Also indexed as: Dental Disease, Gum Disease, Periodontal
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
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
Reduce gingivitis symptoms and repair damaged gum tissues by
taking 50 to 60 mg a day of coenzyme Q10, a powerful antioxidant
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
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. 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.
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.
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
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
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.12 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.567 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
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
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.1920 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.2425 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
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Pack ARC. Folate mouthwash: effects on established gingivitis in
periodontal patients. J Clin Periodontol 1984;11:619–28.
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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
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.
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
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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
13. El-Ashiry GM, Ringsdorf WM, Cheraskin E. Local and systemic
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vitamin C upon gingivitis. J Periodontol 1964;35:250–9.
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bioflavonoids in gingival inflammatory conditions. Oral Surg Oral Med Oral Pathol
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gingiva of patients with periodontal disease. Int J Vitam Nutr Res
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Chem Pathol Pharmacol 1976;14:715–9.
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application of hyaluronic acid in gingivitis therapy. Quintessence Int
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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
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
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
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
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
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The information presented in Aisle7 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