Gingivitis

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 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.

Bloodroot contains alkaloids, principally sanguinarine, that are sometimes used in toothpaste and other oral hygiene products because they inhibit oral bacteria.^11,12 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.¹³ However, a similar study was unable to replicate these results.¹⁴ 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.

Bloodroot contains alkaloids, principally sanguinarine, that are sometimes used in toothpaste and other oral hygiene products because they inhibit oral bacteria.^15,16 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.¹⁷ However, a similar study was unable to replicate these results.¹⁸ 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.

Hyaluronic acid is an important connective tissue component in the gums.²³ 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.^24,25 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.²⁶ No research has investigated whether hyaluronic acid supplements that are swallowed are effective for treating gingivitis.

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.²⁷ 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.²⁸

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.

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.²⁹ A similar trial found neem gel superior to placebo and equally effective as chlorhexidine at reducing plaque and bacteria levels in the mouth.³⁰

People who are deficient in vitamin C may be at increased risk for periodontal disease.³⁴ 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.³⁵ 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,³⁶ including double-blind evidence,³⁷ 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;³⁸ 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.³⁹

Caution: Calcium supplements should be avoided by prostate cancer patients.

Some,⁴¹ but not all,⁴² 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.

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.⁴³ 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.⁴⁴

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.

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.⁴⁵ 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.⁴⁶

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.

People who are deficient in vitamin C may be at increased risk for periodontal disease.⁴⁷ 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.⁴⁸ 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,⁴⁹ including double-blind evidence,⁵⁰ 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;⁵¹ 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.⁵²

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.^53,54 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),⁵⁵ though in another trial studying pregnant women with gingivitis, only the mouthwash—and not folic acid in pill form—was effective.⁵⁶ 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.^57,58,59 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.⁶⁰