Gingivitis

Also indexed as: Dental Disease, Gum Disease, Periodontal Disease

What you need to know

Healthy gums can lead to more smiles and fewer visits to the dentist. Beat the bacteria that cause swollen gums and bad breath. According to research or other evidence, the following self-care steps may be helpful:

Overhaul your hygiene habits
To kick gingivitis and prevent recurrences, brush and floss frequently, and get regular cleanings from a dental professional

Rinse with a folic acid solution
Use 5 ml twice a day of a 0.1% solution to reduce inflammation and bleeding

Get some extra C
For better overall gum health, take 300 mg of vitamin C a day, plus 300 mg of flavonoids, especially if your diet is low in fruits and vegetables

Discover CoQ10
Reduce gingivitis symptoms and repair damaged gum tissues by taking 50 to 60 mg a day of co-Enzyme Q10, a powerful anti-oxidant

Try a natural product
Check out toothpaste or mouthwash containing sage oil, peppermint oil, chamomile tincture, expressed juice from echinacea, and myrrh tincture to treat and prevent gingivitis

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full gingivitis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About gingivitis

Gingivitis is an inflammation of the gums (gingivae), usually caused by bacteria.

Periodontitis is a deeper and more serious inflammation of both the gingivae and tissue that surrounds and supports the teeth.

Both common conditions are often progressive and can eventually result in loss of the underlying bone that supports the teeth. After age 30, periodontal disease is responsible for more tooth loss than are dental cavities. Severe periodontitis sometimes requires surgery to repair damaged gum tissue.

Product ratings for gingivitis

Rating	Nutritional Supplements	Herbs
	Folic acid (rinse only) Vitamin C (only if deficient)
	Co-Enzyme Q10 Hyaluronic acid Vitamin C plus flavonoids	Bloodroot plus zinc (toothpaste) Mouthwash containing sage oil, peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil Neem
	Calcium Flavonoids Folic acid (in pill form)	Chamomile Echinacea
See also: Homoeopathic Remedies for Gingivitis (Periodontal Disease)
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Gingivitis is usually painless, although the gums may be red, swollen, and bleed easily with brushing. There can also be a bad taste in the mouth or persistent bad breath (halitosis). In advanced stages of gingivitis, the gums recede, exposing the nerve roots, and the teeth may become loose. This may be an indication of periodontitis.

Other therapies

Treatment usually involves a regimen of good oral hygiene, including correct tooth brushing, flossing, and professional cleanings. Severe cases might require gum surgery.

Vitamins that may be helpful

A 0.1% solution of folic acid used as a mouth rinse (5 ml taken twice a day for 30 to 60 days) has reduced gum inflammation and bleeding in people with gingivitis in double-blind trials.¹ ² The folic acid solution is rinsed in the mouth for one to five minutes and then spit out. Folic acid was also found to be effective when taken in capsule or tablet form (4 mg per day),³ though in another trial studying pregnant women with gingivitis, only the mouthwash—and not folic acid in pill form—was effective.⁴ However, this may have been due to the body’s increased requirement for folic acid during pregnancy.

Phenytoin (Dilantin®) therapy causes gum disease (gingival hyperplasia) in some people. A regular programme of dental care has been reported to limit or prevent gum disease in people taking phenytoin.⁵ ⁶ ⁷ Double-blind research has shown that a daily oral rinse with a liquid folic acid preparation inhibited phenytoin-induced gum disease more than either folic acid in pill form or placebo.⁸

People who are deficient in vitamin C may be at increased risk for periodontal disease.⁹ When a group of people with periodontitis who normally consumed only 20–35 mg of vitamin C per day were given an additional 70 mg per day, objective improvement of periodontal tissue occurred in only six weeks.¹⁰ It makes sense for people who have a low vitamin C intake (e.g., people who eat few fruits and vegetables) to supplement with vitamin C in order to improve gingival health.

