Approach
Necrotizing gingivitis (NG)
The treatment for NG involves the following: irrigation with 3% hydrogen peroxide for the debridement of necrotic areas; oral hygiene instructions and use of oral rinses; pain control; appropriate use of antibiotics; and patient counseling to improve nutrition, oral care, fluid intake, and smoking cessation.[18]
Professional debridement of plaque and calculus (tartar) from tooth surfaces by a dentist or a dental hygienist is required, plus patient-administered oral rinse (0.12% or 0.2% chlorhexidine or equal portions of 3% hydrogen peroxide and warm water).[67] Tooth brushing with a soft toothbrush and gentle use of dental floss should be also be reinforced. Analgesics may be used to control pain. However, pain often subsides or disappears within a few days of professional debridement and a prolonged course of pain medication is usually not necessary.[17][2]
Professional debridement of dental plaque and calculus removes anaerobic bacteria that can be associated with gingivitis, such as Fusobacterium and spirochetes. Combined with 2 times/day patient rinsing with chlorhexidine or hydrogen peroxide rinses and tooth brushing, most patients achieve symptomatic relief in a few days. In the presence of fever or temperature elevation of ≥101°F (38°C), or in the presence of significant cervical lymphadenopathy, appropriate use of systemic antibiotics should be considered. If symptoms do not resolve, diagnostic tests, including screening for HIV, CBC, and biopsy, may be indicated.[17][2]
Non-necrotizing gingivitis
The treatment for plaque-induced gingivitis involves controlling dental plaque or the biofilm of bacteria that accumulates daily on the teeth.[39] Management of gingivitis is a key primary preventive strategy for periodontitis and a secondary preventive strategy for recurrence of periodontitis.[68]
Individual instruction in routine mechanical oral hygiene procedures includes tooth brushing and cleaning between the teeth with dental floss or other mechanical devices (e.g., interdental brushes) for removing dental plaque from tooth surfaces inaccessible to tooth brushing.[40]
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To remove plaque on a daily basis, soft or moderately soft toothbrushes should be used in a small circular motion with the bristles directed toward the junction between the gums and tooth on the facial and lingual surfaces of all teeth. Use of dental floss or other means of removing dental plaque from tooth surfaces inaccessible to tooth brushing is essential. Minor bleeding with tooth brushing and use of dental floss in the presence of gingivitis is common and ceases as gingivitis resolves.
Tooth cleaning or debridement of the tooth surfaces by a dental hygienist or a dentist can remove plaque and dental calculus above and below the gum line. Dental calculus is formed by calcification of dental plaque and cannot be removed by tooth brushing. Dental calculus forms on the teeth above (supragingival) and under (subgingival) the gingiva (gums). Dental calculus may act as a physical irritant causing inflammation and, because it also serves as a reservoir for pathogens that cause gingivitis, it must be removed. Removal is accomplished by a dentist or dental hygienist who uses various hand- and power-driven debridement devices (e.g., ultrasonics) in a tooth-cleaning procedure that is often termed a dental prophylaxis.
Demonstrated antimicrobial and antiplaque agents incorporated in mouthrinses may be used to augment oral hygiene efforts of patients in whom traditional mechanical methods of controlling dental plaque are partially effective.[67][69][70][71][72]
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Poorly fitting or constructed dental fillings, crowns, and prosthetic dental appliances may retain dental plaque and compromise the ability to remove dental plaque. Correction of such dental restorations and prosthetic devices requires the services of a dentist.
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