Medication Summary
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. [27, 28] Gum-care–specific preparations that show benefit are available. [29] Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to speed the resolution of inflammation when teeth are being cleaned and scaled to remove plaque. [30, 31] It has been demonstrated that some herbal formulations may be beneficial in ameliorating periodontal disease. [32, 33]
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
Class Summary
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.
Erythromycin (EES, Ery-Tab, Erythrocin)
Alternative DOC for patients allergic to penicillin.
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.
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.
Clindamycin (Cleocin)
Alternative for penicillin-allergic patients, a popular choice for severe infections or those recalcitrant with penicillin.
Antiseptic
Class Summary
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.
Analgesics
Class Summary
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.
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.
Topical anesthetics
Class Summary
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 anesthetic
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.
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Healthy mouth and gingiva. Note the healthy light pink color of the gingiva. The interdental papillae are sharp and fill the interdental space. No local edema is present. Image courtesy of Robert J. Lindberg, DMD.
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Moderate chronic gingivitis. Note that the papillae are edematous and blunted. They may bleed with brushing. Note areas of edema overlying some of the root areas. Pallor is seen in these areas. Image courtesy of Robert J. Lindberg, DMD.
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Severe periodontal disease. Loss of the gingival tissue is seen, making the teeth appear long. Even more effacement of the papillae is present. Heaped up ridges are observed in the areas overlying the roots. Image courtesy of Robert J. Lindberg, DMD.
