Treatment of gingival conditions

Refer to Section 4 of the full guidance.

Gingivitis is plaque-induced inflammation of the gingivae characterised by red, swollen tissues that bleed on brushing or probing. 

Clinical signs are visible after around seven days of undisturbed plaque accumulation and the severity of the inflammatory response is greater in older people than in the young. The condition is reversible after the establishment of effective plaque removal.

Gingivitis can also be associated with puberty and pregnancy.

  • Explain to the patient that untreated gingivitis is a risk factor for periodontitis, which can lead to tooth loss, but that they can reduce this risk with good oral hygiene. 
  • Use Oral Hygiene TIPPS to address inadequate plaque removal. Where applicable, give smoking cessation advice.
  • Explain to patients with crowded teeth, partial dentures, bridgework and orthodontic appliances the importance of adequate plaque removal around these local risk factors.
  • Remove supra-gingival plaque, calculus and stain and sub-gingival deposits using an appropriate method. Highlight to the patient areas where supra-gingival deposits are detected.
  • Re-assess at a future visit to determine whether the gingivitis has resolved.

Patients taking certain drugs for existing conditions may be at risk of drug-induced gingival enlargement. In many cases, the condition will respond to non-surgical treatment but in more severe cases modification of the drug regimen by the patient's physician may be considered.

  • Ensure you have an up-to-date medical history for all patients.
  • Where there is mild gingival enlargement, treat as for gingivitis above.
  • Where gingival enlargement hinders adequate plaque removal, consider referring for specialist periodontal care.
  • Re-assess at a future visit to determine whether the gingival enlargement has resolved.

Unexplained gingival enlargement, inflammation and bleeding can be a sign of undiagnosed leukaemia in both children and adults.

In cases where gingivitis or gingival enlargement does not respond to treatment as expected or the extent of the condition is inconsistent with the level of oral hygiene observed, consider urgent referral to a physician.