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 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 therapiesTreatment 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 helpfulA 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 program 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, several 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 coenzyme 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. Herbs that may be helpfulBloodroot 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. References (To view, roll mouse over the "References" heading; to hide, click on the heading) 
Copyright © 2008 Healthnotes, Inc. All rights reserved. www.healthnotes.com Learn more about Healthnotes, the company. Learn more about the authors of Healthnotes. 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 pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2009. |
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