Gingivitis

Gastrointestinal Conditions

Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.

Clinical features

Bleeding of gums linked to trauma such as tooth brushing, flossing, probing, or eating hard foods

Suspected underlying condition (for example, leukaemia. Patient will usually have other systemic symptoms and the bleeding will be spontaneous, not linked to trauma)

Suspected periodontitis (halitosis, foul taste in the mouth, recession of the gum and sensitivity at tooth roots, loosening of teeth and may also present with spontaneous bleeding)

Suspected periodontal abscess (pain which can be severe, bleeding and pus which can be expressed from gingival pockets)

Can resolve in a few weeks, depending on whether the non pharmacological and/or pharmacological measures are followed

Non-pharmacological advice

A key part of the management strategy centres on good oral hygiene and plaque reduction measures: brush teeth twice daily for two minutes using a powered toothbrush (preferable to manual) and use dental floss/tape/interdental brushes at least three times a week. A fluoride-containing toothpaste should be used and people should get into the habit of spitting rather than rinsing when cleaning teeth. A soft toothbrush may be a safer option than a hard one (if using manual, rather than powered) in terms of potential to cause damage to gums or mucous membranes

A recent Cochrane Systematic Review concluded that using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque, or both, more than toothbrushing alone. Interdental brushes may be more effective than floss. However, these findings should be interpreted with caution since the available evidence for tooth cleaning sticks and oral irrigators is limited, short-term outcomes were measured, and participants typically had a low level of baseline gingival inflammation

Recommend routine appointments with a dental surgery (the dentist can advise on individual requirements including check-up time intervals once she/he has assessed the health of the teeth/gums)

Pharmacological advice

A mouthwash may also be considered (for example, chlorhexidine) particularly if the patient finds it difficult to adhere to proper toothbrushing technique or the other oral hygiene measures. Remember toothpaste incompatibilities, staining of teeth and tongue, and latest MHRA advice regarding allergies and anaphylaxis. A recent Cochrane systematic review concluded there is high-quality evidence that using chlorhexidine mouthwash (with the usual tooth-brushing and cleaning) for 4 to 6 weeks or 6 months leads to a large reduction plaque. There is also high-quality evidence of a moderate reduction in gingivitis in people with a mild level of it (but due to only having a mild level this is not considered clinically important). The benefit in people with moderate to severe levels of gingivitis could not be determined. Finally, there was no evidence that one concentration or strength of chlorhexidine rinse was more effective than another

Pregnancy: provide non pharmacological advice and check individual products prior to sale. Some such as Corsodyl^® are fine to use (as per most recent PIL)