis, gum swelling, swollen gums, bleeding gums, gum disease, acute necrotizing ulcerative gingivitis, periodontal disease, ANUG, trench mouth, inflammation of the gingiva, plaque, bacterial plaque, gum swelling, gingival tissue, gingiva, acute infectious gingivitis, Prevotella intermedia, alpha-hemolytic streptococci, Actinomyces species, noma, cancrum oris, chronic gingivitis, blood dyscrasias, inadequate oral hygiene, halitosis, gingival hyperplasia, gingivostomatitis