For people who consume adequate amounts of vitamin C in their diet, a few studies have found that supplemental vitamin C has no additional therapeutic effect. Research,¹¹ including double-blind evidence,¹² shows that vitamin C fails to significantly reduce gingival inflammation in people who are not vitamin C deficient. In one study, administration of vitamin C plus flavonoids (300 mg per day of each) did improve gingival health in a group of people with gingivitis;¹³ there was less improvement, however, when vitamin C was given without flavonoids. Preliminary evidence has suggested that flavonoids by themselves may reduce inflammation of the gums.¹⁴

Preliminary evidence has linked gingivitis to a co-Enzyme Q10 (CoQ10) deficiency.¹⁵ Some researchers believe this deficiency could interfere with the body’s ability to repair damaged gum tissue. In a double-blind trial, 50 mg per day of CoQ10 given for three weeks was significantly more effective than a placebo at reducing symptoms of gingivitis.¹⁶ Compared with conventional approaches alone, topical CoQ10 combined with conventional treatments resulted in better outcomes in a group of people with periodontal disease.¹⁷

Hyaluronic acid is an important connective tissue component in the gums.¹⁸ Double-blind studies of topical hyaluronic acid treatments have shown that applying either a gel twice a day or a spray five times per day to the gum tissues helps reduce bleeding tendency and other indicators of gingivitis.¹⁹ ²⁰ However, plaque removal is still necessary for best results, and one study found that adding weekly topical hyaluronic acid treatments to a single session of scaling and root planing did not make a significant difference in healing.²¹ No research has investigated whether hyaluronic acid supplements that are swallowed are effective for treating gingivitis.

Some,²² but not all,²³ research has found that giving 500 mg of calcium twice per day for six months to people with periodontal disease results in a reduction of symptoms (bleeding gums and loose teeth). Although some doctors recommend calcium supplementation to people with diseases of the gums, supportive scientific evidence remains weak.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Bloodroot contains alkaloids, principally sanguinarine, that are sometimes used in toothpaste and other oral hygiene products because they inhibit oral bacteria.²⁴ ²⁵ Sanguinarine-containing toothpastes and mouth rinses should be used according to manufacturer’s directions. A six-month, double-blind trial found that use of a bloodroot and zinc toothpaste reduced gingivitis significantly better than placebo.²⁶ However, a similar study was unable to replicate these results.²⁷ Thus, at present, it is unknown who will respond to bloodroot toothpaste and who will not. Concerns also exist about the long-term safety of bloodroot.

In a double-blind trial, 1 gram of neem leaf extract in gel twice per day was more effective than chlorhexidine or placebo gel at reducing plaque and bacteria levels in the mouth in 36 Indian adults.²⁸ A similar trial found neem gel superior to placebo and equally effective as chlorhexidine at reducing plaque and bacteria levels in the mouth.²⁹

A mouthwash combination that includes sage oil, peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil has been used successfully to treat gingivitis.³⁰ In cases of acute gum inflammation, 0.5 ml of the herbal mixture in half a glass of water three times daily is recommended by some herbalists. This herbal preparation should be swished slowly in the mouth before spitting out. To prevent recurrences, slightly less of the mixture can be used less frequently.

A toothpaste containing sage oil, peppermint oil, chamomile tincture, expressed juice from Echinacea purpurea, myrrh tincture, and rhatany tincture has been used to accompany this mouthwash in managing gingivitis.³¹

Of the many herbs listed above, chamomile, echinacea, and myrrh should be priorities. These three herbs can provide anti-inflammatory and antimicrobial actions critical to successfully treating gingivitis.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References

1. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619–28.

2. Vogel RI, Fink RA, Frank O, Baker H. The effect of topical application of folic acid on gingival health. J Oral Med 1978;33(1):20–2.

3. Vogel RI, Fink RA, Schneider LC, et al. The effect of folic acid on gingival health. J Periodontol 1976;47:667–8.

4. Pack ARC, Thomson ME. Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy. J Clin Periodontol 1980;7:402–14.

5. Francetti L, Maggiore E, Marchesi A, et al. Oral hygiene in subjects treated with diphenylhydantoin: effects of a professional program. Prev Assist Dent 1991;17(30):40–3 [in Italian].

6. Fitchie JG, Comer RW, Hanes PJ, Reeves GW. The reduction of phenytoin-induced gingival overgrowth in a severely disabled patient: a case report. Compendium 1989;10(6):314.

7. Steinberg SC, Steinberg AD. Phenytoin-induced gingival overgrowth control in severely retarded children. J Periodontol 1982;53(7):429–33.

8. Drew HJ, Vogel RI, Molofsky W, et al. Effect of folate on phenytoin hyperplasia. J Clin Periodontol 1987;14:350–6.

9. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51–9.

10. Aurer-Kozelj J, Kralj-Klobucar N, Buzina R, Bacic M. The effect of ascorbic acid supplementation on periodontal tissue ultrastructure in subjects with progressive periodontitis. Int J Vitam Nutr Res 1982;52:333–41.

11. Woolfe SN, Kenney EB, Hume WR, Carranza FA Jr. Relationship of ascorbic acid levels of blood and gingival tissue with response to periodontal therapy. J Clin Periodontol 1984;11:159–65.

12. Vogel RI, Lamster IB, Wechsler SA, et al. The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. J Periodontol 1986;57:472–9.

13. El-Ashiry GM, Ringsdorf WM, Cheraskin E. Local and systemic influences in periodontal disease. II. Effect of prophylaxis and natural versus synthetic vitamin C upon gingivitis. J Periodontol 1964;35:250–9.

14. Carvel I, Halperin V. Therapeutic effect of water soluble bioflavonoids in gingival inflammatory conditions. Oral Surg Oral Med Oral Pathol 1961;14:847–55.

15. Nakamura R, Littarru GP, Folkers K. Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int J Vitam Nutr Res 1973;43:84–92.

16. Wilkinson EG, Arnold RM, Folkers K. Bioenergetics in clinical medicine. VI. Adjunctive treatment of periodontal disease with coenzyme Q10. Res Commun Chem Pathol Pharmacol 1976;14:715–9.

17. Hanioka T, Tanaka M, Ojima M, et al. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol Aspects Med 1994;15(Suppl):S241–8.

18. Moseley R, Waddington RJ, Embery G. Hyaluronan and its potential role in periodontal healing. Dent Update 2002;29:144-8 [review].

19. Pistorius A, Martin M, Willershausen B, Rockmann P. The clinical application of hyaluronic acid in gingivitis therapy. Quintessence Int 2005;36:531-8.

20. Jentsch H, Pomowski R, Kundt G, Gocke R. Treatment of gingivitis with hyaluronan. J Clin Periodontol 2003;30:159-64.

21. Xu Y, Hofling K, Fimmers R, et al. Clinical and microbiological effects of topical subgingival application of hyaluronic acid gel adjunctive to scaling and root planing in the treatment of chronic periodontitis. J Periodontol 2004;75:1114-8.

22. Krook L, Lutwak L, Whalen JP, et al. Human periodontal disease. Morphology and response calcium therapy. Cornell Vet 1972;62:32–53.

23. Uhrbom E, Jacobson L. Calcium and periodontitis: a clinical effect of calcium medication. J Clin Periodontol 1984;11:230–41.

24. Dzink JL, Socransky SS. Comparative in vitro activity of sanguinarine against oral microbial isolates. Antimicrob Agents Chemother 1985;27(4):663–5.

25. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96(3):199–207.

26. Harper DS, Mueller LJ, Fine JB, et al. Clinical efficacy of a dentifrice and oral rinse containing sanguinaria extract and zinc chloride during 6 months of use. J Periodontol 1990;61(6):352–8.

27. Mauriello SM, Bader JD. Six-month effects of a sanguinarine dentifrice on plaque and gingivitis. J Periodontol 1988;59(4):238–43.

28. Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel—a 6-week clinical study. J Ethnopharmacol 2004;90:99–103.

29. Pai MR, Acharya LD, Udupa N. The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study. Int Dent J 2004;54:219–23.

30. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dentistry 1988;1:A34.

31. Yamnkell S, Emling RC. Two-month evaluation of Parodontax dentifrice. J Clin Dentistry 1988;1:A41.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01